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LIMITED</SupplierName></Supplier><Supplier><SupplierCode>40243</SupplierCode><SupplierName>RIGICON PTY LTD</SupplierName></Supplier><Supplier><SupplierCode>39930</SupplierCode><SupplierName>ROCHE DIABETES CARE AUSTRALIA PTY LIMITED</SupplierName></Supplier><Supplier><SupplierCode>40425</SupplierCode><SupplierName>Rocket Medical</SupplierName></Supplier><Supplier><SupplierCode>40089</SupplierCode><SupplierName>RQSOLUTIONS MEDICAL DEVICES DISTRIBUTION SUPPORT PTY LTD</SupplierName></Supplier><Supplier><SupplierCode>40088</SupplierCode><SupplierName>RTI Surgical Australia Pty Ltd</SupplierName></Supplier><Supplier><SupplierCode>40224</SupplierCode><SupplierName>SALUDA MEDICAL PTY LIMITED</SupplierName></Supplier><Supplier><SupplierCode>40413</SupplierCode><SupplierName>SIGNATURE ORTHOPAEDICS PTY LTD</SupplierName></Supplier><Supplier><SupplierCode>40412</SupplierCode><SupplierName>Signature Spine and Joint Pty Ltd</SupplierName></Supplier><Supplier><SupplierCode>40468</SupplierCode><SupplierName>SIRTEX MEDICAL LIMITED</SupplierName></Supplier><Supplier><SupplierCode>40408</SupplierCode><SupplierName>Slade Health Pty Ltd</SupplierName></Supplier><Supplier><SupplierCode>40406</SupplierCode><SupplierName>SMITH &amp; NEPHEW PTY LIMITED</SupplierName></Supplier><Supplier><SupplierCode>40340</SupplierCode><SupplierName>Smiths Medical Australasia Pty Ltd</SupplierName></Supplier><Supplier><SupplierCode>40284</SupplierCode><SupplierName>Southern Adelaide Local Health Network Incorporated</SupplierName></Supplier><Supplier><SupplierCode>40227</SupplierCode><SupplierName>SOUTHERN CROSS SURGICAL PTY LTD</SupplierName></Supplier><Supplier><SupplierCode>40338</SupplierCode><SupplierName>Southern Implants Australia Pty Ltd</SupplierName></Supplier><Supplier><SupplierCode>40336</SupplierCode><SupplierName>Specialist Medical Supplies</SupplierName></Supplier><Supplier><SupplierCode>40421</SupplierCode><SupplierName>SPECIFICA PTY LTD</SupplierName></Supplier><Supplier><SupplierCode>40335</SupplierCode><SupplierName>Spectrum Surgical</SupplierName></Supplier><Supplier><SupplierCode>40420</SupplierCode><SupplierName>SPINEART AUSTRALIA PTY. LTD.</SupplierName></Supplier><Supplier><SupplierCode>40283</SupplierCode><SupplierName>ST. VINCENT'S HOSPITAL SYDNEY LIMITED</SupplierName></Supplier><Supplier><SupplierCode>40418</SupplierCode><SupplierName>STABLE ORTHOPAEDICS PTY LTD</SupplierName></Supplier><Supplier><SupplierCode>40383</SupplierCode><SupplierName>STERIS AUSTRALIA PTY LTD</SupplierName></Supplier><Supplier><SupplierCode>40330</SupplierCode><SupplierName>STRAUMANN PTY LTD</SupplierName></Supplier><Supplier><SupplierCode>40329</SupplierCode><SupplierName>STRYKER AUSTRALIA PTY LTD</SupplierName></Supplier><Supplier><SupplierCode>31318</SupplierCode><SupplierName>SU-POR AUSTRALIA PTY LTD</SupplierName></Supplier><Supplier><SupplierCode>40325</SupplierCode><SupplierName>Surgical Specialties Pty Limited</SupplierName></Supplier><Supplier><SupplierCode>40324</SupplierCode><SupplierName>Surgical Supplies Australia Pty Ltd</SupplierName></Supplier><Supplier><SupplierCode>40322</SupplierCode><SupplierName>Surgien Pty Ltd</SupplierName></Supplier><Supplier><SupplierCode>40233</SupplierCode><SupplierName>SURGIVISION PTY LTD</SupplierName></Supplier><Supplier><SupplierCode>40417</SupplierCode><SupplierName>SWISSMED PTY LTD</SupplierName></Supplier><Supplier><SupplierCode>40244</SupplierCode><SupplierName>Sydney Local Health District</SupplierName></Supplier><Supplier><SupplierCode>40394</SupplierCode><SupplierName>SYMBIOS ORTHOPAEDICS PTY LTD</SupplierName></Supplier><Supplier><SupplierCode>40452</SupplierCode><SupplierName>Tekmed Pty Ltd</SupplierName></Supplier><Supplier><SupplierCode>40451</SupplierCode><SupplierName>TELEFLEX MEDICAL AUSTRALIA PTY LTD</SupplierName></Supplier><Supplier><SupplierCode>40450</SupplierCode><SupplierName>Terumo Australia</SupplierName></Supplier><Supplier><SupplierCode>40260</SupplierCode><SupplierName>The Trustee for BRAXTON INVESTMENT FUND</SupplierName></Supplier><Supplier><SupplierCode>40403</SupplierCode><SupplierName>The Trustee for CMJH FAMILY TRUST</SupplierName></Supplier><Supplier><SupplierCode>40467</SupplierCode><SupplierName>THE TRUSTEE FOR ELDA TRUST</SupplierName></Supplier><Supplier><SupplierCode>40267</SupplierCode><SupplierName>The Trustee for Giorgios and Katarina Loizou Family Trust</SupplierName></Supplier><Supplier><SupplierCode>40373</SupplierCode><SupplierName>The Trustee for Gregory Family Trust</SupplierName></Supplier><Supplier><SupplierCode>40395</SupplierCode><SupplierName>The Trustee for The Ophthalmopro Unit Trust</SupplierName></Supplier><Supplier><SupplierCode>40442</SupplierCode><SupplierName>TREWAVIS SURGICAL INSTRUMENTS PTY LTD</SupplierName></Supplier><Supplier><SupplierCode>40484</SupplierCode><SupplierName>VANTIVE PTY LTD</SupplierName></Supplier><Supplier><SupplierCode>40439</SupplierCode><SupplierName>Varian Medical Systems Australia</SupplierName></Supplier><Supplier><SupplierCode>40229</SupplierCode><SupplierName>VICKI PARTRIDGE PTY LTD</SupplierName></Supplier><Supplier><SupplierCode>40269</SupplierCode><SupplierName>VISTAMED PTY LTD</SupplierName></Supplier><Supplier><SupplierCode>39936</SupplierCode><SupplierName>Vitramed Pty Ltd</SupplierName></Supplier><Supplier><SupplierCode>40236</SupplierCode><SupplierName>W 9 PTY LTD</SupplierName></Supplier><Supplier><SupplierCode>40435</SupplierCode><SupplierName>W L GORE &amp; ASSOCIATES (AUSTRALIA) PTY LTD</SupplierName></Supplier><Supplier><SupplierCode>40434</SupplierCode><SupplierName>WILLIAM A. COOK AUSTRALIA PTY. LTD.</SupplierName></Supplier><Supplier><SupplierCode>40431</SupplierCode><SupplierName>YPSOMED AUSTRALIA PTY LIMITED</SupplierName></Supplier><Supplier><SupplierCode>40315</SupplierCode><SupplierName>ZIMMER BIOMET PTY LTD</SupplierName></Supplier><Supplier><SupplierCode>40400</SupplierCode><SupplierName>ZIRVE PTY LTD</SupplierName></Supplier></Suppliers><Categories><Category><CategoryID>107553</CategoryID><CategoryDescription>01 - Cardio-thoracic</CategoryDescription></Category><Category><CategoryID>33966</CategoryID><CategoryDescription>01 - Ophthalmic</CategoryDescription></Category><Category><CategoryID>107559</CategoryID><CategoryDescription>01 - Ophthalmic</CategoryDescription></Category><Category><CategoryID>107552</CategoryID><CategoryDescription>02 - Ear, Nose &amp; Throat</CategoryDescription></Category><Category><CategoryID>107577</CategoryID><CategoryDescription>02 - Ophthalmic</CategoryDescription></Category><Category><CategoryID>33961</CategoryID><CategoryDescription>03 - General Miscellaneous</CategoryDescription></Category><Category><CategoryID>107554</CategoryID><CategoryDescription>03 - General Miscellaneous</CategoryDescription></Category><Category><CategoryID>107576</CategoryID><CategoryDescription>03 - Orthopaedic</CategoryDescription></Category><Category><CategoryID>107578</CategoryID><CategoryDescription>04 - Dermatologic</CategoryDescription></Category><Category><CategoryID>33980</CategoryID><CategoryDescription>04 - Neurosurgical</CategoryDescription></Category><Category><CategoryID>107573</CategoryID><CategoryDescription>04 - Neurosurgical</CategoryDescription></Category><Category><CategoryID>107572</CategoryID><CategoryDescription>05 - Urogenital</CategoryDescription></Category><Category><CategoryID>33973</CategoryID><CategoryDescription>06 - Specialist Orthopaedic</CategoryDescription></Category><Category><CategoryID>107566</CategoryID><CategoryDescription>06 - Specialist Orthopaedic</CategoryDescription></Category><Category><CategoryID>107575</CategoryID><CategoryDescription>07 - Plastic and Reconstructive</CategoryDescription></Category><Category><CategoryID>107571</CategoryID><CategoryDescription>08 - Cardiac</CategoryDescription></Category><Category><CategoryID>107560</CategoryID><CategoryDescription>09 - Cardiothoracic</CategoryDescription></Category><Category><CategoryID>107574</CategoryID><CategoryDescription>10 - Vascular</CategoryDescription></Category><Category><CategoryID>107562</CategoryID><CategoryDescription>11 - Hip</CategoryDescription></Category><Category><CategoryID>107563</CategoryID><CategoryDescription>12 - Knee</CategoryDescription></Category><Category><CategoryID>107561</CategoryID><CategoryDescription>13 - Spinal</CategoryDescription></Category></Categories><SubCategories><SubCategory><SubCategoryID>107638</SubCategoryID><SubCategoryDescription>01.01 - ANTERIOR CHAMBER INTRAOCULAR LENSES</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107639</SubCategoryID><SubCategoryDescription>01.02 - POSTERIOR CHAMBER INTRAOCULAR LENSES</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107640</SubCategoryID><SubCategoryDescription>01.03 - INTRAOCULAR FLUIDS</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107641</SubCategoryID><SubCategoryDescription>01.04 - CAPSULAR TENSION RINGS</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107642</SubCategoryID><SubCategoryDescription>01.05 - GLAUCOMA DRAINAGE</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107643</SubCategoryID><SubCategoryDescription>01.06 - EYELID PROSTHESES</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107644</SubCategoryID><SubCategoryDescription>01.07 - LACRIMAL DUCT DRAINAGE PROSTHESES</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>34052</SubCategoryID><SubCategoryDescription>01.08 - ORBITAL PROSTHESES</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107645</SubCategoryID><SubCategoryDescription>01.08 - ORBITAL PROSTHESES</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107646</SubCategoryID><SubCategoryDescription>01.09 - RETINAL DETACHMENT PROSTHESES</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107633</SubCategoryID><SubCategoryDescription>01.10 - Artificial Iris</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107579</SubCategoryID><SubCategoryDescription>02.01 - EAR</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107580</SubCategoryID><SubCategoryDescription>02.02 - NOSE</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107581</SubCategoryID><SubCategoryDescription>02.03 - THROAT</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107588</SubCategoryID><SubCategoryDescription>03.01 - BRACHYTHERAPY</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107589</SubCategoryID><SubCategoryDescription>03.02 - DRUG DELIVERY DEVICES</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107590</SubCategoryID><SubCategoryDescription>03.03 - ENTERAL TUBES</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107591</SubCategoryID><SubCategoryDescription>03.04 - GASTRIC BANDS</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107592</SubCategoryID><SubCategoryDescription>03.05 - HAEMOSTATIC DEVICES</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107593</SubCategoryID><SubCategoryDescription>03.06 - LUMINAL STENTS</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107594</SubCategoryID><SubCategoryDescription>03.07 - PULMONARY/PERITONEAL DEVICES</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>34002</SubCategoryID><SubCategoryDescription>03.08 - CLOSURE DEVICES</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107595</SubCategoryID><SubCategoryDescription>03.08 - CLOSURE DEVICES</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107597</SubCategoryID><SubCategoryDescription>03.10 - Electronic Controlling Devices (Insulin)</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107783</SubCategoryID><SubCategoryDescription>04.01 - ANEURYSM CLIPS</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107784</SubCategoryID><SubCategoryDescription>04.02 - DURA DEFECT REPAIR</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107785</SubCategoryID><SubCategoryDescription>04.03 - HYDROCEPHALUS DEVICES</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107786</SubCategoryID><SubCategoryDescription>04.04 - DEEP BRAIN STIMULATION (DBS)</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>34194</SubCategoryID><SubCategoryDescription>04.05 - NEUROSTIMULATION THERAPIES FOR PAIN MANAGEMENT</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107787</SubCategoryID><SubCategoryDescription>04.05 - NEUROSTIMULATION THERAPIES FOR PAIN MANAGEMENT</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107788</SubCategoryID><SubCategoryDescription>04.06 - INTRATHECAL DRUG DELIVERY SYSTEM</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107789</SubCategoryID><SubCategoryDescription>04.07 - NEUROSTIMULATION THERAPIES FOR SEIZURE CONTROL</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107790</SubCategoryID><SubCategoryDescription>04.08 - NEURO INTERVENTION</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107780</SubCategoryID><SubCategoryDescription>04.09 - Intracranial Pressure (ICP) Monitoring</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107782</SubCategoryID><SubCategoryDescription>04.10 - Cerebrospinal Fluid (CSF) Diversion</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107769</SubCategoryID><SubCategoryDescription>05.01 - Incontinence Prostheses</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107770</SubCategoryID><SubCategoryDescription>05.02 - Ureteric Stents</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107779</SubCategoryID><SubCategoryDescription>05.03 - Voiding Dysfunction Prostheses</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107773</SubCategoryID><SubCategoryDescription>05.05 - Penile Prostheses</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107774</SubCategoryID><SubCategoryDescription>05.06 - Testicular Prostheses</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107775</SubCategoryID><SubCategoryDescription>05.07 - Sacral Neuromodulation</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107776</SubCategoryID><SubCategoryDescription>05.08 - Tubal Obstruction Devices</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107777</SubCategoryID><SubCategoryDescription>05.09 - Nephrostomy Catheters</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107778</SubCategoryID><SubCategoryDescription>05.10 - Vesicoureteral Reflux Prostheses</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107708</SubCategoryID><SubCategoryDescription>06.01 - ANKLE AND FOOT</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107709</SubCategoryID><SubCategoryDescription>06.02 - UPPER LIMB</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>34114</SubCategoryID><SubCategoryDescription>06.03 - SKELETAL RECONSTRUCTION</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107707</SubCategoryID><SubCategoryDescription>06.03 - SKELETAL RECONSTRUCTION</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107804</SubCategoryID><SubCategoryDescription>07.01 - CRANIOMAXILLOFACIAL RECONSTRUCTION &amp; FIXATION</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107805</SubCategoryID><SubCategoryDescription>07.02 - CRANIOMAXILLOFACIAL IMPLANTS</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107806</SubCategoryID><SubCategoryDescription>07.03 - DENTAL IMPLANTS</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107807</SubCategoryID><SubCategoryDescription>07.04 - DISTRACTOR SYSTEMS</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107808</SubCategoryID><SubCategoryDescription>07.05 - SOFT TISSUE &amp; TISSUE EXPANDERS</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107809</SubCategoryID><SubCategoryDescription>07.06 - MAMMARY IMPLANTS</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107755</SubCategoryID><SubCategoryDescription>08.01 - Single Chamber ICDs</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107756</SubCategoryID><SubCategoryDescription>08.02 - Dual Chamber ICDs</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107757</SubCategoryID><SubCategoryDescription>08.03 - ICDs with CRT</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107758</SubCategoryID><SubCategoryDescription>08.04 - Single Chamber Pacemakers</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107759</SubCategoryID><SubCategoryDescription>08.05 - Dual Chamber Pacemakers</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107760</SubCategoryID><SubCategoryDescription>08.06 - CRT Pacemakers</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107761</SubCategoryID><SubCategoryDescription>08.07 - ICD Leads</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107762</SubCategoryID><SubCategoryDescription>08.08 - Pacemaker Leads</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107763</SubCategoryID><SubCategoryDescription>08.09 - Pacemaker/ICD Adaptors</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107764</SubCategoryID><SubCategoryDescription>08.10 - Pacemaker/ICD Extenders</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107765</SubCategoryID><SubCategoryDescription>08.11 - Pacemaker/Lead Accessories</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107766</SubCategoryID><SubCategoryDescription>08.12 - Coronary Stents</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107767</SubCategoryID><SubCategoryDescription>08.13 - Special Purpose Percutaneous Cardiovascular Devices</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107751</SubCategoryID><SubCategoryDescription>08.14 - Implantable Cardiac Event Recorders</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107748</SubCategoryID><SubCategoryDescription>08.15 - Stents For Treatment Of Coarctation Of The Aorta</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107754</SubCategoryID><SubCategoryDescription>08.16 - Remote Monitoring System</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107749</SubCategoryID><SubCategoryDescription>08.17 - Catheter Delivery</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107750</SubCategoryID><SubCategoryDescription>08.18 - Cardiac Ablation</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107753</SubCategoryID><SubCategoryDescription>08.19 - Percutaneous Coronary Interventions</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107654</SubCategoryID><SubCategoryDescription>09.01 - Mechanical Valves</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107655</SubCategoryID><SubCategoryDescription>09.02 - Tissue Valves</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107656</SubCategoryID><SubCategoryDescription>09.03 - Valve Conduits</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107657</SubCategoryID><SubCategoryDescription>09.04 - Atrio-Ventricular Rings and Bands</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107658</SubCategoryID><SubCategoryDescription>09.05 - Patches</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107659</SubCategoryID><SubCategoryDescription>09.06 - Membranes</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107651</SubCategoryID><SubCategoryDescription>09.08 - Cardiac Assisted Fixation Devices</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107662</SubCategoryID><SubCategoryDescription>09.09 - Aorta and Side Branch Grafts</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107652</SubCategoryID><SubCategoryDescription>09.10 - Skeletal Fixation Devices</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107649</SubCategoryID><SubCategoryDescription>09.11 - Implant Ventricular Assist System</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107647</SubCategoryID><SubCategoryDescription>09.12 - Pectus Bar</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107648</SubCategoryID><SubCategoryDescription>09.13 - Chordal Replacement Devices, fixed and adjustable</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107653</SubCategoryID><SubCategoryDescription>09.14 - Surgical cardiac ablation</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107791</SubCategoryID><SubCategoryDescription>10.01 - Vascular Stents</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107792</SubCategoryID><SubCategoryDescription>10.02 - Stent Grafts</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107793</SubCategoryID><SubCategoryDescription>10.03 - Grafts</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107794</SubCategoryID><SubCategoryDescription>10.04 - Vascular Patches</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107796</SubCategoryID><SubCategoryDescription>10.05 - Vessel Bands</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107797</SubCategoryID><SubCategoryDescription>10.06 - Embolic Protection Devices</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107798</SubCategoryID><SubCategoryDescription>10.07 - Arterial Closure Devices</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107799</SubCategoryID><SubCategoryDescription>10.08 - Occlusion Devices</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107800</SubCategoryID><SubCategoryDescription>10.09 - Long Term Vascular Access Devices</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107801</SubCategoryID><SubCategoryDescription>10.10 - Peritoneal Dialysis, Long Term Implantable Catheters</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107795</SubCategoryID><SubCategoryDescription>10.11 - Vascular Reconstruction</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107678</SubCategoryID><SubCategoryDescription>11.01 - FEMORAL COMPONENTS - PRIMARY AND REVISION</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107679</SubCategoryID><SubCategoryDescription>11.02 - FEMORAL HEADS</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107680</SubCategoryID><SubCategoryDescription>11.03 - ACETABULAR COMPONENTS</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107681</SubCategoryID><SubCategoryDescription>11.04 - ACCESSORIES</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107682</SubCategoryID><SubCategoryDescription>12.01 - FEMORAL COMPONENT: TOTAL KNEE ARTHROPLASTY</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107683</SubCategoryID><SubCategoryDescription>12.02 - FEMORAL COMPONENT: UNI-COMPARTMENTAL KNEE ARTHROPLASTY</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107684</SubCategoryID><SubCategoryDescription>12.03 - TIBIAL TRAY COMPONENT - TOTAL KNEE ARTHROPLASTY</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107685</SubCategoryID><SubCategoryDescription>12.04 - TIBIAL TRAY COMPONENT: UNI-COMPARTMENTAL KNEE ARTHROPLASTY</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107686</SubCategoryID><SubCategoryDescription>12.05 - TIBIAL INSERT: TOTAL KNEE ARTHROPLASTY</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107687</SubCategoryID><SubCategoryDescription>12.06 - TIBIAL INSERT: UNI-COMPARTMENTAL ARTHROPLASTY</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107688</SubCategoryID><SubCategoryDescription>12.07 - PATELLO FEMORAL REPLACEMENT - FEMORAL COMPONENT</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107689</SubCategoryID><SubCategoryDescription>12.08 - PATELLAR COMPONENT</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107690</SubCategoryID><SubCategoryDescription>12.09 - TUMOUR PRODUCTS</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107692</SubCategoryID><SubCategoryDescription>12.11 - KNEE ACCESSORIES</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107663</SubCategoryID><SubCategoryDescription>13.01 - Bone Screws</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107664</SubCategoryID><SubCategoryDescription>13.02 - Accessories for bone screws and connector components</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107665</SubCategoryID><SubCategoryDescription>13.03 - Connector</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107666</SubCategoryID><SubCategoryDescription>13.04 - Hook</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107667</SubCategoryID><SubCategoryDescription>13.05 - Plate</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107668</SubCategoryID><SubCategoryDescription>13.06 - Rod</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107669</SubCategoryID><SubCategoryDescription>13.07 - Plate-Rod</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107670</SubCategoryID><SubCategoryDescription>13.08 - Washer/Staple</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107671</SubCategoryID><SubCategoryDescription>13.09 - C-Ring</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107672</SubCategoryID><SubCategoryDescription>13.10 - Fusion Cage</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107673</SubCategoryID><SubCategoryDescription>13.11 - Disc Replacement</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107674</SubCategoryID><SubCategoryDescription>13.12 - Vertebral Body Replacement</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107675</SubCategoryID><SubCategoryDescription>13.13 - Interspinous Fixation</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107676</SubCategoryID><SubCategoryDescription>13.14 - Sacroiliac Joint Fixation</SubCategoryDescription></SubCategory><SubCategory><SubCategoryID>107677</SubCategoryID><SubCategoryDescription>13.15 - Annular closure/reconstruction</SubCategoryDescription></SubCategory></SubCategories><Groups><Group><GroupID>108461</GroupID><GroupDescription>01.01.01 - Aphakic</GroupDescription></Group><Group><GroupID>108462</GroupID><GroupDescription>01.01.02 - Phakic</GroupDescription></Group><Group><GroupID>108463</GroupID><GroupDescription>01.02.01 - Rigid</GroupDescription></Group><Group><GroupID>108464</GroupID><GroupDescription>01.02.02 - Foldable</GroupDescription></Group><Group><GroupID>108465</GroupID><GroupDescription>01.02.03 - Pseudo-phakic, piggy-back</GroupDescription></Group><Group><GroupID>108466</GroupID><GroupDescription>01.03.01 - Viscoelastic</GroupDescription></Group><Group><GroupID>108467</GroupID><GroupDescription>01.03.02 - Non Viscous</GroupDescription></Group><Group><GroupID>108468</GroupID><GroupDescription>01.04.01 - Simple</GroupDescription></Group><Group><GroupID>108469</GroupID><GroupDescription>01.04.02 - Complex</GroupDescription></Group><Group><GroupID>108470</GroupID><GroupDescription>01.05.01 - Ab Externo Long Tube /Reservoir</GroupDescription></Group><Group><GroupID>108471</GroupID><GroupDescription>01.05.02 - Ab Externo</GroupDescription></Group><Group><GroupID>108472</GroupID><GroupDescription>01.05.03 - Ab Interno Glaucoma Drainage Device</GroupDescription></Group><Group><GroupID>108474</GroupID><GroupDescription>01.06.01 - Spacers</GroupDescription></Group><Group><GroupID>108475</GroupID><GroupDescription>01.06.02 - Weights</GroupDescription></Group><Group><GroupID>108476</GroupID><GroupDescription>01.07.01 - Intracanalicular</GroupDescription></Group><Group><GroupID>108478</GroupID><GroupDescription>01.07.03 - Balloon Dilatation Catheters</GroupDescription></Group><Group><GroupID>108479</GroupID><GroupDescription>01.08.01 - Intrascleral</GroupDescription></Group><Group><GroupID>34302</GroupID><GroupDescription>01.08.02 - Extrascleral</GroupDescription></Group><Group><GroupID>108480</GroupID><GroupDescription>01.08.02 - Extrascleral</GroupDescription></Group><Group><GroupID>108481</GroupID><GroupDescription>01.08.03 - Fascial - solid and permeable</GroupDescription></Group><Group><GroupID>108482</GroupID><GroupDescription>01.09.01 - Buckles, bands, tyres and sponges</GroupDescription></Group><Group><GroupID>108484</GroupID><GroupDescription>01.09.03 - Sleeves</GroupDescription></Group><Group><GroupID>108485</GroupID><GroupDescription>01.09.04 - Intraocular Gases</GroupDescription></Group><Group><GroupID>108486</GroupID><GroupDescription>01.09.05 - Intraocular Heavy Liquids</GroupDescription></Group><Group><GroupID>108487</GroupID><GroupDescription>01.09.06 - Intraocular Silicone Oils</GroupDescription></Group><Group><GroupID>108414</GroupID><GroupDescription>01.10.01 - Foldable</GroupDescription></Group><Group><GroupID>107835</GroupID><GroupDescription>02.01.01 - Cochlear Implants</GroupDescription></Group><Group><GroupID>107836</GroupID><GroupDescription>02.01.02 - Speech Processors</GroupDescription></Group><Group><GroupID>107834</GroupID><GroupDescription>02.01.04 - Implantable Bone Conduction Hearing System</GroupDescription></Group><Group><GroupID>107829</GroupID><GroupDescription>02.01.05 - Ossicle/Middle Ear Prosthesis</GroupDescription></Group><Group><GroupID>107830</GroupID><GroupDescription>02.01.06 - Ventilation Tube/Grommet</GroupDescription></Group><Group><GroupID>107828</GroupID><GroupDescription>02.01.08 - Tympanic Membrane Grafts</GroupDescription></Group><Group><GroupID>107832</GroupID><GroupDescription>02.01.09 - Implantable Piezoelectric Bone Conduction Hearing System (all components)</GroupDescription></Group><Group><GroupID>107841</GroupID><GroupDescription>02.02.01 - Septal Button</GroupDescription></Group><Group><GroupID>107839</GroupID><GroupDescription>02.02.02 - Nasal Valve Stent</GroupDescription></Group><Group><GroupID>107840</GroupID><GroupDescription>02.02.03 - Absorbable Nasal Implant</GroupDescription></Group><Group><GroupID>107842</GroupID><GroupDescription>02.03.01 - Tracheal Speaking Valve</GroupDescription></Group><Group><GroupID>107843</GroupID><GroupDescription>02.03.02 - Vocal Chord Medialisation Implant</GroupDescription></Group><Group><GroupID>107844</GroupID><GroupDescription>02.03.03 - Tracheal Stents</GroupDescription></Group><Group><GroupID>107845</GroupID><GroupDescription>02.03.04 - Thyroplasty</GroupDescription></Group><Group><GroupID>107846</GroupID><GroupDescription>02.03.05 - Cannula</GroupDescription></Group><Group><GroupID>107847</GroupID><GroupDescription>02.03.06 - Injectable Material for Vocal Fold Augmentation / Laryngeal Reconstruction</GroupDescription></Group><Group><GroupID>107941</GroupID><GroupDescription>03.01.01 - Hepatic, Yttrium 90, Standard Dose</GroupDescription></Group><Group><GroupID>107942</GroupID><GroupDescription>03.01.02 - Prostatic I-125</GroupDescription></Group><Group><GroupID>107940</GroupID><GroupDescription>03.01.03 - Tissue Expander/Separator</GroupDescription></Group><Group><GroupID>107943</GroupID><GroupDescription>03.02.01 - Infusion Ports</GroupDescription></Group><Group><GroupID>107944</GroupID><GroupDescription>03.02.02 - Infusion Pumps, Balloon Based</GroupDescription></Group><Group><GroupID>107945</GroupID><GroupDescription>03.02.03 - Infusion Pumps, Battery Powered</GroupDescription></Group><Group><GroupID>107946</GroupID><GroupDescription>03.02.04 - Infusion Pumps, Spring Powered</GroupDescription></Group><Group><GroupID>107947</GroupID><GroupDescription>03.02.05 - Infusion Pump Accessories</GroupDescription></Group><Group><GroupID>107948</GroupID><GroupDescription>03.02.06 - Pharmaceutical Beads</GroupDescription></Group><Group><GroupID>107950</GroupID><GroupDescription>03.03.01 - Feeding Tubes</GroupDescription></Group><Group><GroupID>107951</GroupID><GroupDescription>03.03.02 - Gastrostomy Tubes</GroupDescription></Group><Group><GroupID>107952</GroupID><GroupDescription>03.03.03 - Jejunostomy Tubes</GroupDescription></Group><Group><GroupID>107953</GroupID><GroupDescription>03.03.04 - Caecostomy Tubes</GroupDescription></Group><Group><GroupID>107975</GroupID><GroupDescription>03.04.01 - Adjustable Gastric Band with Port</GroupDescription></Group><Group><GroupID>107974</GroupID><GroupDescription>03.04.02 - Gastric Band without Port</GroupDescription></Group><Group><GroupID>107972</GroupID><GroupDescription>03.04.03 - Replacement Injection Ports</GroupDescription></Group><Group><GroupID>107978</GroupID><GroupDescription>03.05.01 - Occluder Pin</GroupDescription></Group><Group><GroupID>107979</GroupID><GroupDescription>03.05.02 - Powder</GroupDescription></Group><Group><GroupID>107980</GroupID><GroupDescription>03.05.03 - Sponges</GroupDescription></Group><Group><GroupID>107981</GroupID><GroupDescription>03.05.04 - Pliable Patches</GroupDescription></Group><Group><GroupID>107982</GroupID><GroupDescription>03.05.05 - Matrix</GroupDescription></Group><Group><GroupID>107983</GroupID><GroupDescription>03.05.06 - Foam</GroupDescription></Group><Group><GroupID>107985</GroupID><GroupDescription>03.06.01 - Biliary Stents</GroupDescription></Group><Group><GroupID>107986</GroupID><GroupDescription>03.06.02 - Colonic Stents</GroupDescription></Group><Group><GroupID>107987</GroupID><GroupDescription>03.06.03 - Oesophageal Stents</GroupDescription></Group><Group><GroupID>107988</GroupID><GroupDescription>03.06.04 - Pancreatic Stents</GroupDescription></Group><Group><GroupID>107989</GroupID><GroupDescription>03.06.05 - Enteral Stents</GroupDescription></Group><Group><GroupID>107990</GroupID><GroupDescription>03.06.06 - Tracheobronchial Stents</GroupDescription></Group><Group><GroupID>107991</GroupID><GroupDescription>03.06.07 - Nerve Repair Stents</GroupDescription></Group><Group><GroupID>107992</GroupID><GroupDescription>03.07.01 - Drainage Catheters</GroupDescription></Group><Group><GroupID>107993</GroupID><GroupDescription>03.07.02 - Endobronchial Valve</GroupDescription></Group><Group><GroupID>107994</GroupID><GroupDescription>03.07.03 - Drainage Shunts, Peritineovenous</GroupDescription></Group><Group><GroupID>108003</GroupID><GroupDescription>03.08.01 - Adhesion Barriers</GroupDescription></Group><Group><GroupID>108004</GroupID><GroupDescription>03.08.02 - Internal Adhesives</GroupDescription></Group><Group><GroupID>35740</GroupID><GroupDescription>03.08.03 - Ligating Devices</GroupDescription></Group><Group><GroupID>108005</GroupID><GroupDescription>03.08.03 - Ligating Devices</GroupDescription></Group><Group><GroupID>108006</GroupID><GroupDescription>03.08.04 - Staples &amp; Tackers</GroupDescription></Group><Group><GroupID>107997</GroupID><GroupDescription>03.08.05 - Polypropylene/Polyester Mesh</GroupDescription></Group><Group><GroupID>107998</GroupID><GroupDescription>03.08.06 - Composite Mesh</GroupDescription></Group><Group><GroupID>107995</GroupID><GroupDescription>03.08.07 - Complete Biomaterial Mesh</GroupDescription></Group><Group><GroupID>108002</GroupID><GroupDescription>03.08.09 - Plugs</GroupDescription></Group><Group><GroupID>108001</GroupID><GroupDescription>03.08.10 - Anastomosis Clip</GroupDescription></Group><Group><GroupID>107996</GroupID><GroupDescription>03.08.11 - Dynamic Wound Closure Devices</GroupDescription></Group><Group><GroupID>108015</GroupID><GroupDescription>03.10.01 - Personal Diabetes Manager</GroupDescription></Group><Group><GroupID>109262</GroupID><GroupDescription>04.01.01 - Aneurysm Clip</GroupDescription></Group><Group><GroupID>109263</GroupID><GroupDescription>04.01.02 - AVM Clip</GroupDescription></Group><Group><GroupID>109264</GroupID><GroupDescription>04.02.01 - Repair, Graft, Small (≤10cm²)</GroupDescription></Group><Group><GroupID>109266</GroupID><GroupDescription>04.02.02 - Repair, Graft, Medium (&gt;10 to 50cm²)</GroupDescription></Group><Group><GroupID>109267</GroupID><GroupDescription>04.02.03 - Repair, Graft, Large (&gt;50 to 100cm²)</GroupDescription></Group><Group><GroupID>109268</GroupID><GroupDescription>04.02.04 - Repair, Graft, Extra Large (&gt;100cm²)</GroupDescription></Group><Group><GroupID>109269</GroupID><GroupDescription>04.02.05 - Repair, Liquid Sealant (0 to 3ml)</GroupDescription></Group><Group><GroupID>109270</GroupID><GroupDescription>04.02.06 - Repair, Liquid Sealant (&gt;3 to 6ml)</GroupDescription></Group><Group><GroupID>109272</GroupID><GroupDescription>04.02.08 - Repair, Self-Adhesive Membrane Sealant, Medium (&gt;10 to 50cm²)</GroupDescription></Group><Group><GroupID>109265</GroupID><GroupDescription>04.02.09 - Repair, Self-Adhesive Membrane Sealant, Large (&gt;50 to 100cm²)</GroupDescription></Group><Group><GroupID>109273</GroupID><GroupDescription>04.03.01 - Valves</GroupDescription></Group><Group><GroupID>109274</GroupID><GroupDescription>04.03.02 - Unitised shunt assembly, with proximal/distal catheter</GroupDescription></Group><Group><GroupID>109275</GroupID><GroupDescription>04.03.03 - Catheter</GroupDescription></Group><Group><GroupID>109276</GroupID><GroupDescription>04.03.04 - Antisyphon Device</GroupDescription></Group><Group><GroupID>109279</GroupID><GroupDescription>04.03.04 - Antisyphon Device</GroupDescription></Group><Group><GroupID>109277</GroupID><GroupDescription>04.03.05 - Reservoir/Priming Device</GroupDescription></Group><Group><GroupID>109278</GroupID><GroupDescription>04.03.06 - Shunt Attachment</GroupDescription></Group><Group><GroupID>109280</GroupID><GroupDescription>04.04.01 - Implantable Pulse Generator</GroupDescription></Group><Group><GroupID>109281</GroupID><GroupDescription>04.04.02 - External Components</GroupDescription></Group><Group><GroupID>109282</GroupID><GroupDescription>04.04.03 - Leads</GroupDescription></Group><Group><GroupID>109283</GroupID><GroupDescription>04.04.04 - Microtargetting Electrodes</GroupDescription></Group><Group><GroupID>109284</GroupID><GroupDescription>04.04.05 - Accessories</GroupDescription></Group><Group><GroupID>35880</GroupID><GroupDescription>04.05.01 - Pulse Generators</GroupDescription></Group><Group><GroupID>109285</GroupID><GroupDescription>04.05.01 - Pulse Generators</GroupDescription></Group><Group><GroupID>109286</GroupID><GroupDescription>04.05.02 - External Components</GroupDescription></Group><Group><GroupID>35882</GroupID><GroupDescription>04.05.03 - Leads</GroupDescription></Group><Group><GroupID>109287</GroupID><GroupDescription>04.05.03 - Leads</GroupDescription></Group><Group><GroupID>109288</GroupID><GroupDescription>04.05.04 - Lead Extension</GroupDescription></Group><Group><GroupID>109289</GroupID><GroupDescription>04.05.05 - Accessories</GroupDescription></Group><Group><GroupID>109290</GroupID><GroupDescription>04.06.01 - Implantable Infusion Pump </GroupDescription></Group><Group><GroupID>109291</GroupID><GroupDescription>04.06.02 - Patient Programmer</GroupDescription></Group><Group><GroupID>109292</GroupID><GroupDescription>04.06.03 - Intrathecal Catheter</GroupDescription></Group><Group><GroupID>109293</GroupID><GroupDescription>04.06.04 - Accessories</GroupDescription></Group><Group><GroupID>109294</GroupID><GroupDescription>04.07.01 - Vagal nerve stimulators</GroupDescription></Group><Group><GroupID>109297</GroupID><GroupDescription>04.08.01 - Stent</GroupDescription></Group><Group><GroupID>109298</GroupID><GroupDescription>04.08.02 - Coils</GroupDescription></Group><Group><GroupID>109299</GroupID><GroupDescription>04.08.03 - Assist Devices</GroupDescription></Group><Group><GroupID>109258</GroupID><GroupDescription>04.09.01 - Transducer</GroupDescription></Group><Group><GroupID>109260</GroupID><GroupDescription>04.10.01 - External Ventricular Drain</GroupDescription></Group><Group><GroupID>109223</GroupID><GroupDescription>05.01.01 - Inflatable</GroupDescription></Group><Group><GroupID>109222</GroupID><GroupDescription>05.01.02 - Permanently Adjustable</GroupDescription></Group><Group><GroupID>109225</GroupID><GroupDescription>05.01.03 - Sling</GroupDescription></Group><Group><GroupID>109226</GroupID><GroupDescription>05.01.04 - Injectable, Synthetic</GroupDescription></Group><Group><GroupID>109228</GroupID><GroupDescription>05.02.01 - Fixed length</GroupDescription></Group><Group><GroupID>109229</GroupID><GroupDescription>05.02.02 - Multi-length</GroupDescription></Group><Group><GroupID>109230</GroupID><GroupDescription>05.02.03 - Urinary diversion</GroupDescription></Group><Group><GroupID>109253</GroupID><GroupDescription>05.03.01 - Urethral Stents</GroupDescription></Group><Group><GroupID>109254</GroupID><GroupDescription>05.03.02 - Prostatic Retractor</GroupDescription></Group><Group><GroupID>109256</GroupID><GroupDescription>05.03.03 - Radiofrequency (RF) Delivery Devices for Transurethral Water Vapour Ablation</GroupDescription></Group><Group><GroupID>109257</GroupID><GroupDescription>05.03.04 - Temporary Implant</GroupDescription></Group><Group><GroupID>109239</GroupID><GroupDescription>05.05.01 - Malleable</GroupDescription></Group><Group><GroupID>109241</GroupID><GroupDescription>05.05.02 - Inflatable - Two component</GroupDescription></Group><Group><GroupID>109242</GroupID><GroupDescription>05.05.03 - Inflatable - Three component</GroupDescription></Group><Group><GroupID>109243</GroupID><GroupDescription>05.06.01 - Testicular prostheses</GroupDescription></Group><Group><GroupID>109244</GroupID><GroupDescription>05.07.01 - Primary Cell Pulse Generator (non-rechargeable)</GroupDescription></Group><Group><GroupID>109245</GroupID><GroupDescription>05.07.02 - External Components</GroupDescription></Group><Group><GroupID>109246</GroupID><GroupDescription>05.07.03 - Lead</GroupDescription></Group><Group><GroupID>109247</GroupID><GroupDescription>05.07.04 - Accessories</GroupDescription></Group><Group><GroupID>109248</GroupID><GroupDescription>05.07.05 - Rechargeable Pulse Generator</GroupDescription></Group><Group><GroupID>109249</GroupID><GroupDescription>05.08.01 - Extraluminal</GroupDescription></Group><Group><GroupID>109251</GroupID><GroupDescription>05.09.01 - Nephrostomy Catheters</GroupDescription></Group><Group><GroupID>109252</GroupID><GroupDescription>05.10.01 - Vesicoureteral Reflux Prostheses</GroupDescription></Group><Group><GroupID>108821</GroupID><GroupDescription>06.01.01 - Ankle joint component</GroupDescription></Group><Group><GroupID>108817</GroupID><GroupDescription>06.01.02 - Sinus Tarsi Implant</GroupDescription></Group><Group><GroupID>108813</GroupID><GroupDescription>06.01.03 - Ankle joint</GroupDescription></Group><Group><GroupID>108814</GroupID><GroupDescription>06.01.04 - Replacement of other joints of the foot including articulations</GroupDescription></Group><Group><GroupID>108823</GroupID><GroupDescription>06.02.01 - Wrist</GroupDescription></Group><Group><GroupID>108824</GroupID><GroupDescription>06.02.02 - Finger Joint Articulations</GroupDescription></Group><Group><GroupID>108825</GroupID><GroupDescription>06.02.03 - Elbow</GroupDescription></Group><Group><GroupID>108826</GroupID><GroupDescription>06.02.04 - Shoulder - Humeral</GroupDescription></Group><Group><GroupID>108827</GroupID><GroupDescription>06.02.05 - Shoulder - Glenoid</GroupDescription></Group><Group><GroupID>108828</GroupID><GroupDescription>06.02.06 - Shoulder - Accessories</GroupDescription></Group><Group><GroupID>108794</GroupID><GroupDescription>06.03.01 - Intramedullary Nails</GroupDescription></Group><Group><GroupID>108795</GroupID><GroupDescription>06.03.02 - Intramedullary Nail Accessories</GroupDescription></Group><Group><GroupID>108787</GroupID><GroupDescription>06.03.03 - Plates</GroupDescription></Group><Group><GroupID>35378</GroupID><GroupDescription>06.03.04 - Screws</GroupDescription></Group><Group><GroupID>108797</GroupID><GroupDescription>06.03.04 - Screws</GroupDescription></Group><Group><GroupID>108788</GroupID><GroupDescription>06.03.05 - Surgical Accessories</GroupDescription></Group><Group><GroupID>108789</GroupID><GroupDescription>06.03.06 - Staples</GroupDescription></Group><Group><GroupID>108790</GroupID><GroupDescription>06.03.07 - Soft Tissue Fixation Devices</GroupDescription></Group><Group><GroupID>108791</GroupID><GroupDescription>06.03.08 - Soft Tissue Substitute</GroupDescription></Group><Group><GroupID>108803</GroupID><GroupDescription>06.03.11 - External Fixateurs</GroupDescription></Group><Group><GroupID>108812</GroupID><GroupDescription>06.03.12 - Internal Fixator</GroupDescription></Group><Group><GroupID>108809</GroupID><GroupDescription>06.03.14 - Bone Cement</GroupDescription></Group><Group><GroupID>108806</GroupID><GroupDescription>06.03.15 - Bone Graft Substitute</GroupDescription></Group><Group><GroupID>108792</GroupID><GroupDescription>06.03.16 - Meshes</GroupDescription></Group><Group><GroupID>108793</GroupID><GroupDescription>06.03.17 - Tumour / Limb Deficiency</GroupDescription></Group><Group><GroupID>109349</GroupID><GroupDescription>07.01.01 - Mesh - Metal</GroupDescription></Group><Group><GroupID>109350</GroupID><GroupDescription>07.01.02 - Mesh - Non-metal</GroupDescription></Group><Group><GroupID>109351</GroupID><GroupDescription>07.01.03 - Mesh - Composite</GroupDescription></Group><Group><GroupID>109352</GroupID><GroupDescription>07.01.04 - Non-mesh</GroupDescription></Group><Group><GroupID>109353</GroupID><GroupDescription>07.01.05 - Fracture or Reconstruction Plates</GroupDescription></Group><Group><GroupID>109354</GroupID><GroupDescription>07.01.06 - Screws</GroupDescription></Group><Group><GroupID>109355</GroupID><GroupDescription>07.01.07 - Ancillary Components</GroupDescription></Group><Group><GroupID>109359</GroupID><GroupDescription>07.01.08 - Non-mesh, non-resorbable</GroupDescription></Group><Group><GroupID>109361</GroupID><GroupDescription>07.02.01 - Chin</GroupDescription></Group><Group><GroupID>109362</GroupID><GroupDescription>07.02.02 - Cranium</GroupDescription></Group><Group><GroupID>109363</GroupID><GroupDescription>07.02.03 - Ear</GroupDescription></Group><Group><GroupID>109364</GroupID><GroupDescription>07.02.04 - Malar</GroupDescription></Group><Group><GroupID>109365</GroupID><GroupDescription>07.02.05 - Mandible, Maxilla and Temperomandibular Joint (TMJ)</GroupDescription></Group><Group><GroupID>109366</GroupID><GroupDescription>07.02.06 - Nose and Zygoma</GroupDescription></Group><Group><GroupID>109367</GroupID><GroupDescription>07.02.07 - Orbit</GroupDescription></Group><Group><GroupID>109368</GroupID><GroupDescription>07.02.08 - External Prostheses, Bone Attachment</GroupDescription></Group><Group><GroupID>109360</GroupID><GroupDescription>07.02.09 - Anatomical Biomodel</GroupDescription></Group><Group><GroupID>109369</GroupID><GroupDescription>07.03.01 - Abutment</GroupDescription></Group><Group><GroupID>109370</GroupID><GroupDescription>07.03.02 - Zygomatic Bone Implant</GroupDescription></Group><Group><GroupID>109371</GroupID><GroupDescription>07.03.03 - Endosseous Implant</GroupDescription></Group><Group><GroupID>109372</GroupID><GroupDescription>07.03.04 - Subperiosteal</GroupDescription></Group><Group><GroupID>109373</GroupID><GroupDescription>07.04.01 - Complete</GroupDescription></Group><Group><GroupID>109374</GroupID><GroupDescription>07.04.02 - Component</GroupDescription></Group><Group><GroupID>109376</GroupID><GroupDescription>07.05.02 - Tissue Expanders</GroupDescription></Group><Group><GroupID>109377</GroupID><GroupDescription>07.05.03 - Skin, Artificial</GroupDescription></Group><Group><GroupID>109378</GroupID><GroupDescription>07.05.04 - Coupler</GroupDescription></Group><Group><GroupID>109379</GroupID><GroupDescription>07.06.01 - Saline Filled</GroupDescription></Group><Group><GroupID>109380</GroupID><GroupDescription>07.06.02 - Gel Filled</GroupDescription></Group><Group><GroupID>109123</GroupID><GroupDescription>08.01.02 - Features of 8.1.1 plus auto test sensing parameters, auto capture threshold test, lead impedance test, wireless remote analysis</GroupDescription></Group><Group><GroupID>109124</GroupID><GroupDescription>08.01.03 - Single Chamber, Subcutaneous</GroupDescription></Group><Group><GroupID>109121</GroupID><GroupDescription>08.01.05 - Extravascular</GroupDescription></Group><Group><GroupID>109136</GroupID><GroupDescription>08.02.02 - Features of 8.2.1 plus auto test sensing parameters, auto capture threshold test, lead impedance test, wireless remote analysis</GroupDescription></Group><Group><GroupID>109138</GroupID><GroupDescription>08.03.02 - Features of 8.3.1 plus auto test sensing parameters, auto capture threshold test, lead impedance test, wireless remote analysis</GroupDescription></Group><Group><GroupID>109144</GroupID><GroupDescription>08.04.03 - SSIR with small/compact size, multi-programmability &amp; longevity, &amp; four or more advanced features</GroupDescription></Group><Group><GroupID>109140</GroupID><GroupDescription>08.04.04 - Leadless pacemaker</GroupDescription></Group><Group><GroupID>109153</GroupID><GroupDescription>08.05.04 - DDDR with continuous threshold monitoring in atrium + ventricle with ability to adapt pacing outputs accordingly, &amp; with four or more advanced features</GroupDescription></Group><Group><GroupID>109155</GroupID><GroupDescription>08.06.02 - Features of 8.6.1 plus continuous threshold monitoring in atrium &amp; ventricle with ability to adapt pacing outputs accordingly</GroupDescription></Group><Group><GroupID>109156</GroupID><GroupDescription>08.07.01 - Coronary Sinus</GroupDescription></Group><Group><GroupID>109157</GroupID><GroupDescription>08.07.02 - Subcutaneous</GroupDescription></Group><Group><GroupID>109160</GroupID><GroupDescription>08.07.05 - Transvenous/Steroid/Passive</GroupDescription></Group><Group><GroupID>109161</GroupID><GroupDescription>08.07.06 - Transvenous/Steroid/Active</GroupDescription></Group><Group><GroupID>109162</GroupID><GroupDescription>08.07.07 - Epicardial Patches</GroupDescription></Group><Group><GroupID>109163</GroupID><GroupDescription>08.08.01 - Non-transvenous, Bi-Polar, Steroid</GroupDescription></Group><Group><GroupID>109164</GroupID><GroupDescription>08.08.02 - Non-transvenous, Uni-Polar, Steroid</GroupDescription></Group><Group><GroupID>109165</GroupID><GroupDescription>08.08.03 - Non-transvenous, Uni-Polar, Non-Steroid</GroupDescription></Group><Group><GroupID>109168</GroupID><GroupDescription>08.08.06 - Transvenous, Uni-Polar, Passive, Steroid, Left Ventricular</GroupDescription></Group><Group><GroupID>109170</GroupID><GroupDescription>08.08.08 - Transvenous, Bi-Polar, Passive, Steroid, Right Ventricular/Atrial</GroupDescription></Group><Group><GroupID>109171</GroupID><GroupDescription>08.08.09 - Transvenous, Bi-Polar, Active, Steroid, Right Ventricular/Atrial</GroupDescription></Group><Group><GroupID>109173</GroupID><GroupDescription>08.08.11 - Transvenous, Multi-Polar, Passive, Steroid, Left Ventricular</GroupDescription></Group><Group><GroupID>109178</GroupID><GroupDescription>08.09.01 - Pacemaker/ICD Adaptors</GroupDescription></Group><Group><GroupID>109179</GroupID><GroupDescription>08.10.01 - Pacemaker/ICD Adaptors</GroupDescription></Group><Group><GroupID>109180</GroupID><GroupDescription>08.11.01 - Pacemaker/Lead Accessories</GroupDescription></Group><Group><GroupID>109181</GroupID><GroupDescription>08.11.02 - Antibacterial Envelope</GroupDescription></Group><Group><GroupID>109186</GroupID><GroupDescription>08.12.01 - Drug Eluting</GroupDescription></Group><Group><GroupID>109187</GroupID><GroupDescription>08.12.02 - Bare Metal</GroupDescription></Group><Group><GroupID>109188</GroupID><GroupDescription>08.13.01 - Cardiac Defect Occluders</GroupDescription></Group><Group><GroupID>109194</GroupID><GroupDescription>08.13.03 - Left Atrial Appendage Closure</GroupDescription></Group><Group><GroupID>109117</GroupID><GroupDescription>08.14.01 - Implantable Cardiac Event Recorders</GroupDescription></Group><Group><GroupID>109104</GroupID><GroupDescription>08.15.01 - Uncovered</GroupDescription></Group><Group><GroupID>109105</GroupID><GroupDescription>08.15.02 - Covered</GroupDescription></Group><Group><GroupID>109119</GroupID><GroupDescription>08.16.01 - Remote Monitoring System</GroupDescription></Group><Group><GroupID>109120</GroupID><GroupDescription>08.16.02 - Implantable Cardiac Event Recorders</GroupDescription></Group><Group><GroupID>109113</GroupID><GroupDescription>08.17.01 - Transcatheter Aortic Valve Implantation</GroupDescription></Group><Group><GroupID>109106</GroupID><GroupDescription>08.17.02 - Mitral Valve Repair</GroupDescription></Group><Group><GroupID>109115</GroupID><GroupDescription>08.18.01 - Radio frequency (RF) Ablation</GroupDescription></Group><Group><GroupID>109116</GroupID><GroupDescription>08.18.02 - Cryoablation</GroupDescription></Group><Group><GroupID>109114</GroupID><GroupDescription>08.18.03 - Pulsed Field Ablation</GroupDescription></Group><Group><GroupID>109118</GroupID><GroupDescription>08.19.01 - Coronary Drug Coated Balloon Catheters</GroupDescription></Group><Group><GroupID>108502</GroupID><GroupDescription>09.01.01 - Bi-Leaflet, rotatable</GroupDescription></Group><Group><GroupID>108504</GroupID><GroupDescription>09.02.01 - Stented, anatomical</GroupDescription></Group><Group><GroupID>108505</GroupID><GroupDescription>09.02.02 - Stented, non anatomical</GroupDescription></Group><Group><GroupID>108506</GroupID><GroupDescription>09.02.03 - Non-Stented</GroupDescription></Group><Group><GroupID>108522</GroupID><GroupDescription>09.02.04 - Rapid deployment aortic valve with dedicated single use tools</GroupDescription></Group><Group><GroupID>108524</GroupID><GroupDescription>09.03.01 - Mechanical Valve</GroupDescription></Group><Group><GroupID>108525</GroupID><GroupDescription>09.03.02 - Tissue Valve, stented anatomical</GroupDescription></Group><Group><GroupID>108531</GroupID><GroupDescription>09.04.04 - Atrio-Ventricular Ring or Band, Standard</GroupDescription></Group><Group><GroupID>108532</GroupID><GroupDescription>09.04.05 - Atrio-Ventricular Ring or Band, Modified</GroupDescription></Group><Group><GroupID>108535</GroupID><GroupDescription>09.05.01 - Tissue</GroupDescription></Group><Group><GroupID>108536</GroupID><GroupDescription>09.05.02 - Synthetic</GroupDescription></Group><Group><GroupID>108537</GroupID><GroupDescription>09.06.01 - Non-cardiovascular &lt; 100cm²</GroupDescription></Group><Group><GroupID>108538</GroupID><GroupDescription>09.06.02 - Non-cardiovascular ≥100cm² and &lt;200cm²</GroupDescription></Group><Group><GroupID>108539</GroupID><GroupDescription>09.06.03 - Non-cardiovascular  ≥200cm²</GroupDescription></Group><Group><GroupID>108498</GroupID><GroupDescription>09.08.02 - Surgical closure devices (atrial appendage)</GroupDescription></Group><Group><GroupID>108545</GroupID><GroupDescription>09.09.01 - Modified Tube (end modified eg valsalva)</GroupDescription></Group><Group><GroupID>108546</GroupID><GroupDescription>09.09.02 - Tube with one side branch</GroupDescription></Group><Group><GroupID>108547</GroupID><GroupDescription>09.09.03 - Tube with multiple side branches (more than 1)</GroupDescription></Group><Group><GroupID>108550</GroupID><GroupDescription>09.09.04 - Hybrid stent graft (unbranched)</GroupDescription></Group><Group><GroupID>108549</GroupID><GroupDescription>09.09.05 - Hybrid stent graft (Branched)</GroupDescription></Group><Group><GroupID>108548</GroupID><GroupDescription>09.09.06 - Straight Tube</GroupDescription></Group><Group><GroupID>108499</GroupID><GroupDescription>09.10.01 - Skeletal fixation, sternum</GroupDescription></Group><Group><GroupID>108491</GroupID><GroupDescription>09.11.01 - Ventricular Assist System</GroupDescription></Group><Group><GroupID>108492</GroupID><GroupDescription>09.11.02 - External Components</GroupDescription></Group><Group><GroupID>108493</GroupID><GroupDescription>09.11.03 - Patient Mobility Accessories</GroupDescription></Group><Group><GroupID>108488</GroupID><GroupDescription>09.12.01 - Pectus Bar</GroupDescription></Group><Group><GroupID>108489</GroupID><GroupDescription>09.12.02 - Stabilisers</GroupDescription></Group><Group><GroupID>108490</GroupID><GroupDescription>09.13.01 - Chordal Replacement Devices, fixed and adjustable</GroupDescription></Group><Group><GroupID>108500</GroupID><GroupDescription>09.14.01 - RF Ablation</GroupDescription></Group><Group><GroupID>108501</GroupID><GroupDescription>09.14.02 - Cryoablation</GroupDescription></Group><Group><GroupID>109303</GroupID><GroupDescription>10.01.01 - Bare Metal Stents</GroupDescription></Group><Group><GroupID>109304</GroupID><GroupDescription>10.01.02 - Drug Eluting Stents</GroupDescription></Group><Group><GroupID>109309</GroupID><GroupDescription>10.02.01 - Tube (Thoracic Aorta)</GroupDescription></Group><Group><GroupID>109310</GroupID><GroupDescription>10.02.02 - Tube (Abdominal Aorta)</GroupDescription></Group><Group><GroupID>109311</GroupID><GroupDescription>10.02.03 - Tube (Aorto-uni-iliac)</GroupDescription></Group><Group><GroupID>109312</GroupID><GroupDescription>10.02.04 - Bifurcated</GroupDescription></Group><Group><GroupID>109313</GroupID><GroupDescription>10.02.05 - Branched</GroupDescription></Group><Group><GroupID>109314</GroupID><GroupDescription>10.02.06 - Fenestrated</GroupDescription></Group><Group><GroupID>109315</GroupID><GroupDescription>10.02.07 - Accessory Component (Aortic)</GroupDescription></Group><Group><GroupID>109316</GroupID><GroupDescription>10.02.08 - Accessory Component (Other including iliac limb and extension)</GroupDescription></Group><Group><GroupID>109317</GroupID><GroupDescription>10.02.09 - Iliac Graft Plug</GroupDescription></Group><Group><GroupID>109318</GroupID><GroupDescription>10.02.10 - Tube, Peripheral, Balloon Expandable</GroupDescription></Group><Group><GroupID>109319</GroupID><GroupDescription>10.02.11 - Tube, Peripheral, Self Expandable</GroupDescription></Group><Group><GroupID>109320</GroupID><GroupDescription>10.03.01 - Tube</GroupDescription></Group><Group><GroupID>109321</GroupID><GroupDescription>10.03.02 - Bifurcated</GroupDescription></Group><Group><GroupID>109322</GroupID><GroupDescription>10.03.03 - Branched or Fenestrated</GroupDescription></Group><Group><GroupID>109323</GroupID><GroupDescription>10.03.04 - Tapered or End-modified</GroupDescription></Group><Group><GroupID>109324</GroupID><GroupDescription>10.04.01 - Vascular Patches</GroupDescription></Group><Group><GroupID>109327</GroupID><GroupDescription>10.05.01 - Vessel Bands</GroupDescription></Group><Group><GroupID>109328</GroupID><GroupDescription>10.06.01 - Venous</GroupDescription></Group><Group><GroupID>109329</GroupID><GroupDescription>10.06.02 - Arterial</GroupDescription></Group><Group><GroupID>109330</GroupID><GroupDescription>10.07.01 - Arterial Closure Devices</GroupDescription></Group><Group><GroupID>109331</GroupID><GroupDescription>10.08.01 - Particle</GroupDescription></Group><Group><GroupID>109332</GroupID><GroupDescription>10.08.02 - Coil, Peripheral</GroupDescription></Group><Group><GroupID>109333</GroupID><GroupDescription>10.08.03 - Polymer</GroupDescription></Group><Group><GroupID>109334</GroupID><GroupDescription>10.08.04 - Complex Occlusion Devices, including detachable balloon, sphere or umbrella</GroupDescription></Group><Group><GroupID>109335</GroupID><GroupDescription>10.08.05 - Liquid</GroupDescription></Group><Group><GroupID>109336</GroupID><GroupDescription>10.08.06 - Delivery Device For Occlusion Media</GroupDescription></Group><Group><GroupID>109337</GroupID><GroupDescription>10.09.01 - Percutaneous Catheters, Single Lumen</GroupDescription></Group><Group><GroupID>109338</GroupID><GroupDescription>10.09.02 - Percutaneous Catheters, Multiple Lumen</GroupDescription></Group><Group><GroupID>109339</GroupID><GroupDescription>10.09.03 - Percutaneous Catheters, Multiple Lumen for Haemodialysis</GroupDescription></Group><Group><GroupID>109340</GroupID><GroupDescription>10.09.04 - Infuser Ports, Single Chamber</GroupDescription></Group><Group><GroupID>109341</GroupID><GroupDescription>10.09.05 - Infuser Ports, Multiple Chamber</GroupDescription></Group><Group><GroupID>109344</GroupID><GroupDescription>10.10.01 - Peritoneal Dialysis, Long Term Implantable Catheters</GroupDescription></Group><Group><GroupID>109326</GroupID><GroupDescription>10.11.01 - Drug-coated Balloon Catheter</GroupDescription></Group><Group><GroupID>108595</GroupID><GroupDescription>11.01.01 - Cemented</GroupDescription></Group><Group><GroupID>108596</GroupID><GroupDescription>11.01.02 - Cemented, Long Lengths (≥200mm)</GroupDescription></Group><Group><GroupID>108597</GroupID><GroupDescription>11.01.03 - Uncemented</GroupDescription></Group><Group><GroupID>108598</GroupID><GroupDescription>11.01.04 - Uncemented, HA Coated</GroupDescription></Group><Group><GroupID>108599</GroupID><GroupDescription>11.01.05 - Uncemented, Long Lengths (≥200mm)</GroupDescription></Group><Group><GroupID>108600</GroupID><GroupDescription>11.01.06 - Uncemented, Long Lengths, HA Coated (≥ 200mm)</GroupDescription></Group><Group><GroupID>108601</GroupID><GroupDescription>11.01.07 - Uncemented, Modular</GroupDescription></Group><Group><GroupID>108602</GroupID><GroupDescription>11.01.08 - Uncemented, Modular, HA Coated</GroupDescription></Group><Group><GroupID>108603</GroupID><GroupDescription>11.01.09 - Uncemented, Modular, Long Lengths (Stem ≥200mm;  Body ≥75mm;  Cone ≥70mm;  Spacer/Sleeve ≥50mm)</GroupDescription></Group><Group><GroupID>108604</GroupID><GroupDescription>11.01.10 - Uncemented, Modular, HA Coated, Long Lengths (Stem ≥200mm;  Body ≥75mm;  Cone ≥70mm;  Spacer/Sleeve ≥50mm)</GroupDescription></Group><Group><GroupID>108607</GroupID><GroupDescription>11.01.13 - Monoblock Hemis</GroupDescription></Group><Group><GroupID>108608</GroupID><GroupDescription>11.01.14 - Femoral Neck</GroupDescription></Group><Group><GroupID>108610</GroupID><GroupDescription>11.02.01 - Conventional Femoral Heads, ≤32mm</GroupDescription></Group><Group><GroupID>108611</GroupID><GroupDescription>11.02.02 - Conventional Femoral Heads, &gt;32mm</GroupDescription></Group><Group><GroupID>108613</GroupID><GroupDescription>11.02.04 - Resurfacing, Cemented</GroupDescription></Group><Group><GroupID>108615</GroupID><GroupDescription>11.02.06 - Bipolar/Multipolar</GroupDescription></Group><Group><GroupID>108616</GroupID><GroupDescription>11.03.01 - Cups, Cemented</GroupDescription></Group><Group><GroupID>108617</GroupID><GroupDescription>11.03.02 - Shells, Uncemented</GroupDescription></Group><Group><GroupID>108618</GroupID><GroupDescription>11.03.03 - Shells, Uncemented, HA</GroupDescription></Group><Group><GroupID>108619</GroupID><GroupDescription>11.03.04 - Insert/Liner</GroupDescription></Group><Group><GroupID>108620</GroupID><GroupDescription>11.03.05 - Bonded Shell/Liner</GroupDescription></Group><Group><GroupID>108622</GroupID><GroupDescription>11.03.07 - Resurfacing Cup</GroupDescription></Group><Group><GroupID>108623</GroupID><GroupDescription>11.03.08 - Acetabular Reconstruction Devices</GroupDescription></Group><Group><GroupID>108624</GroupID><GroupDescription>11.04.01 - Augment</GroupDescription></Group><Group><GroupID>108625</GroupID><GroupDescription>11.04.02 - Bolt</GroupDescription></Group><Group><GroupID>108626</GroupID><GroupDescription>11.04.03 - Bone Screw</GroupDescription></Group><Group><GroupID>108627</GroupID><GroupDescription>11.04.04 - Calcar Block</GroupDescription></Group><Group><GroupID>108628</GroupID><GroupDescription>11.04.05 - Cement Restrictor</GroupDescription></Group><Group><GroupID>108629</GroupID><GroupDescription>11.04.06 - Centraliser</GroupDescription></Group><Group><GroupID>108630</GroupID><GroupDescription>11.04.07 - Claw</GroupDescription></Group><Group><GroupID>108631</GroupID><GroupDescription>11.04.08 - Connector</GroupDescription></Group><Group><GroupID>108632</GroupID><GroupDescription>11.04.09 - Dome Plug</GroupDescription></Group><Group><GroupID>108633</GroupID><GroupDescription>11.04.10 - Head Taper Insert</GroupDescription></Group><Group><GroupID>108634</GroupID><GroupDescription>11.04.11 - Neck Adapter</GroupDescription></Group><Group><GroupID>108635</GroupID><GroupDescription>11.04.12 - Nut</GroupDescription></Group><Group><GroupID>108636</GroupID><GroupDescription>11.04.13 - Pin</GroupDescription></Group><Group><GroupID>108637</GroupID><GroupDescription>11.04.14 - Plug - Including Dome Plug</GroupDescription></Group><Group><GroupID>108638</GroupID><GroupDescription>11.04.15 - Plug and Hood</GroupDescription></Group><Group><GroupID>108640</GroupID><GroupDescription>11.04.17 - Ring</GroupDescription></Group><Group><GroupID>108641</GroupID><GroupDescription>11.04.18 - Screw</GroupDescription></Group><Group><GroupID>108642</GroupID><GroupDescription>11.04.19 - Sleeve</GroupDescription></Group><Group><GroupID>108643</GroupID><GroupDescription>11.04.20 - Spacer- Unique</GroupDescription></Group><Group><GroupID>108645</GroupID><GroupDescription>11.04.22 - Trochanter Plate</GroupDescription></Group><Group><GroupID>108647</GroupID><GroupDescription>11.04.24 - Washer</GroupDescription></Group><Group><GroupID>108648</GroupID><GroupDescription>11.04.25 - Wire - Cobalt Chrome</GroupDescription></Group><Group><GroupID>108649</GroupID><GroupDescription>11.04.26 - Wire - Stainless Steel</GroupDescription></Group><Group><GroupID>108650</GroupID><GroupDescription>11.04.27 - Insert Orientation Spacer Ring</GroupDescription></Group><Group><GroupID>108651</GroupID><GroupDescription>11.04.28 - Acetabular Stem or equivalent</GroupDescription></Group><Group><GroupID>108652</GroupID><GroupDescription>12.01.01 - Cemented, Alloy</GroupDescription></Group><Group><GroupID>108653</GroupID><GroupDescription>12.01.02 - Cemented, Alloy, PMMA Coating</GroupDescription></Group><Group><GroupID>108654</GroupID><GroupDescription>12.01.03 - Cemented, Non-Alloy</GroupDescription></Group><Group><GroupID>108655</GroupID><GroupDescription>12.01.04 - Uncemented, Alloy</GroupDescription></Group><Group><GroupID>108656</GroupID><GroupDescription>12.01.05 - Uncemented, Alloy, HA Coating</GroupDescription></Group><Group><GroupID>108657</GroupID><GroupDescription>12.02.01 - Cemented, Alloy</GroupDescription></Group><Group><GroupID>108658</GroupID><GroupDescription>12.02.02 - Cemented, Non-Alloy</GroupDescription></Group><Group><GroupID>108659</GroupID><GroupDescription>12.02.03 - Uncemented, Alloy</GroupDescription></Group><Group><GroupID>108660</GroupID><GroupDescription>12.03.01 - Cemented, All polyethylene</GroupDescription></Group><Group><GroupID>108661</GroupID><GroupDescription>12.03.02 - Cemented, Alloy</GroupDescription></Group><Group><GroupID>108663</GroupID><GroupDescription>12.03.04 - Cemented, Alloy, for Mobile Insert</GroupDescription></Group><Group><GroupID>108664</GroupID><GroupDescription>12.03.05 - Uncemented, Alloy</GroupDescription></Group><Group><GroupID>108666</GroupID><GroupDescription>12.03.07 - Uncemented, Alloy, for Mobile Insert</GroupDescription></Group><Group><GroupID>108667</GroupID><GroupDescription>12.04.01 - Cemented, Alloy Polyethylene</GroupDescription></Group><Group><GroupID>108668</GroupID><GroupDescription>12.04.02 - Cemented, Alloy</GroupDescription></Group><Group><GroupID>108669</GroupID><GroupDescription>12.04.03 - Cemented, Alloy, Moulded Polyethylene</GroupDescription></Group><Group><GroupID>108670</GroupID><GroupDescription>12.04.04 - Cemented, Alloy, for Mobile Insert</GroupDescription></Group><Group><GroupID>108671</GroupID><GroupDescription>12.04.05 - Uncemented, Alloy</GroupDescription></Group><Group><GroupID>108672</GroupID><GroupDescription>12.04.06 - Uncemented, Alloy, for Mobile Insert</GroupDescription></Group><Group><GroupID>108673</GroupID><GroupDescription>12.05.01 - Minimally Stabilised</GroupDescription></Group><Group><GroupID>108674</GroupID><GroupDescription>12.05.02 - Posterior Stabilised</GroupDescription></Group><Group><GroupID>108675</GroupID><GroupDescription>12.05.03 - Totally Constrained</GroupDescription></Group><Group><GroupID>108676</GroupID><GroupDescription>12.06.01 - Tibial Insert: Uni-Compartmental Arthroplasty</GroupDescription></Group><Group><GroupID>108677</GroupID><GroupDescription>12.07.01 - Alloy</GroupDescription></Group><Group><GroupID>108678</GroupID><GroupDescription>12.07.02 - Non-Alloy</GroupDescription></Group><Group><GroupID>108679</GroupID><GroupDescription>12.08.01 - Cemented, All Polyethylene</GroupDescription></Group><Group><GroupID>108681</GroupID><GroupDescription>12.08.03 - Uncemented, Polyethylene, Metal Backed</GroupDescription></Group><Group><GroupID>108684</GroupID><GroupDescription>12.09.01 - Distal Femur</GroupDescription></Group><Group><GroupID>108685</GroupID><GroupDescription>12.09.02 - Proximal Tibia</GroupDescription></Group><Group><GroupID>108686</GroupID><GroupDescription>12.09.03 - Diaphyseal Extension Piece (Femoral or Tibial)</GroupDescription></Group><Group><GroupID>108687</GroupID><GroupDescription>12.09.04 - Bone Anchorage Piece</GroupDescription></Group><Group><GroupID>108688</GroupID><GroupDescription>12.09.05 - Tibial Inserts</GroupDescription></Group><Group><GroupID>108689</GroupID><GroupDescription>12.09.06 - Augments</GroupDescription></Group><Group><GroupID>108690</GroupID><GroupDescription>12.09.07 - Stems</GroupDescription></Group><Group><GroupID>108691</GroupID><GroupDescription>12.09.08 - Couplers or adaptors, incorporating stem extenders, sleeves and other couplings</GroupDescription></Group><Group><GroupID>108694</GroupID><GroupDescription>12.11.01 - Augments</GroupDescription></Group><Group><GroupID>108695</GroupID><GroupDescription>12.11.02 - Axles for hinged prostheses</GroupDescription></Group><Group><GroupID>108696</GroupID><GroupDescription>12.11.03 - Bolts</GroupDescription></Group><Group><GroupID>108697</GroupID><GroupDescription>12.11.04 - Connectors for hinged prostheses</GroupDescription></Group><Group><GroupID>108699</GroupID><GroupDescription>12.11.06 - End caps</GroupDescription></Group><Group><GroupID>108700</GroupID><GroupDescription>12.11.07 - Offset couplers/adaptors</GroupDescription></Group><Group><GroupID>108701</GroupID><GroupDescription>12.11.08 - Pegs, lugs, etc</GroupDescription></Group><Group><GroupID>108702</GroupID><GroupDescription>12.11.09 - Screws</GroupDescription></Group><Group><GroupID>108703</GroupID><GroupDescription>12.11.10 - Stems - straight or offset</GroupDescription></Group><Group><GroupID>108704</GroupID><GroupDescription>12.11.11 - Stem Extenders, Sleeves and other couplings</GroupDescription></Group><Group><GroupID>108705</GroupID><GroupDescription>12.11.12 - Temporary Spacers</GroupDescription></Group><Group><GroupID>108552</GroupID><GroupDescription>13.01.01 - Pedicle, Monoaxial</GroupDescription></Group><Group><GroupID>108553</GroupID><GroupDescription>13.01.02 - Pedicle, Polyaxial</GroupDescription></Group><Group><GroupID>108554</GroupID><GroupDescription>13.01.03 - Standard</GroupDescription></Group><Group><GroupID>108555</GroupID><GroupDescription>13.02.01 - Nut/Set Screw/Locking Screw</GroupDescription></Group><Group><GroupID>108556</GroupID><GroupDescription>13.02.02 - Collar/Sleeve</GroupDescription></Group><Group><GroupID>108557</GroupID><GroupDescription>13.02.03 - Cap/Cover Plate</GroupDescription></Group><Group><GroupID>108558</GroupID><GroupDescription>13.02.04 - Cap/Cover Plate, Complex</GroupDescription></Group><Group><GroupID>108559</GroupID><GroupDescription>13.02.05 - Block/Screw head</GroupDescription></Group><Group><GroupID>108560</GroupID><GroupDescription>13.02.06 - Cross Link Rod</GroupDescription></Group><Group><GroupID>108561</GroupID><GroupDescription>13.02.07 - Hook/Clamp/Plate</GroupDescription></Group><Group><GroupID>108562</GroupID><GroupDescription>13.02.08 - Sublaminar Cable</GroupDescription></Group><Group><GroupID>108563</GroupID><GroupDescription>13.03.01 - In-Line</GroupDescription></Group><Group><GroupID>108564</GroupID><GroupDescription>13.03.02 - Offset</GroupDescription></Group><Group><GroupID>108565</GroupID><GroupDescription>13.03.03 - Transverse (Rod-to-Rod)</GroupDescription></Group><Group><GroupID>108566</GroupID><GroupDescription>13.04.01 - Hook</GroupDescription></Group><Group><GroupID>108567</GroupID><GroupDescription>13.05.01 - Integral Fixation</GroupDescription></Group><Group><GroupID>108568</GroupID><GroupDescription>13.05.02 - No Integral Fixation</GroupDescription></Group><Group><GroupID>108572</GroupID><GroupDescription>13.06.01 - Standard</GroupDescription></Group><Group><GroupID>108573</GroupID><GroupDescription>13.06.02 - Telescoping</GroupDescription></Group><Group><GroupID>108574</GroupID><GroupDescription>13.06.03 - Dual Unit</GroupDescription></Group><Group><GroupID>108570</GroupID><GroupDescription>13.06.05 - Rod, Percutaneous Controlled Expansion</GroupDescription></Group><Group><GroupID>108575</GroupID><GroupDescription>13.07.01 - Plate Rod</GroupDescription></Group><Group><GroupID>108576</GroupID><GroupDescription>13.08.01 - Washer</GroupDescription></Group><Group><GroupID>108577</GroupID><GroupDescription>13.08.02 - Staple</GroupDescription></Group><Group><GroupID>108578</GroupID><GroupDescription>13.09.01 - C-Ring</GroupDescription></Group><Group><GroupID>108579</GroupID><GroupDescription>13.10.01 - Interbody, Integral Fixation</GroupDescription></Group><Group><GroupID>108580</GroupID><GroupDescription>13.10.02 - Interbody, No Integral Fixation</GroupDescription></Group><Group><GroupID>108581</GroupID><GroupDescription>13.10.03 - Facet Joint</GroupDescription></Group><Group><GroupID>108582</GroupID><GroupDescription>13.11.01 - System</GroupDescription></Group><Group><GroupID>108583</GroupID><GroupDescription>13.11.02 - End Plate</GroupDescription></Group><Group><GroupID>108584</GroupID><GroupDescription>13.11.03 - Core</GroupDescription></Group><Group><GroupID>108586</GroupID><GroupDescription>13.12.01 - Telescoping Cage</GroupDescription></Group><Group><GroupID>108587</GroupID><GroupDescription>13.12.02 - Stackable Cage</GroupDescription></Group><Group><GroupID>108588</GroupID><GroupDescription>13.12.03 - Mesh</GroupDescription></Group><Group><GroupID>108589</GroupID><GroupDescription>13.12.04 - Mesh, End Plate</GroupDescription></Group><Group><GroupID>108591</GroupID><GroupDescription>13.12.05 - Non Stackable Cage, other</GroupDescription></Group><Group><GroupID>108592</GroupID><GroupDescription>13.13.01 - Interspinous Fixation Device</GroupDescription></Group><Group><GroupID>108593</GroupID><GroupDescription>13.14.01 - Sacroiliac Joint Fixation Device</GroupDescription></Group><Group><GroupID>108594</GroupID><GroupDescription>13.15.01 - Annular closure/reconstruction device</GroupDescription></Group></Groups><SubGroups><SubGroup><SubGroupID>109704</SubGroupID><SubGroupDescription>01.01.01.01 - Rigid</SubGroupDescription></SubGroup><SubGroup><SubGroupID>109705</SubGroupID><SubGroupDescription>01.01.02.01 - Rigid</SubGroupDescription></SubGroup><SubGroup><SubGroupID>109706</SubGroupID><SubGroupDescription>01.01.02.02 - Foldable</SubGroupDescription></SubGroup><SubGroup><SubGroupID>109707</SubGroupID><SubGroupDescription>01.02.02.01 - Microincision</SubGroupDescription></SubGroup><SubGroup><SubGroupID>109709</SubGroupID><SubGroupDescription>01.02.02.03 - Edge modification</SubGroupDescription></SubGroup><SubGroup><SubGroupID>109710</SubGroupID><SubGroupDescription>01.02.02.04 - Presbyopia correcting</SubGroupDescription></SubGroup><SubGroup><SubGroupID>109712</SubGroupID><SubGroupDescription>01.02.03.01 - Monofocal</SubGroupDescription></SubGroup><SubGroup><SubGroupID>109713</SubGroupID><SubGroupDescription>01.02.03.02 - Multi-focal</SubGroupDescription></SubGroup><SubGroup><SubGroupID>109714</SubGroupID><SubGroupDescription>01.03.01.01 - Dual Fluids</SubGroupDescription></SubGroup><SubGroup><SubGroupID>109715</SubGroupID><SubGroupDescription>01.05.02.01 - Cannulated</SubGroupDescription></SubGroup><SubGroup><SubGroupID>109716</SubGroupID><SubGroupDescription>01.05.02.02 - Non-Cannulated</SubGroupDescription></SubGroup><SubGroup><SubGroupID>109717</SubGroupID><SubGroupDescription>01.05.03.01 - at Schlemm's canal</SubGroupDescription></SubGroup><SubGroup><SubGroupID>109718</SubGroupID><SubGroupDescription>01.05.03.02 - external to Schlemm's canal</SubGroupDescription></SubGroup><SubGroup><SubGroupID>109720</SubGroupID><SubGroupDescription>01.06.02.01 - Gold &lt;1.8 grams</SubGroupDescription></SubGroup><SubGroup><SubGroupID>109721</SubGroupID><SubGroupDescription>01.06.02.02 - Gold ≥1.8 grams</SubGroupDescription></SubGroup><SubGroup><SubGroupID>109722</SubGroupID><SubGroupDescription>01.06.02.03 - Platinum</SubGroupDescription></SubGroup><SubGroup><SubGroupID>36869</SubGroupID><SubGroupDescription>01.08.02.01 - Complex and permeable</SubGroupDescription></SubGroup><SubGroup><SubGroupID>109723</SubGroupID><SubGroupDescription>01.08.02.01 - Complex and permeable</SubGroupDescription></SubGroup><SubGroup><SubGroupID>109725</SubGroupID><SubGroupDescription>01.09.01.01 - Sponges</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112874</SubGroupID><SubGroupDescription>02.01.02.01 - Initial</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112875</SubGroupID><SubGroupDescription>02.01.02.02 - Replacement</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112870</SubGroupID><SubGroupDescription>02.01.04.01 - Sound Processor</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112871</SubGroupID><SubGroupDescription>02.01.04.02 - Osseointegration</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112872</SubGroupID><SubGroupDescription>02.01.04.03 - Cover Screw</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112866</SubGroupID><SubGroupDescription>02.01.05.01 - Stapes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112867</SubGroupID><SubGroupDescription>02.01.05.02 - Malleus</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112868</SubGroupID><SubGroupDescription>02.01.05.03 - Partial Ossicle Replacement (one or two)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112869</SubGroupID><SubGroupDescription>02.01.05.04 - Total Ossicle Replacement (three)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112864</SubGroupID><SubGroupDescription>02.01.05.05 - Active Middle Ear Implants</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112862</SubGroupID><SubGroupDescription>02.01.08.01 - Xenografts, Small (≤10cm2)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112863</SubGroupID><SubGroupDescription>02.01.08.02 - Xenografts, Medium (&gt;10cm2 to 50cm2)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112713</SubGroupID><SubGroupDescription>03.01.02.01 - Standard Dose</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112714</SubGroupID><SubGroupDescription>03.01.02.02 - Single Seed or Partial Dose</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112712</SubGroupID><SubGroupDescription>03.01.03.01 - Gel 3ml</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112711</SubGroupID><SubGroupDescription>03.01.03.02 - Gel 10mL or Balloon</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112715</SubGroupID><SubGroupDescription>03.02.01.01 - Single Lumen</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112716</SubGroupID><SubGroupDescription>03.02.01.02 - Multiple Lumen</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112717</SubGroupID><SubGroupDescription>03.02.02.01 - Fixed Flow Rate</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112718</SubGroupID><SubGroupDescription>03.02.02.02 - Variable Flow Rate</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112720</SubGroupID><SubGroupDescription>03.02.03.02 - Insulin infusion pump (as 3.2.3.1) with integral calculator to determine boluses and active insulin</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112723</SubGroupID><SubGroupDescription>03.02.03.03 - Device has capability to automatically adjust the insulin delivery based on continuous glucose monitoring data</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112721</SubGroupID><SubGroupDescription>03.02.03.04 - Other Pharmacology</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112722</SubGroupID><SubGroupDescription>03.02.03.05 - Programmable/Reprogrammable Flow Rate and Bolus</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112724</SubGroupID><SubGroupDescription>03.02.03.06 - Insulin Infusion Pump - accessories subsequent annual supply</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112725</SubGroupID><SubGroupDescription>03.02.04.01 - Fixed Flow Rate</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112727</SubGroupID><SubGroupDescription>03.02.05.01 - Kit</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112728</SubGroupID><SubGroupDescription>03.02.05.02 - Administration Cassette</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112729</SubGroupID><SubGroupDescription>03.02.05.03 - Administration Reservoir</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112730</SubGroupID><SubGroupDescription>03.02.05.04 - Administration Set</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112731</SubGroupID><SubGroupDescription>03.02.05.05 - Other</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112732</SubGroupID><SubGroupDescription>03.02.06.01 - Single Units</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112734</SubGroupID><SubGroupDescription>03.03.02.01 - Initial</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112735</SubGroupID><SubGroupDescription>03.03.02.02 - Subsequent</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112736</SubGroupID><SubGroupDescription>03.03.02.03 - Placement set</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112753</SubGroupID><SubGroupDescription>03.05.02.01 - Integrated Delivery System</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112754</SubGroupID><SubGroupDescription>03.05.02.02 - Delivery Catheter</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112755</SubGroupID><SubGroupDescription>03.05.03.01 - Absorbable ≤75cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112756</SubGroupID><SubGroupDescription>03.05.03.02 - Absorbable &gt;75cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112759</SubGroupID><SubGroupDescription>03.05.04.01 - Absorbable ≤50cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112760</SubGroupID><SubGroupDescription>03.05.04.02 - Absorbable 51 cm² – 75cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112761</SubGroupID><SubGroupDescription>03.05.04.03 - Absorbable &gt;75cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112762</SubGroupID><SubGroupDescription>03.05.05.01 - Liquid ≤6ml</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112763</SubGroupID><SubGroupDescription>03.05.05.02 - Liquid &gt;6ml</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112764</SubGroupID><SubGroupDescription>03.05.05.03 - Non-liquid ≤50cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112765</SubGroupID><SubGroupDescription>03.05.05.04 - Non-liquid &gt;50cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112766</SubGroupID><SubGroupDescription>03.05.05.05 - Accessory Extender</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112767</SubGroupID><SubGroupDescription>03.05.05.06 - Powder &gt;6ml</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112768</SubGroupID><SubGroupDescription>03.06.01.01 - Non-reinforced Wall</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112769</SubGroupID><SubGroupDescription>03.06.01.02 - Reinforced Wall, Uncovered/Bare Metal</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112770</SubGroupID><SubGroupDescription>03.06.01.03 - Reinforced Wall, Covered</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112772</SubGroupID><SubGroupDescription>03.06.03.02 - Reinforced Wall, Uncovered/Bare Metal</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112773</SubGroupID><SubGroupDescription>03.06.03.03 - Reinforced Wall, Covered</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112774</SubGroupID><SubGroupDescription>03.06.03.04 - Biodegradable</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112775</SubGroupID><SubGroupDescription>03.06.04.01 - Self-expanding metal, Covered</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112777</SubGroupID><SubGroupDescription>03.07.01.01 - Pleural</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112778</SubGroupID><SubGroupDescription>03.07.01.02 - Intraperitoneal</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112779</SubGroupID><SubGroupDescription>03.07.01.03 - Biliary</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112780</SubGroupID><SubGroupDescription>03.07.01.04 - Para/Thoraceulesis</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112781</SubGroupID><SubGroupDescription>03.07.01.05 - Percutaneous</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112776</SubGroupID><SubGroupDescription>03.07.01.06 - Anal Fistula</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112809</SubGroupID><SubGroupDescription>03.08.01.01 - Sheet ≤100cm2</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112810</SubGroupID><SubGroupDescription>03.08.01.02 - Sheet &gt;100cm2</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112814</SubGroupID><SubGroupDescription>03.08.01.03 - Spray</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112811</SubGroupID><SubGroupDescription>03.08.01.04 - Gel/Liquid</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112815</SubGroupID><SubGroupDescription>03.08.02.01 - Adhesive ≤2ml</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112816</SubGroupID><SubGroupDescription>03.08.02.02 - Adhesive &gt;2-5ml</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112817</SubGroupID><SubGroupDescription>03.08.02.03 - Adhesive &gt;5ml</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112818</SubGroupID><SubGroupDescription>03.08.02.04 - Adhesive Accessory</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112819</SubGroupID><SubGroupDescription>03.08.02.05 - Adhesive Peristrips</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112820</SubGroupID><SubGroupDescription>03.08.02.06 - Pleurodesis Powder</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112822</SubGroupID><SubGroupDescription>03.08.02.07 - Sponge ≤10cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112823</SubGroupID><SubGroupDescription>03.08.02.08 - Sponge 10-40cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112824</SubGroupID><SubGroupDescription>03.08.02.09 - Sponge &gt;40cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112821</SubGroupID><SubGroupDescription>03.08.02.12 - Pleural Sealant</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112832</SubGroupID><SubGroupDescription>03.08.03.01 - Clips</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112833</SubGroupID><SubGroupDescription>03.08.03.02 - Clip Applier</SubGroupDescription></SubGroup><SubGroup><SubGroupID>38179</SubGroupID><SubGroupDescription>03.08.03.03 - Clips with Disposable Applier</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112834</SubGroupID><SubGroupDescription>03.08.03.03 - Clips with Disposable Applier</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112835</SubGroupID><SubGroupDescription>03.08.03.04 - Clip Reload Cartridge</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112836</SubGroupID><SubGroupDescription>03.08.03.05 - Sutures</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112827</SubGroupID><SubGroupDescription>03.08.03.06 - Ligating Bands with Disposable Applier</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112829</SubGroupID><SubGroupDescription>03.08.03.07 - Cinched suture applier</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112831</SubGroupID><SubGroupDescription>03.08.03.08 - Suture with cinch</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112828</SubGroupID><SubGroupDescription>03.08.03.10 - Laparoscopic Suturing Device</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112838</SubGroupID><SubGroupDescription>03.08.04.01 - Staples, Non-bone (Reload)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112839</SubGroupID><SubGroupDescription>03.08.04.02 - Staplers</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112840</SubGroupID><SubGroupDescription>03.08.04.03 - Staples, Reinforcer</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112841</SubGroupID><SubGroupDescription>03.08.04.04 - Staples, Non-bone with Disposable Applier</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112837</SubGroupID><SubGroupDescription>03.08.04.05 - Tackers</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112844</SubGroupID><SubGroupDescription>03.08.04.06 - Suture Fasteners</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112842</SubGroupID><SubGroupDescription>03.08.04.07 - Tacks, Reload</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112843</SubGroupID><SubGroupDescription>03.08.04.08 - Adhesive Tackers</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112790</SubGroupID><SubGroupDescription>03.08.05.01 - ≤200cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112791</SubGroupID><SubGroupDescription>03.08.05.02 - 201-400cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112793</SubGroupID><SubGroupDescription>03.08.05.04 - &gt;600-&lt;2500cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112789</SubGroupID><SubGroupDescription>03.08.05.05 - ≥2500cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112794</SubGroupID><SubGroupDescription>03.08.06.01 - ≤200cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112795</SubGroupID><SubGroupDescription>03.08.06.02 - 201-400cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112796</SubGroupID><SubGroupDescription>03.08.06.03 - 401-600cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112798</SubGroupID><SubGroupDescription>03.08.06.04 - 601cm²-1000cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112799</SubGroupID><SubGroupDescription>03.08.06.05 - &gt;1000cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112782</SubGroupID><SubGroupDescription>03.08.07.01 - ≤200cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112783</SubGroupID><SubGroupDescription>03.08.07.02 - 201-400cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112784</SubGroupID><SubGroupDescription>03.08.07.03 - 401-600cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112785</SubGroupID><SubGroupDescription>03.08.07.04 - 601-800cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112786</SubGroupID><SubGroupDescription>03.08.07.05 - &gt;800cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112808</SubGroupID><SubGroupDescription>03.08.09.01 - Fistula Closure</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112787</SubGroupID><SubGroupDescription>03.08.11.01 - Closure Set</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112788</SubGroupID><SubGroupDescription>03.08.11.02 - Extension Kit</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113070</SubGroupID><SubGroupDescription>04.03.01.01 - Valve, Externally Adjustable</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113071</SubGroupID><SubGroupDescription>04.03.01.02 - Valve, Non-externally adjustable</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113072</SubGroupID><SubGroupDescription>04.03.01.03 - Valve and gravitational unit, externally adjustable</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113073</SubGroupID><SubGroupDescription>04.03.06.01 - Connector</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113074</SubGroupID><SubGroupDescription>04.03.06.02 - Right Angled Guide</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113075</SubGroupID><SubGroupDescription>04.04.01.01 - Primary Cell Pulse Generator (non-rechargeable)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113076</SubGroupID><SubGroupDescription>04.04.01.02 - Rechargeable Pulse Generator</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113077</SubGroupID><SubGroupDescription>04.04.02.01 - Patient Programmer</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113078</SubGroupID><SubGroupDescription>04.04.02.02 - Recharger</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113079</SubGroupID><SubGroupDescription>04.04.03.01 - Permanent Lead</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113080</SubGroupID><SubGroupDescription>04.04.03.02 - Lead Extension</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113085</SubGroupID><SubGroupDescription>04.04.05.01 - Burr Hole Cover</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113086</SubGroupID><SubGroupDescription>04.04.05.02 - Connectors and cables</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113084</SubGroupID><SubGroupDescription>04.04.05.03 - Intraoperative accessories</SubGroupDescription></SubGroup><SubGroup><SubGroupID>38453</SubGroupID><SubGroupDescription>04.05.01.01 - Primary Cell Pulse Generator (non-rechargeable)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113087</SubGroupID><SubGroupDescription>04.05.01.01 - Primary Cell Pulse Generator (non-rechargeable)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>38454</SubGroupID><SubGroupDescription>04.05.01.02 - Rechargeable Pulse Generator</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113088</SubGroupID><SubGroupDescription>04.05.01.02 - Rechargeable Pulse Generator</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113090</SubGroupID><SubGroupDescription>04.05.02.01 - Patient Programmer</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113091</SubGroupID><SubGroupDescription>04.05.02.02 - Patient Programmer Antenna</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113092</SubGroupID><SubGroupDescription>04.05.02.03 - On/Off switching device</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113093</SubGroupID><SubGroupDescription>04.05.02.04 - Recharger</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113094</SubGroupID><SubGroupDescription>04.05.02.05 - External Neurostimulator</SubGroupDescription></SubGroup><SubGroup><SubGroupID>38585</SubGroupID><SubGroupDescription>04.05.03.01 - Permanent Lead</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113096</SubGroupID><SubGroupDescription>04.05.03.01 - Permanent Lead</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113097</SubGroupID><SubGroupDescription>04.05.03.02 - Trial Lead</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113099</SubGroupID><SubGroupDescription>04.05.05.01 - Revision Kits</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113100</SubGroupID><SubGroupDescription>04.05.05.02 - Plug</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113101</SubGroupID><SubGroupDescription>04.05.05.03 - Intraoperative Accessories</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113102</SubGroupID><SubGroupDescription>04.05.05.04 - Lead Delivery System</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113098</SubGroupID><SubGroupDescription>04.05.05.05 - Connectors and Cables</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113104</SubGroupID><SubGroupDescription>04.06.03.02 - Two piece</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113105</SubGroupID><SubGroupDescription>04.06.04.01 - Revision Kit</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113106</SubGroupID><SubGroupDescription>04.06.04.02 - Refill/Catheter Access Kits</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113108</SubGroupID><SubGroupDescription>04.07.01.01 - Implantable pulse generator</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113107</SubGroupID><SubGroupDescription>04.07.01.02 - Lead</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113112</SubGroupID><SubGroupDescription>04.08.03.02 - Coil detachment device</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113113</SubGroupID><SubGroupDescription>04.08.03.04 - Vascular embolisation balloon</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113118</SubGroupID><SubGroupDescription>05.01.01.01 - Pump</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113119</SubGroupID><SubGroupDescription>05.01.01.02 - Occlusive cuff</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113120</SubGroupID><SubGroupDescription>05.01.01.03 - Regulating Balloon</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113122</SubGroupID><SubGroupDescription>05.01.01.05 - Accessory kit</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113123</SubGroupID><SubGroupDescription>05.01.01.06 - System</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113115</SubGroupID><SubGroupDescription>05.01.02.01 - Single</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113116</SubGroupID><SubGroupDescription>05.01.02.02 - Double</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113117</SubGroupID><SubGroupDescription>05.01.02.03 - Port</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113126</SubGroupID><SubGroupDescription>05.01.03.01 - Male</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113127</SubGroupID><SubGroupDescription>05.01.03.02 - Female</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113130</SubGroupID><SubGroupDescription>05.01.04.03 - 2 ml</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113131</SubGroupID><SubGroupDescription>05.01.04.04 - 2.5 ml</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113133</SubGroupID><SubGroupDescription>05.02.01.01 - Polyurethane</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113134</SubGroupID><SubGroupDescription>05.02.01.02 - Other synthetic</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113135</SubGroupID><SubGroupDescription>05.02.01.03 - Metal</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113136</SubGroupID><SubGroupDescription>05.02.02.01 - Polyurethane</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113137</SubGroupID><SubGroupDescription>05.02.02.02 - Other synthetic</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113162</SubGroupID><SubGroupDescription>05.03.01.01 - Metal</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113163</SubGroupID><SubGroupDescription>05.03.01.02 - Paediatric</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113142</SubGroupID><SubGroupDescription>05.05.03.01 - Cylinder</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113143</SubGroupID><SubGroupDescription>05.05.03.02 - Reservoir</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113144</SubGroupID><SubGroupDescription>05.05.03.03 - Pump</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113145</SubGroupID><SubGroupDescription>05.05.03.04 - Deactivation set</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113146</SubGroupID><SubGroupDescription>05.05.03.05 - Accessory kit</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113147</SubGroupID><SubGroupDescription>05.05.03.06 - Pump and cylinder</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113149</SubGroupID><SubGroupDescription>05.07.01.01 - Extended Battery Life</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113150</SubGroupID><SubGroupDescription>05.07.02.01 - Programmer</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113152</SubGroupID><SubGroupDescription>05.07.02.02 - External Neurostimulator</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113151</SubGroupID><SubGroupDescription>05.07.02.03 - Recharger</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113154</SubGroupID><SubGroupDescription>05.07.03.01 - Permanent</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113155</SubGroupID><SubGroupDescription>05.07.03.02 - Trial</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113156</SubGroupID><SubGroupDescription>05.07.03.03 - Extension</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113153</SubGroupID><SubGroupDescription>05.07.03.04 - Trial kit including leads</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113157</SubGroupID><SubGroupDescription>05.07.04.01 - Implant/Revision Kits</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113158</SubGroupID><SubGroupDescription>05.07.04.02 - Foramen Needle</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113159</SubGroupID><SubGroupDescription>05.07.04.03 - Connectors and Cables</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113160</SubGroupID><SubGroupDescription>05.08.01.01 - Clip</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113161</SubGroupID><SubGroupDescription>05.08.01.02 - Band</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112314</SubGroupID><SubGroupDescription>06.01.01.01 - Liner - fixed bearing</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112315</SubGroupID><SubGroupDescription>06.01.01.02 - Liner - mobile bearing</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112299</SubGroupID><SubGroupDescription>06.01.02.01 - Metal</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112287</SubGroupID><SubGroupDescription>06.01.03.01 - Talar component</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112288</SubGroupID><SubGroupDescription>06.01.03.02 - Tibial component</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112289</SubGroupID><SubGroupDescription>06.01.03.03 - Tibial component, cemented/uncemented, fixed bearing</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112290</SubGroupID><SubGroupDescription>06.01.03.04 - Stem extension</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112294</SubGroupID><SubGroupDescription>06.01.04.04 - Great toe, resurfacing hemi articulation, metatarsal</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112295</SubGroupID><SubGroupDescription>06.01.04.05 - Great toe, resurfacing hemi articulation, phalangeal</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112296</SubGroupID><SubGroupDescription>06.01.04.06 - Great toe, non articulating articulation (for silastic implant replacement)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112327</SubGroupID><SubGroupDescription>06.02.01.01 - Carpal component</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112328</SubGroupID><SubGroupDescription>06.02.01.02 - Radial component</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112329</SubGroupID><SubGroupDescription>06.02.01.03 - Carpal spacer</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112330</SubGroupID><SubGroupDescription>06.02.01.04 - Distal ulnar stem</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112331</SubGroupID><SubGroupDescription>06.02.01.05 - Distal ulnar head</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112333</SubGroupID><SubGroupDescription>06.02.01.06 - Tendon Spacer</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112332</SubGroupID><SubGroupDescription>06.02.01.07 - Distal Radio-Ulnar Plate</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112339</SubGroupID><SubGroupDescription>06.02.02.05 - Thumb, carpometacarpal - proximal component</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112341</SubGroupID><SubGroupDescription>06.02.02.06 - Thumb, carpometacarpal - distal component</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112343</SubGroupID><SubGroupDescription>06.02.02.09 - Finger, metacarpophalangeal - proximal component</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112344</SubGroupID><SubGroupDescription>06.02.02.10 - Finger, metacarpophalangeal - distal component</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112345</SubGroupID><SubGroupDescription>06.02.02.11 - Finger, interphalangeal - proximal component</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112346</SubGroupID><SubGroupDescription>06.02.02.12 - Finger, interphalangeal - distal component</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112347</SubGroupID><SubGroupDescription>06.02.02.13 - Interpositional Devices</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112348</SubGroupID><SubGroupDescription>06.02.03.01 - Distal humeral component/s</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112349</SubGroupID><SubGroupDescription>06.02.03.02 - Proximal radial stem</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112350</SubGroupID><SubGroupDescription>06.02.03.03 - Proximal radial head/neck</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112351</SubGroupID><SubGroupDescription>06.02.03.04 - Proximal ulnar component</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112353</SubGroupID><SubGroupDescription>06.02.03.06 - Elbow pin</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112356</SubGroupID><SubGroupDescription>06.02.03.07 - Accessories - bushing / insert / spool</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112357</SubGroupID><SubGroupDescription>06.02.03.08 - Accessories - circlips</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112359</SubGroupID><SubGroupDescription>06.02.03.10 - Accessories - cement restrictor</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112362</SubGroupID><SubGroupDescription>06.02.04.02 - Humeral component - cemented</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112363</SubGroupID><SubGroupDescription>06.02.04.03 - Humeral component - uncemented </SubGroupDescription></SubGroup><SubGroup><SubGroupID>112364</SubGroupID><SubGroupDescription>06.02.04.04 - Modular humeral component - metaphyseal, cemented</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112365</SubGroupID><SubGroupDescription>06.02.04.05 - Modular humeral component - metaphyseal, uncemented</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112367</SubGroupID><SubGroupDescription>06.02.04.07 - Modular humeral component - diaphyseal, uncemented, long (&gt;220mm)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112368</SubGroupID><SubGroupDescription>06.02.04.08 - Modular Humeral component - diaphyseal, cemented, short (≤220mm)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112369</SubGroupID><SubGroupDescription>06.02.04.09 - Modular Humeral component - diaphyseal, uncemented, short (≤220mm)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112372</SubGroupID><SubGroupDescription>06.02.04.12 - Standard humeral head</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112373</SubGroupID><SubGroupDescription>06.02.04.13 - Resurfacing humeral head </SubGroupDescription></SubGroup><SubGroup><SubGroupID>112374</SubGroupID><SubGroupDescription>06.02.04.14 - Humeral cup</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112378</SubGroupID><SubGroupDescription>06.02.04.18 - Special purpose/tumour prosthesis - tumour section</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112381</SubGroupID><SubGroupDescription>06.02.04.21 - Necks/collar (modular)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112402</SubGroupID><SubGroupDescription>06.02.05.01 - Glenoid component, All poly</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112403</SubGroupID><SubGroupDescription>06.02.05.02 - Glenoid component, Metal backed</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112404</SubGroupID><SubGroupDescription>06.02.05.03 - Glenoid component &amp; insert</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112405</SubGroupID><SubGroupDescription>06.02.05.04 - Glenoid insert</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112409</SubGroupID><SubGroupDescription>06.02.05.05 - Reverse glenoid component, Base plate, uncemented</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112410</SubGroupID><SubGroupDescription>06.02.05.06 - Glenosphere</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112413</SubGroupID><SubGroupDescription>06.02.06.01 - Humeral sleeve</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112414</SubGroupID><SubGroupDescription>06.02.06.02 - Humeral spacer</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112416</SubGroupID><SubGroupDescription>06.02.06.04 - Taper assembly</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112417</SubGroupID><SubGroupDescription>06.02.06.05 - Eccentrical adaptor</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112412</SubGroupID><SubGroupDescription>06.02.06.06 - Definition screw / Locking Screw</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112419</SubGroupID><SubGroupDescription>06.02.06.07 - Reverse humeral tray</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112420</SubGroupID><SubGroupDescription>06.02.06.08 - Spacer</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112057</SubGroupID><SubGroupDescription>06.03.01.01 - Femoral, Proximal short (&lt;220mm)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112058</SubGroupID><SubGroupDescription>06.03.01.02 - Femoral, Proximal long (≥220mm)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112059</SubGroupID><SubGroupDescription>06.03.01.03 - Femoral, Distal</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112060</SubGroupID><SubGroupDescription>06.03.01.04 - Tibial/Fibular</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112061</SubGroupID><SubGroupDescription>06.03.01.05 - Humeral</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112062</SubGroupID><SubGroupDescription>06.03.01.06 - Arthrodesis knee</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112063</SubGroupID><SubGroupDescription>06.03.01.07 - Arthrodesis ankle</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112071</SubGroupID><SubGroupDescription>06.03.01.08 - Flexible/paediatric</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112072</SubGroupID><SubGroupDescription>06.03.01.09 - Radial/Ulnar</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112073</SubGroupID><SubGroupDescription>06.03.01.10 - Dynamic distraction - electronic</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112069</SubGroupID><SubGroupDescription>06.03.01.11 - Arthrodesis Other</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112079</SubGroupID><SubGroupDescription>06.03.01.13 - Arthrodesis</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112070</SubGroupID><SubGroupDescription>06.03.01.14 - Calcaneal</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112089</SubGroupID><SubGroupDescription>06.03.02.01 - Intramedullary nail lag screw</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112080</SubGroupID><SubGroupDescription>06.03.02.02 - Reconstruction screw</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112081</SubGroupID><SubGroupDescription>06.03.02.03 - Set screw/Locking bolt</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112087</SubGroupID><SubGroupDescription>06.03.02.04 - End caps and extension caps</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111933</SubGroupID><SubGroupDescription>06.03.03.01 - Standard (screw size ≥4.5mm)(including blade) ≤ 6 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111934</SubGroupID><SubGroupDescription>06.03.03.02 - Standard (screw size ≥4.5mm)(including blade) ≥ 7 to ≤ 15 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111935</SubGroupID><SubGroupDescription>06.03.03.03 - Standard (screw size ≥4.5mm)(including blade) ≥ 16 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111936</SubGroupID><SubGroupDescription>06.03.03.04 - Small (screw size 2.71mm – 4.49mm)(including blade) ≤ 6 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111937</SubGroupID><SubGroupDescription>06.03.03.05 - Small (screw size 2.71mm – 4.49mm)(including blade) ≥ 7 to ≤ 15 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111938</SubGroupID><SubGroupDescription>06.03.03.06 - Small (screw size 2.71mm – 4.49mm)(including blade) ≥ 16 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111939</SubGroupID><SubGroupDescription>06.03.03.07 - Mini (screw size ≤2.7mm)(including blade) ≤ 6 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111940</SubGroupID><SubGroupDescription>06.03.03.08 - Mini (screw size ≤2.7mm)(including blade) ≥ 7 to ≤ 15 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111941</SubGroupID><SubGroupDescription>06.03.03.09 - Mini (screw size ≤2.7mm)(including blade) ≥ 16 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111942</SubGroupID><SubGroupDescription>06.03.03.10 - Dynamic - Hip ≤ 6 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111943</SubGroupID><SubGroupDescription>06.03.03.11 - Dynamic - Hip ≥ 7 to ≤ 15 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111944</SubGroupID><SubGroupDescription>06.03.03.12 - Dynamic - Hip ≥ 16 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111945</SubGroupID><SubGroupDescription>06.03.03.13 - Dynamic - supracondylar ≤ 6 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111946</SubGroupID><SubGroupDescription>06.03.03.14 - Dynamic - supracondylar ≥ 7 to ≤ 15 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111947</SubGroupID><SubGroupDescription>06.03.03.15 - Dynamic - supracondylar ≥ 16 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111948</SubGroupID><SubGroupDescription>06.03.03.16 - Periarticular anatomic - Clavicle plate ≤ 6 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111949</SubGroupID><SubGroupDescription>06.03.03.17 - Periarticular anatomic - Clavicle plate ≥ 7 to ≤ 15 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111950</SubGroupID><SubGroupDescription>06.03.03.18 - Periarticular anatomic - Clavicle plate ≥ 16 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111951</SubGroupID><SubGroupDescription>06.03.03.19 - Periarticular anatomic - Humerus ≤ 6 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111952</SubGroupID><SubGroupDescription>06.03.03.20 - Periarticular anatomic - Humerus ≥ 7 to ≤ 15 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111953</SubGroupID><SubGroupDescription>06.03.03.21 - Periarticular anatomic - Humerus ≥ 16 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111954</SubGroupID><SubGroupDescription>06.03.03.22 - Periarticular anatomic - Radius ≤ 6 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111955</SubGroupID><SubGroupDescription>06.03.03.23 - Periarticular anatomic - Radius ≥ 7 to ≤ 15 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111956</SubGroupID><SubGroupDescription>06.03.03.24 - Periarticular anatomic - Radius ≥ 16 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111957</SubGroupID><SubGroupDescription>06.03.03.25 - Periarticular anatomic - Ulna ≤ 6 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111958</SubGroupID><SubGroupDescription>06.03.03.26 - Periarticular anatomic - Ulna ≥ 7 to ≤ 15 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111959</SubGroupID><SubGroupDescription>06.03.03.27 - Periarticular anatomic - Ulna ≥ 16 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111960</SubGroupID><SubGroupDescription>06.03.03.28 - Periarticular anatomic - Hand-phalangeal</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111961</SubGroupID><SubGroupDescription>06.03.03.29 - Periarticular anatomic - Pelvis ≤ 6 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111962</SubGroupID><SubGroupDescription>06.03.03.30 - Periarticular anatomic - Pelvis ≥ 7 to ≤ 15 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111963</SubGroupID><SubGroupDescription>06.03.03.31 - Periarticular anatomic - Pelvis ≥ 16 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111964</SubGroupID><SubGroupDescription>06.03.03.32 - Periarticular anatomic - Femur ≤ 6 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111965</SubGroupID><SubGroupDescription>06.03.03.33 - Periarticular anatomic - Femur ≥ 7 to ≤ 15 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111966</SubGroupID><SubGroupDescription>06.03.03.34 - Periarticular anatomic - Femur ≥ 16 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111967</SubGroupID><SubGroupDescription>06.03.03.35 - Periarticular anatomic - Fibula ≤ 6 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111968</SubGroupID><SubGroupDescription>06.03.03.36 - Periarticular anatomic - Fibula ≥ 7 to ≤ 15 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111969</SubGroupID><SubGroupDescription>06.03.03.37 - Periarticular anatomic - Fibula ≥ 16 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111970</SubGroupID><SubGroupDescription>06.03.03.38 - Periarticular anatomic - Tibia ≤ 6 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111971</SubGroupID><SubGroupDescription>06.03.03.39 - Periarticular anatomic - Tibia ≥ 7 to ≤ 15 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111972</SubGroupID><SubGroupDescription>06.03.03.40 - Periarticular anatomic - Tibia ≥ 16 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111973</SubGroupID><SubGroupDescription>06.03.03.41 - Periarticular anatomic - Calcaneal ≤ 6 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111974</SubGroupID><SubGroupDescription>06.03.03.42 - Periarticular anatomic - Calcaneal ≥ 7 to ≤ 15 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111975</SubGroupID><SubGroupDescription>06.03.03.43 - Periarticular anatomic - Calcaneal ≥ 16 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111976</SubGroupID><SubGroupDescription>06.03.03.44 - Periarticular anatomic - Foot</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111977</SubGroupID><SubGroupDescription>06.03.03.45 - Periarticular anatomic - Cable plate (hook/grip) ≤ 6 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111978</SubGroupID><SubGroupDescription>06.03.03.46 - Periarticular anatomic - Cable plate (hook/grip) ≥ 7 to ≤ 15 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111980</SubGroupID><SubGroupDescription>06.03.03.48 - Periarticular anatomic - Cable plate with integrated cables - 2 or less, ≤ 6 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111981</SubGroupID><SubGroupDescription>06.03.03.49 - Periarticular anatomic - Cable plate with integrated cables - &gt; 2, ≤ 6 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111931</SubGroupID><SubGroupDescription>06.03.03.50 - Cable plate with 1 or more cables, ≤ 6 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111932</SubGroupID><SubGroupDescription>06.03.03.51 - Cable plate with 1 or more cables, ≥ 7 holes to ≤ 15 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112121</SubGroupID><SubGroupDescription>06.03.04.01 - Standard ( ≥4.5mm)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112122</SubGroupID><SubGroupDescription>06.03.04.02 - Small (2.71mm – 4.49mm)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112123</SubGroupID><SubGroupDescription>06.03.04.03 - Mini (2.01 – 2.7 mm)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112124</SubGroupID><SubGroupDescription>06.03.04.04 - Micro (≤ 2.0mm)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112125</SubGroupID><SubGroupDescription>06.03.04.05 - Dynamic</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112126</SubGroupID><SubGroupDescription>06.03.04.06 - Screw Washers</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112128</SubGroupID><SubGroupDescription>06.03.04.07 - Screw post/peg</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112129</SubGroupID><SubGroupDescription>06.03.04.08 - Screw Accessories - Nuts</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112130</SubGroupID><SubGroupDescription>06.03.04.09 - Screw Accessories - Locking Nuts / Insert</SubGroupDescription></SubGroup><SubGroup><SubGroupID>38853</SubGroupID><SubGroupDescription>06.03.04.10 - Screw Accessories - Caps</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112120</SubGroupID><SubGroupDescription>06.03.04.10 - Screw Accessories - Caps</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111984</SubGroupID><SubGroupDescription>06.03.05.01 - Wires</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111985</SubGroupID><SubGroupDescription>06.03.05.02 - Pins</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111986</SubGroupID><SubGroupDescription>06.03.05.03 - Cables</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111987</SubGroupID><SubGroupDescription>06.03.05.04 - Cables - with in-built locking device</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111988</SubGroupID><SubGroupDescription>06.03.05.05 - Cables - with &gt;1 locking device</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111989</SubGroupID><SubGroupDescription>06.03.05.06 - Wire forms (including washers/screws) - all sizes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111990</SubGroupID><SubGroupDescription>06.03.05.07 - Cerclage bands</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111991</SubGroupID><SubGroupDescription>06.03.05.08 - Locking device for wires/cables</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111992</SubGroupID><SubGroupDescription>06.03.05.09 - Hook/Grip for wires/cables</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111993</SubGroupID><SubGroupDescription>06.03.05.10 - Grooved Button for wires/cables</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111994</SubGroupID><SubGroupDescription>06.03.05.11 - Wedges</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111983</SubGroupID><SubGroupDescription>06.03.05.12 - Chest Wall Reconstruction Plates</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111982</SubGroupID><SubGroupDescription>06.03.05.13 - Chest Wall Reconstruction Plate Accessories</SubGroupDescription></SubGroup><SubGroup><SubGroupID>111999</SubGroupID><SubGroupDescription>06.03.06.01 - Staples</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112000</SubGroupID><SubGroupDescription>06.03.07.01 - No suture (including arrows)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112001</SubGroupID><SubGroupDescription>06.03.07.02 - Suture, Small anchors (≤2.3mm)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112002</SubGroupID><SubGroupDescription>06.03.07.03 - Suture, Medium anchors (2.4 – 3.9mm)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112003</SubGroupID><SubGroupDescription>06.03.07.04 - Suture, Large anchors (≥4mm)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112004</SubGroupID><SubGroupDescription>06.03.07.05 - Button/thread/tape or Button/thread/button</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112005</SubGroupID><SubGroupDescription>06.03.07.06 - Button</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112006</SubGroupID><SubGroupDescription>06.03.07.07 - Interference Screw (± sleeve)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112007</SubGroupID><SubGroupDescription>06.03.07.08 - Screw/Pin/Post</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112009</SubGroupID><SubGroupDescription>06.03.08.02 - Non-biological</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112010</SubGroupID><SubGroupDescription>06.03.08.03 - Non-biological cartilage substitute</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112155</SubGroupID><SubGroupDescription>06.03.11.02 - Frame Complete - Monoplanar &amp; Modular Frames</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112156</SubGroupID><SubGroupDescription>06.03.11.03 - Frame Component - Monoplanar, Clamp</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112173</SubGroupID><SubGroupDescription>06.03.11.04 - Frame Component - Monoplanar, Body</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112157</SubGroupID><SubGroupDescription>06.03.11.05 - Frame Component - Monoplanar, Adaptor</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112158</SubGroupID><SubGroupDescription>06.03.11.06 - Frame Component - Full Circular Ring</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112159</SubGroupID><SubGroupDescription>06.03.11.07 - Frame Component - Partial Circular Ring</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112174</SubGroupID><SubGroupDescription>06.03.11.08 - Frame Component - Circular Coupling Device</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112160</SubGroupID><SubGroupDescription>06.03.11.09 - Frame Component - Circular Frame Strut Device</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112161</SubGroupID><SubGroupDescription>06.03.11.10 - Frame Component - Foot Plate</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112162</SubGroupID><SubGroupDescription>06.03.11.11 - Frame Component - Circular Frame, Nuts &amp; Spacers</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112163</SubGroupID><SubGroupDescription>06.03.11.12 - Frame Component - Coupling Device</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112164</SubGroupID><SubGroupDescription>06.03.11.13 - Frame Component - Rods</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112165</SubGroupID><SubGroupDescription>06.03.11.14 - Frame Component - Pins</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112166</SubGroupID><SubGroupDescription>06.03.11.15 - Frame Component - Pin Clamp Assembly</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112167</SubGroupID><SubGroupDescription>06.03.11.16 - Frame Component  - Pin Clamp Assembly Post</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112168</SubGroupID><SubGroupDescription>06.03.11.17 - Articulating Hinge</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112170</SubGroupID><SubGroupDescription>06.03.11.18 - Upper body kit</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112171</SubGroupID><SubGroupDescription>06.03.11.19 - Lower body kit</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112169</SubGroupID><SubGroupDescription>06.03.11.20 - Simple fixture kit - Lower body (Uniplanar)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112286</SubGroupID><SubGroupDescription>06.03.12.01 - Elbow</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112273</SubGroupID><SubGroupDescription>06.03.14.01 - Cement only</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112274</SubGroupID><SubGroupDescription>06.03.14.02 - Cement with Antibiotic</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112275</SubGroupID><SubGroupDescription>06.03.14.03 - Cement with Complex Delivery System</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112276</SubGroupID><SubGroupDescription>06.03.14.04 - Cement with Antibiotic and Complex Delivery System</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112277</SubGroupID><SubGroupDescription>06.03.14.05 - Accessories - Restrictors</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112213</SubGroupID><SubGroupDescription>06.03.15.01 - Ceramic, 0-5cc</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112214</SubGroupID><SubGroupDescription>06.03.15.02 - Ceramic, &gt;5cc - 10cc</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112215</SubGroupID><SubGroupDescription>06.03.15.03 - Ceramic, &gt;10cc - 20cc</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112216</SubGroupID><SubGroupDescription>06.03.15.04 - Ceramic, &gt;20cc</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112218</SubGroupID><SubGroupDescription>06.03.15.06 - Demineralised Bone Matrix, 2 – 5cc</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112219</SubGroupID><SubGroupDescription>06.03.15.07 - Demineralised Bone Matrix, &gt;5cc - 10cc</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112221</SubGroupID><SubGroupDescription>06.03.15.09 - Composite (Extracellular Collagen Matrix with DBM or Ceramic), 0 - 5cc</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112222</SubGroupID><SubGroupDescription>06.03.15.10 - Composite (Extracellular Collagen Matrix with DBM or Ceramic), &gt;5cc - 10cc</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112223</SubGroupID><SubGroupDescription>06.03.15.11 - Composite (Extracellular Collagen Matrix with DBM or Ceramic), &gt;10cc - 20cc</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112224</SubGroupID><SubGroupDescription>06.03.15.12 - Composite (Extracellular Collagen Matrix with DBM or Ceramic), &gt;20cc</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112011</SubGroupID><SubGroupDescription>06.03.16.01 - Metallic</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112014</SubGroupID><SubGroupDescription>06.03.17.02 - Spacer</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112016</SubGroupID><SubGroupDescription>06.03.17.04 - Central Screw</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112017</SubGroupID><SubGroupDescription>06.03.17.05 - Healing Cylinder</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112018</SubGroupID><SubGroupDescription>06.03.17.06 - Healing Screw</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112019</SubGroupID><SubGroupDescription>06.03.17.07 - Fixture</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112020</SubGroupID><SubGroupDescription>06.03.17.08 - Abutment</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112021</SubGroupID><SubGroupDescription>06.03.17.09 - Abutment Screw</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112022</SubGroupID><SubGroupDescription>06.03.17.10 - Oncology Humeral Stem</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112023</SubGroupID><SubGroupDescription>06.03.17.11 - Humeral Ancharge Piece</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112024</SubGroupID><SubGroupDescription>06.03.17.12 - Humerus Extension Piece</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112026</SubGroupID><SubGroupDescription>06.03.17.14 - Humerus Connection Piece</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112027</SubGroupID><SubGroupDescription>06.03.17.15 - Oncology Humeral Body</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112028</SubGroupID><SubGroupDescription>06.03.17.16 - Wedge</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112029</SubGroupID><SubGroupDescription>06.03.17.17 - Humerus Connecting Screw</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112030</SubGroupID><SubGroupDescription>06.03.17.18 - Humerus Hex Socket Bolt</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112031</SubGroupID><SubGroupDescription>06.03.17.19 - Plug Screw Axis</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112033</SubGroupID><SubGroupDescription>06.03.17.21 - Humeral Bearing</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112034</SubGroupID><SubGroupDescription>06.03.17.22 - Humeral Head/Cap</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112035</SubGroupID><SubGroupDescription>06.03.17.23 - Distal Humerus Flange</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112036</SubGroupID><SubGroupDescription>06.03.17.24 - Humeral Collar Round Smooth</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112037</SubGroupID><SubGroupDescription>06.03.17.25 - Humeral Component for use with Hemi Head</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112038</SubGroupID><SubGroupDescription>06.03.17.26 - Humeral Head Fixation Screw</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112039</SubGroupID><SubGroupDescription>06.03.17.27 - Humeral Component with Liner and re-attachment</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112040</SubGroupID><SubGroupDescription>06.03.17.28 - Humeral Collar Round Coated</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112041</SubGroupID><SubGroupDescription>06.03.17.29 - Humeral Stem</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112042</SubGroupID><SubGroupDescription>06.03.17.30 - Humeral Shaft</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112043</SubGroupID><SubGroupDescription>06.03.17.31 - Humeral Intergral Shaft &amp; Stem Coated</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112045</SubGroupID><SubGroupDescription>06.03.17.33 - Humeral Component with Liner</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112046</SubGroupID><SubGroupDescription>06.03.17.34 - Humeral Component with Reattachment for use with Hemi Head</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112047</SubGroupID><SubGroupDescription>06.03.17.35 - Glenoid / Glensophere component</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112048</SubGroupID><SubGroupDescription>06.03.17.36 - Humeral Hemi-Head</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112049</SubGroupID><SubGroupDescription>06.03.17.37 - Femoral Stem - Uncemented</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112051</SubGroupID><SubGroupDescription>06.03.17.39 - Tibial Stem - Uncemented</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112053</SubGroupID><SubGroupDescription>06.03.17.41 - Valgus Sleeve</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112877</SubGroupID><SubGroupDescription>07.01.01.01 - &lt;0.2mm thick, 1-50cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112878</SubGroupID><SubGroupDescription>07.01.01.02 - &lt;0.2mm thick, 51-100cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112879</SubGroupID><SubGroupDescription>07.01.01.03 - 0.2-0.49mm thick, 1-10cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112880</SubGroupID><SubGroupDescription>07.01.01.04 - 0.2-0.49mm thick, 11-50cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112881</SubGroupID><SubGroupDescription>07.01.01.05 - 0.2-0.49mm thick, 51-200cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112882</SubGroupID><SubGroupDescription>07.01.01.06 - 0.2-0.49mm thick, &gt;200cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112883</SubGroupID><SubGroupDescription>07.01.01.07 - 0.5-0.8mm thick, 1-10cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112884</SubGroupID><SubGroupDescription>07.01.01.08 - 0.5-0.8mm thick, 11-50cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112885</SubGroupID><SubGroupDescription>07.01.01.09 - 0.5-0.8mm thick, 51-200cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112886</SubGroupID><SubGroupDescription>07.01.01.10 - 0.5-0.8mm thick, &gt;200cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112888</SubGroupID><SubGroupDescription>07.01.02.02 - &lt;0.2mm thick, 11-25cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112889</SubGroupID><SubGroupDescription>07.01.02.03 - 0.2-0.49mm thick, 1-10cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112890</SubGroupID><SubGroupDescription>07.01.02.04 - 0.2-0.49mm thick, 11-25cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112891</SubGroupID><SubGroupDescription>07.01.02.05 - 0.2-0.49mm thick, 26-50cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112893</SubGroupID><SubGroupDescription>07.01.02.07 - 0.5-0.8mm thick, 1-10cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112894</SubGroupID><SubGroupDescription>07.01.02.08 - 0.5-0.8mm thick, 11-25cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112895</SubGroupID><SubGroupDescription>07.01.02.09 - 0.5-0.8mm thick, 26-50cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112896</SubGroupID><SubGroupDescription>07.01.02.10 - 0.5-0.8mm thick, 51-100cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112897</SubGroupID><SubGroupDescription>07.01.02.11 - 0.5-0.8mm thick, 101-200cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112898</SubGroupID><SubGroupDescription>07.01.02.12 - &gt;0.8mm thick, 1-10cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112899</SubGroupID><SubGroupDescription>07.01.02.13 - &gt;0.8mm thick, 11-25cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112900</SubGroupID><SubGroupDescription>07.01.02.14 - &gt;0.8mm thick, 26-50cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112901</SubGroupID><SubGroupDescription>07.01.02.15 - &gt;0.8mm thick, 51-100cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112902</SubGroupID><SubGroupDescription>07.01.02.16 - &gt;0.8mm thick, 101-200cm2</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112903</SubGroupID><SubGroupDescription>07.01.03.01 - 0.5-0.8mm thick, 1-25cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112904</SubGroupID><SubGroupDescription>07.01.03.02 - 0.5-0.8mm thick, 26-50cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112905</SubGroupID><SubGroupDescription>07.01.03.03 - &gt;0.8mm thick 26-50cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112906</SubGroupID><SubGroupDescription>07.01.04.01 - Resorbable</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112907</SubGroupID><SubGroupDescription>07.01.04.02 - Polymer</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112908</SubGroupID><SubGroupDescription>07.01.04.03 - Block</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112909</SubGroupID><SubGroupDescription>07.01.05.01 - &lt;0.5mm thick, &lt;4 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112910</SubGroupID><SubGroupDescription>07.01.05.02 - &lt;0.5mm thick, 4-7 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112911</SubGroupID><SubGroupDescription>07.01.05.03 - &lt;0.5mm thick, 8-15 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112912</SubGroupID><SubGroupDescription>07.01.05.04 - &lt;0.5mm thick, 16-32 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112913</SubGroupID><SubGroupDescription>07.01.05.05 - 0.5-0.99mm thick, &lt;4 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112914</SubGroupID><SubGroupDescription>07.01.05.06 - 0.5-0.99mm thick, 4-7 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112915</SubGroupID><SubGroupDescription>07.01.05.07 - 0.5-0.99mm thick, 8-32 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112916</SubGroupID><SubGroupDescription>07.01.05.08 - 0.5-0.99mm thick, &gt;32 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112917</SubGroupID><SubGroupDescription>07.01.05.09 - 1.0-1.99mm thick, &lt;4 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112918</SubGroupID><SubGroupDescription>07.01.05.10 - 1.0-1.99mm thick, 4-7 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112919</SubGroupID><SubGroupDescription>07.01.05.11 - 1.0-1.99mm thick, 8-15 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112920</SubGroupID><SubGroupDescription>07.01.05.12 - 1.0-1.99mm thick, 16-32 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112921</SubGroupID><SubGroupDescription>07.01.05.13 - 1.0-1.99mm thick, &gt;32 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112922</SubGroupID><SubGroupDescription>07.01.05.14 - 2.0-2.99mm thick, 4-7 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112923</SubGroupID><SubGroupDescription>07.01.05.15 - 2.0-2.99mm thick, 8-15 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112924</SubGroupID><SubGroupDescription>07.01.05.16 - 2.0-2.99mm thick, 16-32 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112925</SubGroupID><SubGroupDescription>07.01.05.17 - 2.0-2.99mm thick, &gt;32 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112926</SubGroupID><SubGroupDescription>07.01.05.18 - ≥3mm thick, 4-7 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112927</SubGroupID><SubGroupDescription>07.01.05.19 - ≥3mm thick, 8-15 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112928</SubGroupID><SubGroupDescription>07.01.05.20 - ≥3mm thick, 16-32 holes</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112929</SubGroupID><SubGroupDescription>07.01.06.01 - Diameter ≤1.24mm</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112930</SubGroupID><SubGroupDescription>07.01.06.02 - Diameter 1.25-3.24mm</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112932</SubGroupID><SubGroupDescription>07.01.07.01 - Pin</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112934</SubGroupID><SubGroupDescription>07.01.07.03 - Washer</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112935</SubGroupID><SubGroupDescription>07.01.07.04 - Wedges and Burr Hole Covers</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112936</SubGroupID><SubGroupDescription>07.01.07.05 - Anchor Bone</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112937</SubGroupID><SubGroupDescription>07.01.07.06 - Clamps</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112938</SubGroupID><SubGroupDescription>07.01.07.07 - Screws</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112940</SubGroupID><SubGroupDescription>07.01.07.09 - Probe</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112944</SubGroupID><SubGroupDescription>07.01.08.01 - &lt;6cm2</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112945</SubGroupID><SubGroupDescription>07.01.08.02 - &gt;6cm2 - &lt;8cm2</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112946</SubGroupID><SubGroupDescription>07.01.08.03 - &gt;8cm2</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112947</SubGroupID><SubGroupDescription>07.02.02.01 - Complex</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112948</SubGroupID><SubGroupDescription>07.02.02.02 - Polymer</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112949</SubGroupID><SubGroupDescription>07.02.02.03 - Composite</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112950</SubGroupID><SubGroupDescription>07.02.02.04 - Surgical Guide</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112952</SubGroupID><SubGroupDescription>07.02.03.01 - Helical Rim</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112953</SubGroupID><SubGroupDescription>07.02.03.02 - Ear Base</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112954</SubGroupID><SubGroupDescription>07.02.04.01 - Complex</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112955</SubGroupID><SubGroupDescription>07.02.04.02 - Polymer</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112956</SubGroupID><SubGroupDescription>07.02.05.01 - Mandible, Full</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112957</SubGroupID><SubGroupDescription>07.02.05.02 - Fossa Replacement</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112958</SubGroupID><SubGroupDescription>07.02.05.03 - Mandibular Angle</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112959</SubGroupID><SubGroupDescription>07.02.05.04 - Condylar Device</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112960</SubGroupID><SubGroupDescription>07.02.05.05 - Plate</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112969</SubGroupID><SubGroupDescription>07.02.05.07 - Surgical Guide</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112970</SubGroupID><SubGroupDescription>07.02.05.08 - Maxilla</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112961</SubGroupID><SubGroupDescription>07.02.05.09 - Hemi-mandible</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112974</SubGroupID><SubGroupDescription>07.02.06.01 - Nasal Dorsum</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112975</SubGroupID><SubGroupDescription>07.02.06.02 - Nasal Arch</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112976</SubGroupID><SubGroupDescription>07.02.06.03 - Nasal Shell Shape</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112977</SubGroupID><SubGroupDescription>07.02.06.04 - Nasal Valve Support</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112978</SubGroupID><SubGroupDescription>07.02.06.05 - Naso-orbital Ethmoid Implant</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112972</SubGroupID><SubGroupDescription>07.02.06.07 - Zygoma Plate</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112979</SubGroupID><SubGroupDescription>07.02.07.01 - Complete Orbital Shape</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112980</SubGroupID><SubGroupDescription>07.02.07.02 - Orbital Floor</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112981</SubGroupID><SubGroupDescription>07.02.07.03 - Rim</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112982</SubGroupID><SubGroupDescription>07.02.07.04 - Wedge for Orbit</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112983</SubGroupID><SubGroupDescription>07.02.07.05 - Surgical Guide</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112984</SubGroupID><SubGroupDescription>07.02.08.01 - Endosseous Implant</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112988</SubGroupID><SubGroupDescription>07.03.01.01 - Permanent</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112989</SubGroupID><SubGroupDescription>07.03.01.02 - Temporary</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112990</SubGroupID><SubGroupDescription>07.03.01.03 - Cover Screw/Cap</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112991</SubGroupID><SubGroupDescription>07.03.03.01 - Screws</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112992</SubGroupID><SubGroupDescription>07.03.03.02 - Plates</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112993</SubGroupID><SubGroupDescription>07.03.03.03 - Implants and Fixtures</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112994</SubGroupID><SubGroupDescription>07.03.03.04 - Graft Material &lt;0.5ml</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112995</SubGroupID><SubGroupDescription>07.03.03.05 - Graft Material 0.5ml-&lt;1.0ml</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112996</SubGroupID><SubGroupDescription>07.03.03.06 - Graft Material ≥1.0ml</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112997</SubGroupID><SubGroupDescription>07.04.01.01 - External Midface System</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112999</SubGroupID><SubGroupDescription>07.04.01.03 - Internal/Intraoral</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113000</SubGroupID><SubGroupDescription>07.04.02.01 - Distractor Body</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113001</SubGroupID><SubGroupDescription>07.04.02.02 - Footplate</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113002</SubGroupID><SubGroupDescription>07.04.02.03 - Cross Bar/Rod</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113004</SubGroupID><SubGroupDescription>07.04.02.05 - Pin</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113005</SubGroupID><SubGroupDescription>07.04.02.06 - Screws</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113006</SubGroupID><SubGroupDescription>07.04.02.07 - External Distractor Component</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113007</SubGroupID><SubGroupDescription>07.04.02.08 - Body Extension</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113011</SubGroupID><SubGroupDescription>07.05.02.01 - Skin or Mammary</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113014</SubGroupID><SubGroupDescription>07.05.03.01 - &lt;50cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113015</SubGroupID><SubGroupDescription>07.05.03.02 - 50-149cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113016</SubGroupID><SubGroupDescription>07.05.03.03 - 150-400cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113017</SubGroupID><SubGroupDescription>07.05.03.04 - &gt;400cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113019</SubGroupID><SubGroupDescription>07.06.01.01 - &lt;500cc</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113020</SubGroupID><SubGroupDescription>07.06.01.02 - ≥500cc</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113021</SubGroupID><SubGroupDescription>07.06.02.01 - &lt;500cc</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113022</SubGroupID><SubGroupDescription>07.06.02.02 - ≥500cc</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113192</SubGroupID><SubGroupDescription>08.12.01.01 - General Purpose</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113194</SubGroupID><SubGroupDescription>08.12.02.01 - General Purpose</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113195</SubGroupID><SubGroupDescription>08.12.02.02 - Special Purpose for specific indications</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113168</SubGroupID><SubGroupDescription>08.17.02.01 - Leaflet</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113176</SubGroupID><SubGroupDescription>08.18.01.01 - Irrigated Cardiac Ablation Catheter</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113177</SubGroupID><SubGroupDescription>08.18.01.02 - Patch</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113178</SubGroupID><SubGroupDescription>08.18.01.03 - Mapping Catheter</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113174</SubGroupID><SubGroupDescription>08.18.01.04 - Non-irrigated cardiac ablation catheter</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113179</SubGroupID><SubGroupDescription>08.18.01.05 - Intracardiac Electrophysiology Catheter</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113180</SubGroupID><SubGroupDescription>08.18.02.01 - Ablation Catheter</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113181</SubGroupID><SubGroupDescription>08.18.02.02 - Mapping Catheter</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113173</SubGroupID><SubGroupDescription>08.18.03.01 - Ablation and Mapping Catheter</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112699</SubGroupID><SubGroupDescription>09.05.01.01 - &lt; 25cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112700</SubGroupID><SubGroupDescription>09.05.01.02 - 25-75cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112701</SubGroupID><SubGroupDescription>09.05.01.03 - &gt;75cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112702</SubGroupID><SubGroupDescription>09.05.02.01 - Cardiovascular &lt; 75cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112703</SubGroupID><SubGroupDescription>09.05.02.02 - Cardiovascular ≥ 75cm²</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112707</SubGroupID><SubGroupDescription>09.09.06.02 - 11-20cm length</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112708</SubGroupID><SubGroupDescription>09.09.06.03 - 21-49cm length</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112709</SubGroupID><SubGroupDescription>09.09.06.04 - ≥50cm length</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112655</SubGroupID><SubGroupDescription>09.11.02.01 - System Controller</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112657</SubGroupID><SubGroupDescription>09.11.02.03 - Battery Set</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112658</SubGroupID><SubGroupDescription>09.11.02.04 - Battery Clip Set</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112661</SubGroupID><SubGroupDescription>09.11.03.01 - Stabilisation Belt</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112659</SubGroupID><SubGroupDescription>09.11.03.02 - Modular Belt</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112660</SubGroupID><SubGroupDescription>09.11.03.03 - Shower Bag</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112650</SubGroupID><SubGroupDescription>09.12.01.99 - No SubGroup</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112651</SubGroupID><SubGroupDescription>09.12.02.99 - No SubGroup</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112672</SubGroupID><SubGroupDescription>09.14.01.01 - Monopolar</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112673</SubGroupID><SubGroupDescription>09.14.01.02 - Bipolar</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112674</SubGroupID><SubGroupDescription>09.14.01.03 - System</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112676</SubGroupID><SubGroupDescription>09.14.02.01 - Probe</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112677</SubGroupID><SubGroupDescription>09.14.02.02 - System</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113025</SubGroupID><SubGroupDescription>10.01.01.01 - Balloon Expandable</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113026</SubGroupID><SubGroupDescription>10.01.01.02 - Self Expandable, &lt;150mm</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113027</SubGroupID><SubGroupDescription>10.01.01.03 - Self Expandable, ≥150mm</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113029</SubGroupID><SubGroupDescription>10.01.01.04 - Self-Expanding, large diameter for treatment of aortic dissection disease</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113028</SubGroupID><SubGroupDescription>10.01.01.05 - Catheter with 4 or 6 stents</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113030</SubGroupID><SubGroupDescription>10.01.02.01 - Self Expandable</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113033</SubGroupID><SubGroupDescription>10.02.01.01 - &lt;180mm length</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113034</SubGroupID><SubGroupDescription>10.02.01.02 - ≥180mm length</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113035</SubGroupID><SubGroupDescription>10.02.04.01 - Body and 2 limbs</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113036</SubGroupID><SubGroupDescription>10.02.04.02 - Body and 1 limb</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113037</SubGroupID><SubGroupDescription>10.02.04.03 - Body only</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113039</SubGroupID><SubGroupDescription>10.02.05.02 - Multiple Branch</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113040</SubGroupID><SubGroupDescription>10.02.07.01 - Thoracic</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113041</SubGroupID><SubGroupDescription>10.02.07.02 - Abdominal</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113042</SubGroupID><SubGroupDescription>10.02.10.01 - ≤12mm diameter</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113043</SubGroupID><SubGroupDescription>10.02.10.02 - &gt;12mm diameter</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113045</SubGroupID><SubGroupDescription>10.02.11.01 - &lt;150mm length</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113046</SubGroupID><SubGroupDescription>10.02.11.02 - 150-249mm length</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113047</SubGroupID><SubGroupDescription>10.02.11.03 - ≥250mm length</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113048</SubGroupID><SubGroupDescription>10.03.01.01 - ≤10cm length</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113049</SubGroupID><SubGroupDescription>10.03.01.02 - 11-20cm length</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113050</SubGroupID><SubGroupDescription>10.03.01.03 - 21-49cm length</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113051</SubGroupID><SubGroupDescription>10.03.01.04 - ≥50cm length</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113054</SubGroupID><SubGroupDescription>10.04.01.01 - 0 - 100 sq cm</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113055</SubGroupID><SubGroupDescription>10.04.01.02 - 101 - 150 sq cm</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113056</SubGroupID><SubGroupDescription>10.04.01.03 - &gt;150 sq cm</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113057</SubGroupID><SubGroupDescription>10.04.01.04 - Pledgets</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113059</SubGroupID><SubGroupDescription>10.08.02.01 - ≤200mm length</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113060</SubGroupID><SubGroupDescription>10.08.02.02 - &gt;200mm length</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113065</SubGroupID><SubGroupDescription>10.08.03.03 - 2ml</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113067</SubGroupID><SubGroupDescription>10.08.05.02 - Cyanoacrylate</SubGroupDescription></SubGroup><SubGroup><SubGroupID>113069</SubGroupID><SubGroupDescription>10.08.06.02 - Detachment Controller</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112526</SubGroupID><SubGroupDescription>11.01.01.01 - Unpolished</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112527</SubGroupID><SubGroupDescription>11.01.01.02 - Unpolished - precoat</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112528</SubGroupID><SubGroupDescription>11.01.01.03 - Polished</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112529</SubGroupID><SubGroupDescription>11.01.01.04 - Polished and Unpolished, Modular</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112530</SubGroupID><SubGroupDescription>11.01.02.01 - Polished and Unpolished, Conventional</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112531</SubGroupID><SubGroupDescription>11.01.03.01 - Grit Blast</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112532</SubGroupID><SubGroupDescription>11.01.03.02 - Beaded</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112533</SubGroupID><SubGroupDescription>11.01.03.03 - Mesh</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112534</SubGroupID><SubGroupDescription>11.01.03.04 - Plasma</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112535</SubGroupID><SubGroupDescription>11.01.04.01 - Grit Blast</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112536</SubGroupID><SubGroupDescription>11.01.04.02 - Beaded</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112538</SubGroupID><SubGroupDescription>11.01.04.04 - Plasma</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112539</SubGroupID><SubGroupDescription>11.01.05.01 - Grit Blast</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112543</SubGroupID><SubGroupDescription>11.01.06.01 - Grit Blast</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112546</SubGroupID><SubGroupDescription>11.01.06.04 - Plasma</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112547</SubGroupID><SubGroupDescription>11.01.07.01 - Grit Blast</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112548</SubGroupID><SubGroupDescription>11.01.07.02 - Beaded</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112550</SubGroupID><SubGroupDescription>11.01.07.04 - Plasma</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112551</SubGroupID><SubGroupDescription>11.01.07.05 - Unpolished and Polished</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112552</SubGroupID><SubGroupDescription>11.01.08.01 - Grit Blast</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112553</SubGroupID><SubGroupDescription>11.01.08.02 - Beaded</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112555</SubGroupID><SubGroupDescription>11.01.08.04 - Plasma</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112556</SubGroupID><SubGroupDescription>11.01.08.05 - Unpolished and Polished</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112557</SubGroupID><SubGroupDescription>11.01.09.01 - Grit Blast</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112560</SubGroupID><SubGroupDescription>11.01.09.04 - Plasma</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112561</SubGroupID><SubGroupDescription>11.01.09.05 - Unpolished and Polished</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112562</SubGroupID><SubGroupDescription>11.01.10.01 - Grit Blast</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112565</SubGroupID><SubGroupDescription>11.01.10.04 - Plasma</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112574</SubGroupID><SubGroupDescription>11.02.01.01 - Stainless Steel</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112575</SubGroupID><SubGroupDescription>11.02.01.02 - Cobalt Chrome</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112576</SubGroupID><SubGroupDescription>11.02.01.03 - Alumina</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112578</SubGroupID><SubGroupDescription>11.02.01.05 - Ceramic Mix</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112579</SubGroupID><SubGroupDescription>11.02.01.06 - Ceramicised Metal</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112580</SubGroupID><SubGroupDescription>11.02.02.01 - Stainless Steel</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112581</SubGroupID><SubGroupDescription>11.02.02.02 - Cobalt Chrome</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112582</SubGroupID><SubGroupDescription>11.02.02.03 - Alumina</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112584</SubGroupID><SubGroupDescription>11.02.02.05 - Ceramic Mix</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112585</SubGroupID><SubGroupDescription>11.02.02.06 - Ceramicised Metal</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112586</SubGroupID><SubGroupDescription>11.02.04.01 - Metal</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112590</SubGroupID><SubGroupDescription>11.02.06.01 - Bipolar</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112591</SubGroupID><SubGroupDescription>11.02.06.02 - Tripolar/Multipolar</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112592</SubGroupID><SubGroupDescription>11.03.01.01 - Unmodified polyethylene</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112593</SubGroupID><SubGroupDescription>11.03.01.02 - Modified polyethylene</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112594</SubGroupID><SubGroupDescription>11.03.01.03 - Constrained, modified and unmodified polythylene</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112595</SubGroupID><SubGroupDescription>11.03.01.04 - Metal Shell</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112596</SubGroupID><SubGroupDescription>11.03.02.01 - Grit Blast</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112597</SubGroupID><SubGroupDescription>11.03.02.02 - Beaded</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112598</SubGroupID><SubGroupDescription>11.03.02.03 - Mesh</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112599</SubGroupID><SubGroupDescription>11.03.02.04 - Plasma</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112600</SubGroupID><SubGroupDescription>11.03.02.05 - Porous Metal</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112601</SubGroupID><SubGroupDescription>11.03.03.01 - Grit Blast</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112602</SubGroupID><SubGroupDescription>11.03.03.02 - Beaded</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112603</SubGroupID><SubGroupDescription>11.03.03.03 - Mesh</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112604</SubGroupID><SubGroupDescription>11.03.03.04 - Plasma</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112606</SubGroupID><SubGroupDescription>11.03.04.01 - Unmodified polyethylene</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112607</SubGroupID><SubGroupDescription>11.03.04.02 - Modified polyethylene</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112608</SubGroupID><SubGroupDescription>11.03.04.03 - Ceramic</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112609</SubGroupID><SubGroupDescription>11.03.04.04 - Metal</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112610</SubGroupID><SubGroupDescription>11.03.04.05 - Constrained</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112611</SubGroupID><SubGroupDescription>11.03.04.06 - Ceramic Mix</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112612</SubGroupID><SubGroupDescription>11.03.05.01 - Unmodified polyethylene</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112613</SubGroupID><SubGroupDescription>11.03.05.02 - Modified polyethylene</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112616</SubGroupID><SubGroupDescription>11.03.05.05 - Ceramic Mix</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112618</SubGroupID><SubGroupDescription>11.03.07.02 - Metal, HA Coated</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112620</SubGroupID><SubGroupDescription>11.03.08.01 - Shell</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112621</SubGroupID><SubGroupDescription>11.03.08.02 - Cage</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112491</SubGroupID><SubGroupDescription>12.01.01.01 - Minimally Stabilised</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112492</SubGroupID><SubGroupDescription>12.01.01.02 - Posterior Stabilised</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112493</SubGroupID><SubGroupDescription>12.01.01.03 - Totally Constrained</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112494</SubGroupID><SubGroupDescription>12.01.02.01 - Minimally Stabilised</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112496</SubGroupID><SubGroupDescription>12.01.03.01 - Minimally Stabilised</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112497</SubGroupID><SubGroupDescription>12.01.03.02 - Posterior Stabilised</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112498</SubGroupID><SubGroupDescription>12.01.03.03 - Totally Constrained</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112499</SubGroupID><SubGroupDescription>12.01.04.01 - Minimally Stabilised</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112500</SubGroupID><SubGroupDescription>12.01.04.02 - Posterior Stabilised</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112502</SubGroupID><SubGroupDescription>12.01.05.01 - Minimally Stabilised</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112503</SubGroupID><SubGroupDescription>12.01.05.02 - Posterior Stabilised</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112504</SubGroupID><SubGroupDescription>12.02.01.01 - PMMA Coating</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112505</SubGroupID><SubGroupDescription>12.02.03.01 - HA Coating</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112508</SubGroupID><SubGroupDescription>12.03.05.01 - HA Coating</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112509</SubGroupID><SubGroupDescription>12.03.07.01 - HA Coating</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112510</SubGroupID><SubGroupDescription>12.04.05.01 - HA Coating</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112511</SubGroupID><SubGroupDescription>12.04.06.01 - HA Coating</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112514</SubGroupID><SubGroupDescription>12.08.03.02 - Moulded</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112516</SubGroupID><SubGroupDescription>12.09.01.01 - Condylar only (only when combined with a proximal tibial replacement)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112517</SubGroupID><SubGroupDescription>12.09.01.02 - Condylar, including metaphyseal and/or diaphyseal</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112518</SubGroupID><SubGroupDescription>12.09.02.01 - Condylar only (only when combined with a proximal tibial replacement)</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112519</SubGroupID><SubGroupDescription>12.09.02.02 - Condylar, including metaphyseal and/or diaphyseal</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112520</SubGroupID><SubGroupDescription>12.09.03.01 - Incorporating Bone Fixation</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112521</SubGroupID><SubGroupDescription>12.09.04.01 - With Compression</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112523</SubGroupID><SubGroupDescription>12.09.08.01 - Collar</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112524</SubGroupID><SubGroupDescription>12.09.08.02 - Adaptor</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112525</SubGroupID><SubGroupDescription>12.09.08.03 - Stem extender</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112629</SubGroupID><SubGroupDescription>13.03.03.01 - Fixed</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112630</SubGroupID><SubGroupDescription>13.03.03.02 - Adjustable</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112631</SubGroupID><SubGroupDescription>13.05.01.01 - Cervical</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112632</SubGroupID><SubGroupDescription>13.05.01.02 - ThoracoLumbar / Lumbar / Lumbosacral</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112633</SubGroupID><SubGroupDescription>13.05.02.01 - Cervical</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112634</SubGroupID><SubGroupDescription>13.05.02.02 - ThoracoLumbar</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112635</SubGroupID><SubGroupDescription>13.05.02.03 - Occipital</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112637</SubGroupID><SubGroupDescription>13.05.02.05 - Laminoplasty Plate</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112639</SubGroupID><SubGroupDescription>13.06.03.01 - Thoracolumbar</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112640</SubGroupID><SubGroupDescription>13.06.03.02 - Occipital</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112641</SubGroupID><SubGroupDescription>13.10.01.01 - Cervical</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112642</SubGroupID><SubGroupDescription>13.10.01.02 - ThoracoLumbar / Lumbar</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112643</SubGroupID><SubGroupDescription>13.10.02.01 - Cervical</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112644</SubGroupID><SubGroupDescription>13.10.02.02 - ThoracoLumbar / Lumbar</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112645</SubGroupID><SubGroupDescription>13.11.01.01 - Cervical</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112646</SubGroupID><SubGroupDescription>13.11.01.02 - Lumbar</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112647</SubGroupID><SubGroupDescription>13.12.01.01 - Integral Fixation</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112648</SubGroupID><SubGroupDescription>13.12.01.02 - No Integral Fixation</SubGroupDescription></SubGroup><SubGroup><SubGroupID>112649</SubGroupID><SubGroupDescription>13.12.01.03 - End Plate</SubGroupDescription></SubGroup></SubGroups><ProsthesisItems><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>SHV03</BillingCode><Name>Conduit - Arterial</Name><SupplierCode>40283</SupplierCode><CategoryID>107553</CategoryID><ARTGs><ARTG>246032</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4499</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QHV07</BillingCode><Name>Patch, Conduit and Pericardium</Name><SupplierCode>40287</SupplierCode><CategoryID>107553</CategoryID><ARTGs><ARTG>370980</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3195</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV02</BillingCode><Name>Valve - Pulmonary</Name><SupplierCode>40307</SupplierCode><CategoryID>107553</CategoryID><ARTGs><ARTG>236613</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>11223</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV01</BillingCode><Name>Valve - Aortic</Name><SupplierCode>40307</SupplierCode><CategoryID>107553</CategoryID><ARTGs><ARTG>236613</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>11223</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV50</BillingCode><Name>Pericardium</Name><SupplierCode>40307</SupplierCode><CategoryID>107553</CategoryID><ARTGs><ARTG>236613</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2949</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV56</BillingCode><Name>Conduit - Aortic</Name><SupplierCode>40307</SupplierCode><CategoryID>107553</CategoryID><ARTGs><ARTG>236613</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2423</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>SHV01</BillingCode><Name>Valve - Aortic</Name><SupplierCode>40283</SupplierCode><CategoryID>107553</CategoryID><ARTGs><ARTG>246032</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>11421</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>SHV02</BillingCode><Name>Valve - Pulmonary</Name><SupplierCode>40283</SupplierCode><CategoryID>107553</CategoryID><ARTGs><ARTG>246032</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>11421</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV03</BillingCode><Name>Conduit - Pulmonary</Name><SupplierCode>40307</SupplierCode><CategoryID>107553</CategoryID><ARTGs><ARTG>236613</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2423</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QHV01</BillingCode><Name>Valve and Valved Conduit</Name><SupplierCode>40287</SupplierCode><CategoryID>107553</CategoryID><ARTGs><ARTG>370980</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>10240</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QHV11</BillingCode><Name>Vascular Graft (Various)</Name><SupplierCode>40287</SupplierCode><CategoryID>107553</CategoryID><ARTGs><ARTG>370980</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4071</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC44</BillingCode><Name>Malleable Bone Segments Super Critical Fluid CO2Treated (Freeze Dried)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3541</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC48</BillingCode><Name>Hemipelvis – Segment Super Critical Fluid CO2 Treated  (Frozen)</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1708</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA36</BillingCode><Name>Humerus – Shaft (Freeze Dried) - various sizes</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4453</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB22</BillingCode><Name>Hemipelvis - iliac crest</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3500</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC22</BillingCode><Name>Patella Tendon with Bone Block – Whole with Quads – Super Critical Fluid CO2 Treated  (Frozen)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2967</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC99</BillingCode><Name>Malleable Bone Segments</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2587</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA24</BillingCode><Name>Femoral Head – Hemi (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3499</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCA08</BillingCode><Name>Fascia Lata [Small; Medium; Large pieces]</Name><Size>[Small; Medium; Large pieces]</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3923</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC56</BillingCode><Name>Cortical Ring (Frozen) 5mm – 9mm</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1910</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA09</BillingCode><Name>Gracilis Tendon, Freeze Dried, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2222</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC34</BillingCode><Name>Femoral Condyle Whole (Frozen) Super Critical Fluid CO2 Treated</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3541</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA58</BillingCode><Name>Malleable Bone Segments Super Critical Fluid CO2Treated (Frozen)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3541</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA92</BillingCode><Name>HTO Wedge – Super Critical Fluid CO2  Treated (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1641</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC17</BillingCode><Name>Cortical Ring Super Critical Fluid CO2 Treated  (Frozen)  5mm – 9mm</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1947</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCA06</BillingCode><Name>Compressible Cancellous Block (FZ)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3500</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA18</BillingCode><Name>Cancellous Block (Frozen) - various sizes</Name><Size>See attached documents</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1718</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT07</BillingCode><Name>Cortical Strut &gt;15 - 20cm</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4322</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB71</BillingCode><Name>Tendon - Tibialis Posterior</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2911</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT22</BillingCode><Name>Femoral Head</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>8000</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB53</BillingCode><Name>Humerus - Ring</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1874</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB42</BillingCode><Name>Tibial Shaft - third</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3423</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB89</BillingCode><Name>Cervical Spacers - Parrallel (Freeze Dried)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1840</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB38</BillingCode><Name>Ulna - Shaft</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3170</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA45</BillingCode><Name>Cortical Cancellous Block (Freeze Dried) - various sizes</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1674</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA57</BillingCode><Name>Cortical Plate Super Critical Fluid CO2 Treated (Frozen) various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1623</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA53</BillingCode><Name>Morsellised Bone Super Critical Fluid CO2 Treated  (Freeze Dried) Packs of 5 – 10cc</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2482</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC11</BillingCode><Name>Femoral Strut (Freeze Dried) - various sizes</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3996</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA25</BillingCode><Name>Fibular Ring Super Critical Fluid CO2 Treated (Frozen)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1947</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC82</BillingCode><Name>Freeze Dried Cortico-Cancellous Bone Granules 5-9cc</Name><Size>5-9cc</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2800</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA11</BillingCode><Name>Cancellous Cube (Frozen) 3cm3 cubes</Name><Size>See attached documents</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1718</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA13</BillingCode><Name>Achilles Tendon with Bone Block Super Critical Fluid CO2 Treated (Frozen)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3027</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA20</BillingCode><Name>Patella Bone-Tendon-Bone, Hemi with Quadriceps, Frozen, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3540</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA34</BillingCode><Name>Tibia – Whole Super Critical Fluid CO2 Treated  (Frozen)</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>7921</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC06</BillingCode><Name>Cervical Spacers – Lordotic Super Critical Fluid CO2Treated (Freeze Dried) 5mm – 9mm</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1947</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC93</BillingCode><Name>Demineralized Bone Fibres / Cortico-Cancellous Granules (FZ) 5-9g</Name><Size>5-9g</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3800</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC26</BillingCode><Name>Humeral Head – Whole Super Critical Fluid CO2 Treated, (Freeze Dried)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2099</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA20</BillingCode><Name>Humerus – Strut (Freeze Dried) - various sizes</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2700</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC43</BillingCode><Name>Morsellised Bone (Freeze Dried) Packs of 15 – 30cc</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2531</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCA16</BillingCode><Name>Anterior Tibialis Tendon</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3125</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA10</BillingCode><Name>Tibia – Distal Super Critical Fluid CO2 Treated  (Frozen)</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3743</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA15</BillingCode><Name>Milled Cancellous Chips, Freeze dried, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1455</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA30</BillingCode><Name>Cancellous Dowel (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1632</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC31</BillingCode><Name>Tibia – Proximal (Freeze Dried) - various sizes</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3663</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC90</BillingCode><Name>Demineralized Bone Fibres / Cortico-Cancellous Granules (FD) 2-4cc</Name><Size>2-4cc</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2750</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA54</BillingCode><Name>Cortical Strut (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2525</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA29</BillingCode><Name>Tricortical Cancellous Wedge (Freeze Dried) - various sizes</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1674</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA90</BillingCode><Name>Humerus – Distal Segment Super Critical Fluid CO2 Treated  (Frozen(</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3206</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC54</BillingCode><Name>Cancellous Block (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1632</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC52</BillingCode><Name>Tibia – Proximal Super Critical Fluid CO2 Treated  (Frozen)</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3663</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA68</BillingCode><Name>Cancellous Plug Super Critical Fluid CO2 Treated (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1663</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA06</BillingCode><Name>Anterior Tibialis Tendon, Frozen, Non-Irradiated</Name><Size>Various</Size><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>299298</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3624</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA46</BillingCode><Name>Femoral Strut (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3703</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC92</BillingCode><Name>Demineralized Bone Fibres / Cortico-Cancellous Granules (FZ) 1-4g</Name><Size>1-4g</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2750</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB57</BillingCode><Name>Femoral Shaft - Half</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3595</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB43</BillingCode><Name>Tibial Shaft - half</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3170</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT16</BillingCode><Name>Fascia Lata - Small (10cm x 5cm)</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>905</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB25</BillingCode><Name>Humerus - Distal</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3145</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB40</BillingCode><Name>Ulna - Ring</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2399</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QBB05</BillingCode><Name>Meniscus</Name><SupplierCode>40287</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>231769</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3340</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT62</BillingCode><Name>Bone - Milled &lt;5 gr (&lt;10cc equivalent)</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1561</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB33</BillingCode><Name>Tendon - Patellar with bone plugs</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2861</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT17</BillingCode><Name>Femur - Distal (Shaft &amp; Condyles)</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>5210</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB46</BillingCode><Name>Tibia - Proximal with Patellar Tendon</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>5158</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT40</BillingCode><Name>Patellar unit whole with or without tibial block</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4013</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB30</BillingCode><Name>Humerus - Entire with rotator cuff</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4118</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT13</BillingCode><Name>Radius</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1908</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT60</BillingCode><Name>Osteotomy Wedge</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4013</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QBB74</BillingCode><Name>Demineralised Bone Matrix 3-5cc, Freeze Dried</Name><Size>5g</Size><SupplierCode>40287</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>231769</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2926</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB01</BillingCode><Name>Tendon - Achilles</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2562</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT47</BillingCode><Name>Meniscal Graft</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2036</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QBB16</BillingCode><Name>Ulna - Whole</Name><SupplierCode>40287</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>231769</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4182</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT19</BillingCode><Name>Femoral Shaft/Tibial Shaft - Middle third</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4013</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB28</BillingCode><Name>Humerus - Proximal half with rotator cuff</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3595</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT67</BillingCode><Name>Milled Bone 10g</Name><Size>10g</Size><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3902</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB15</BillingCode><Name>Femur - Proximal half</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3893</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB11</BillingCode><Name>Femur - Distal third</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3372</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB56</BillingCode><Name>Femoral Shaft - Segment</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2248</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC27</BillingCode><Name>Cancellous Dowel - Frozen - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1632</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA37</BillingCode><Name>Patella Bone-Tendon-Bone, Hemi with 10.0mm Shaped Bone Blocks, Frozen, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><ChangeExplanation>Change to Benefit</ChangeExplanation><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4237</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA41</BillingCode><Name>Humerus – Proximal (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3690</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCA13</BillingCode><Name>Patella Tendon with Bone Blocks - Whole</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3804</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC39</BillingCode><Name>Femoral Strut Super Critical Fluid CO2 Treated (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3775</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB12</BillingCode><Name>Femur - Entire</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>8264</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT37</BillingCode><Name>Bone - Milled &lt;30g Freeze Dried</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>750</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT31</BillingCode><Name>Hemipelvis - iliac crest</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4013</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB49</BillingCode><Name>Radius - Ring</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2399</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QBB27</BillingCode><Name>Femoral Head - Whole (Various Sizes), Frozen</Name><SupplierCode>40287</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>231769</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4051</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA81</BillingCode><Name>Tricortical Cancellous Wedge Super Critical Fluid CO2 Treated (Freeze Dried)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1553</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA53</BillingCode><Name>Meniscus with Hemi Plateau, Medial, Frozen, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>5680</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA33</BillingCode><Name>Tibial Shaft Super Critical Fluid CO2  Treated  (Frozen) - various sizes</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>5416</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC97</BillingCode><Name>Bone allograft kit (Demineralized and Mineralized Bone Matrix) 5-10g / 5-10cc </Name><Size>5-10g / 5-10cc </Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>6193</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA73</BillingCode><Name>Radius – Whole Super Critical Fluid CO2 Treated  (Frozen)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4109</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AUB05</BillingCode><Name>Cortical Strut</Name><SupplierCode>40310</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2451</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>MAA04</BillingCode><Name>Grafton Demineralized Bone Matrix: Matrix PLF, 2.5cm x 10cm x 0.8cm (2)</Name><SupplierCode>40151</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229633</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1978</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV25</BillingCode><Name>Femur - Proximal (shaft, trochanter, neck)</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>6628</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV29</BillingCode><Name>Fibula - Segment (12cm)</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2264</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV18</BillingCode><Name>Elbow - joint</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>8867</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>SYN08</BillingCode><Name>DBX Putty - 1.00cc</Name><SupplierCode>39932</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1450</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV07</BillingCode><Name>Bone Plug/Dowel - Cancellous</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1689</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB41</BillingCode><Name>Tibial Shaft</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4994</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA02</BillingCode><Name>Gracilis Tendon Super Critical Fluid CO2 Treated  (Frozen)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2293</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA30</BillingCode><Name>AlloPatchHD Acellular Human Dermis, ≥ 25cm² ≥ 1.8mm, Hydrated, Non-Irradiated</Name><Size>≥ 25cm²  ≥ 1.8mm Thick</Size><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>299299</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3479</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA55</BillingCode><Name>Femoral Shaft Super Critical Fluid CO2 Treated (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2292</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA04</BillingCode><Name>Peroneus Longus Tendon, Freeze Dried, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2420</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>DHR01</BillingCode><Name>Femoral Head</Name><SupplierCode>40309</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>260540</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4616</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA16</BillingCode><Name>Demineralized Cancellous Chips, Freeze dried, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1449</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC94</BillingCode><Name>Moulded Demineralized Fibres (Large) </Name><Size>Large</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3750</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA70</BillingCode><Name>Tibial Shaft Super Critical Fluid CO2 Treated (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>5091</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA69</BillingCode><Name>Femoral Strut Super Critical Fluid CO2 Treated (Frozen) - various sizes</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3996</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC83</BillingCode><Name>Freeze Dried Cortico-Cancellous Bone Granules 10-15cc</Name><Size>10-15cc</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3200</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC07</BillingCode><Name>Cervical Spacers - Lordotic (Freeze Dried)  5mm – 9mm</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1910</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA25</BillingCode><Name>Arch Wedge, Freeze dried, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2089</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA07</BillingCode><Name>Cancellous Dowel Plug Super Critical Fluid CO2 Treated (Freeze Dried) - various sizes</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1752</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC55</BillingCode><Name>Morsellised Bone 2.5-5mg</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2268</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC87</BillingCode><Name>Demineralized Bone Fibres (FD) 5-9cc</Name><Size>5-9cc</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3800</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC64</BillingCode><Name>Humerus – Distal Segment (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3145</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA22</BillingCode><Name>Morsellised Bone Super Critical Fluid CO2 Treated  (Frozen) Packs of 15mg – 30mg</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2580</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC33</BillingCode><Name>Hemipelvis – Whole Super Critical Fluid CO2 Treated  (Frozen)</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>9452</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA37</BillingCode><Name>Cervical Spacers - Parrallel (Freeze Dried) 5mm – 9mm</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1910</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA08</BillingCode><Name>Gracilis Tendon, Frozen, Non-Irradiated</Name><Size>Various</Size><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>299298</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3281</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC47</BillingCode><Name>Tibial Strut (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3265</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA49</BillingCode><Name>Humerus – Strut Super Critical Fluid CO2 Treated (Freeze Dried)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2574</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCA09</BillingCode><Name>Spinal Anterior Longitudonal Ligament Patch</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4023</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA61</BillingCode><Name>Cortical Sheet (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1592</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA93</BillingCode><Name>Fibular Ring Super Critical Fluid CO2 Treated (Freeze Dried)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1947</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC35</BillingCode><Name>Cortical Segment Super Critical Fluid CO2 Treated (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3206</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC59</BillingCode><Name>Cervical Spacers - Parrallell (frozen) 5mm – 9mm</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1910</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC18</BillingCode><Name>Cortical Strut Super Critical Fluid CO2 Treated (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2574</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA47</BillingCode><Name>Bone-Tendon-Bone, Hemi with Quadriceps, Freeze Dried, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3832</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA12</BillingCode><Name>Evans Wedge, Freeze dried, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2339</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC85</BillingCode><Name>Engineered Cancellous Block with DBM Component (Various Sizes)</Name><Size>Various Sizes</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3200</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA39</BillingCode><Name>Menisci with Tibial Plateau, Frozen, Non-irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>5807</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA71</BillingCode><Name>Patella Tendon with Bone Block – Whole Super Critical Fluid CO2 Treated (Frozen)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2917</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA95</BillingCode><Name>Tibial Shaft (Freeze Dried) - various sizes</Name><Size>See attached documents</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>5416</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA97</BillingCode><Name>Femur – Distal (Freeze Dried) - various sizes</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3775</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCA04</BillingCode><Name>Unicortical Cancellous Block Super Critical Fluid CO2 Treated (Freeze Dried)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1553</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA24</BillingCode><Name>Unicortical Cancellous Block Super Critical Fluid CO2 Treated (Freeze Dried)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1553</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA48</BillingCode><Name>Bone-Tendon-Bone, Hemi with 10.0mm Shaped Bone Blocks, Freeze Dried, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3680</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA94</BillingCode><Name>Cortical Plate (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1592</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCA10</BillingCode><Name>Achilles Tendon</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3923</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA38</BillingCode><Name>Cortical Cancellous Block Super Critical Fluid CO2Treated (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1623</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC36</BillingCode><Name>Malleable Bone Segments (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2422</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA32</BillingCode><Name>Morsellised Bone – Super Critical Fluid CO2 Treated  Packs of 2.5gm – 5gm</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2314</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA13</BillingCode><Name>High Tibial Osteotomy Wedge Cortical Bone Wedges, (2-Piece), Freeze Dried, Non-Irradiated</Name><Size>Various diameters and lengths:  6-8mm x 3-6cm Length  10-18 x 5.5cm Length</Size><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>299298</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2950</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA14</BillingCode><Name>Hemi Patella Tendon with Bone Block (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3528</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV27</BillingCode><Name>Fibula - Entire</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4978</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV63</BillingCode><Name>Bone - Cancellous Bone Matrix Lyophilised 10cc</Name><Size>10cc</Size><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2504</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV32</BillingCode><Name>Hemipelvis - Complete</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>11295</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV52</BillingCode><Name>Bone - Cancellous Bone Matrix, Lyophilised 40cc</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3899</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>SYN12</BillingCode><Name>Bone, Cancellous Chips - 30cc</Name><SupplierCode>39932</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1700</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV58</BillingCode><Name>Tendon - Semitendinosus</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4116</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV28</BillingCode><Name>Fibula - Segment (6cm)</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1689</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AUB08</BillingCode><Name>Bone – Cortico-Cancellous Crunch &lt;20g Sterile</Name><SupplierCode>40310</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2215</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV14</BillingCode><Name>Cortical Strut</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1803</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV11</BillingCode><Name>Bone - Milled 40cc</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3104</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV21</BillingCode><Name>Fascia Lata</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1870</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC19</BillingCode><Name>Morsellised Bone (Freeze Dried) Packs of 5 – 10cc</Name><Size>Please see attached documents</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2432</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA05</BillingCode><Name>Fibula – Whole Super Critical Fluid CO2 Treated (Frozen)</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>8780</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA05</BillingCode><Name>Fascia Lata, ≥ 120cm²  ≤ 180cm², Frozen, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2400</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC03</BillingCode><Name>Femoral Ring Super Critical Fluid CO2 Treated (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2182</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC79</BillingCode><Name>Compressible Cancellous Strip (FD)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3500</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC40</BillingCode><Name>Cervical Spacers - Parallel Super Critical Fluid CO2Treated (Frozen)  5mm – 9mm</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1947</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA98</BillingCode><Name>Femoral Head – Whole (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3499</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA42</BillingCode><Name>Cancellous Cube – Super Critical Fluid CO2 Treated (Frozen) 3cm3 cubes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1663</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA52</BillingCode><Name>Demineralized 80%Cortical/20%Cancellous Granules, Freeze dried, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1500</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA03</BillingCode><Name>Femur – Proximal Super Critical Fluid CO2 Treated  (Frozen)</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3996</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA40</BillingCode><Name>Femur – Distal Super Critical Fluid CO2 Treated (Freeze Dried)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3775</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCA12</BillingCode><Name>Achilles Tendon with Pre-Shaped Bone Block</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3923</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC98</BillingCode><Name>Cortical – Demineralized Bone Matrix 1-4g/1-4cc</Name><Size>1-4g/1-4cc</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2676</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA40</BillingCode><Name>Patella Bone-Tendon-Bone, Whole (Special) with Quadriceps, Frozen, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>6150</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA89</BillingCode><Name>Cortical Segment (Frozen) - various sizes</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3449</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA78</BillingCode><Name>Morsellised Bone Super Critical Fluid CO2 Treated  (Frozen) Packs of 7.5gm – 15gm</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2482</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA76</BillingCode><Name>Anterior Tibialis Tendon Super Critical Fluid CO2 Treated  (Frozen)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2967</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC77</BillingCode><Name>Demineralized Bone Matrix/Cortico-Cancellous Granules 1-4cc</Name><Size>1-4cc</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2700</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA59</BillingCode><Name>Tibia – Distal (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3473</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA56</BillingCode><Name>Femur – Whole Super Critical Fluid CO2 Treated  (Frozen)</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>9013</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA10</BillingCode><Name>Achillies Tendon, Frozen, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2971</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC62</BillingCode><Name>Femoral Head – Hemi Super Critical Fluid CO2 Treated  (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3499</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA96</BillingCode><Name>Femoral Head – Hemi Super Critical Fluid CO2 Treated (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3499</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC57</BillingCode><Name>Femoral Condyle Whole – Super Critical Fluid CO2 Treated  (Frozen)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3086</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC01</BillingCode><Name>Femoral Ring Super Critical CO2 Treated (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2182</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA44</BillingCode><Name>Tibia – Distal (Freeze Dried) - various sizes</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3743</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC21</BillingCode><Name>Tibial Strut Super Critical Fluid CO2 Treated (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3329</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC38</BillingCode><Name>Semitendonosis Tendon Super Critical Fluid CO2 Treated (Frozen)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2968</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA50</BillingCode><Name>Achilles Tendon, without Calcaneus, Freeze Dried, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2992</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC60</BillingCode><Name>Achilles Tendon Super Critical Fluid CO2 Treated (Frozen)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2611</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCA02</BillingCode><Name>Cancellous Plug Super Critical Fluid CO2 Treated (Freeze Dried)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1593</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA28</BillingCode><Name>AlloPatchHD Acellular Human Dermis, ≥ 25cm² ≤1.7mm, Dehydrated, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2777</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCA15</BillingCode><Name>Patella Tendon with Pre-Shaped Bone Blocks</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3804</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB29</BillingCode><Name>Humerus - Entire</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4188</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT63</BillingCode><Name>Bone - Milled 5-9 gr (10-18cc equivalent)</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3512</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT48</BillingCode><Name>Cortical Strut &gt;20cm</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4569</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB60</BillingCode><Name>Bone - Cancellous Crunch 60cc</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3232</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT33</BillingCode><Name>Humerus - Entire with rotator cuff</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>6173</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QBB37</BillingCode><Name>Hemipelvis - Part/Whole</Name><SupplierCode>40287</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>231769</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4000</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT66</BillingCode><Name>Milled Bone Pellets (x3)</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4692</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QBB60</BillingCode><Name>Autologous Bone (Not Processed)</Name><SupplierCode>40287</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>231769</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1514</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB69</BillingCode><Name>Tendon - Achilles with machined conical bone block</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3636</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB62</BillingCode><Name>Bone - Cancellous Crunch 15cc</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1169</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB35</BillingCode><Name>Tibia - Plateau (prox 1/3)</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3258</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB02</BillingCode><Name>Tendon - Achilles with bone block</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2969</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT35</BillingCode><Name>Humerus - Proximal</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2968</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>MAB05</BillingCode><Name>Fibula – Half (Proximal/Distal)</Name><SupplierCode>40287</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>231769</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4047</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB13</BillingCode><Name>Femoral Shaft - Middle Third</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3244</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB26</BillingCode><Name>Humeral Head Addition</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2059</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT01</BillingCode><Name>Tendon - Achilles with bone block</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4692</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCA11</BillingCode><Name>Achilles Tendon with Bone Block</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3923</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA17</BillingCode><Name>Tibial Strut Super Critical Fluid CO2 Treated (Frozen) - various sizes</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3515</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC78</BillingCode><Name>Demineralized Bone Matrix/Cortico-Cancellous Granules 5-9cc</Name><Size> 5-9cc</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3800</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA77</BillingCode><Name>Femoral Condyle Whole Super Critical Fluid CO2 Treated (Freeze Dried)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3541</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB24</BillingCode><Name>Hemipelvis - Complete</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>8663</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB70</BillingCode><Name>Tendon - Semi tendinosis</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2912</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB44</BillingCode><Name>Tibia - Whole with Patellar Tendon</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>7059</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB63</BillingCode><Name>Bone - Cortico-Cancellous Crunch (40/60) 60cc</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3232</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QBB32</BillingCode><Name>Fibula - Whole</Name><SupplierCode>40287</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>231769</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>5790</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT45</BillingCode><Name>Tibia - Proximal</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3445</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB36</BillingCode><Name>Tibia - Proximal</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3400</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT30</BillingCode><Name>Hemipelvis - Complete</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>8643</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT64</BillingCode><Name>Bone - Milled 10-19 gr (20-38cc equivalent)</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>5853</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB17</BillingCode><Name>Femoral Rings</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2140</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB23</BillingCode><Name>Hemipelvis - Tricortical iliac wedge</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1592</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB54</BillingCode><Name>Fibula - Segment</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3053</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB07</BillingCode><Name>Tibial Strut</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3515</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB06</BillingCode><Name>Radius</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4030</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT61</BillingCode><Name>Tendon - Achilles</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3392</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT25</BillingCode><Name>Fibula - Entire</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4322</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB59</BillingCode><Name>Femoral Hemi-condyle</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3027</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT03</BillingCode><Name>Bone Plug/Dowel - Cancellous</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4646</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT65</BillingCode><Name>Proximal Femur with Femoral Head</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>7778</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT34</BillingCode><Name>Humerus - Proximal with rotator cuff</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4452</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB16</BillingCode><Name>Femoral Head</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3499</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QBB76</BillingCode><Name>Cancellous Bone Block (Various Sizes, Custom), Frozen</Name><Size>Cut to shape with specifically designed precision instruments</Size><SupplierCode>40287</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>231769</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4760</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT46</BillingCode><Name>Tendon - Single (ant and post tibilias, FDL, EDL, hamstring, gracilis)</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4692</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB47</BillingCode><Name>Radius - Shaft</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3850</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB50</BillingCode><Name>Humeral Shaft</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4118</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB14</BillingCode><Name>Femur - Proximal third</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1690</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT38</BillingCode><Name>Bone - Milled 30-50g Freeze Dried</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>900</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB31</BillingCode><Name>Ligament - Medial</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2305</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QBB15</BillingCode><Name>Radius - Whole</Name><SupplierCode>40287</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>231769</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3955</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT08</BillingCode><Name>Bone - Milled 20-29gr (40-58cc equivalent)</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>9756</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB10</BillingCode><Name>Femur - Distal Half</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3703</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QBB45</BillingCode><Name>11-20g Milled Cancellous Bone (Various Grades), Frozen</Name><SupplierCode>40287</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>231769</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3018</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB73</BillingCode><Name>Tendon - Peroneus Longus</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2911</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB21</BillingCode><Name>Hemipelvis - Acetabulum</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3759</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB27</BillingCode><Name>Humerus - Proximal</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3690</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA72</BillingCode><Name>Cortical Strut</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2700</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB37</BillingCode><Name>Tibia – Proximal</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3663</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA21</BillingCode><Name>Femoral Strut</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3996</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA22</BillingCode><Name>Cancellous Cube – Super Critical Fluid CO2 Treated (Freeze Dried)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1593</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA28</BillingCode><Name>Morsellised Bone (Freeze Dried) (6-10cc)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2707</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB60</BillingCode><Name>Femoral Head – Hemi</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3773</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB98</BillingCode><Name>Hemi Patella Tendon with Bone Block</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3804</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD09</BillingCode><Name>Demineralized Bone Fibres / Cortico-Cancellous Granules (FD) 2-4cc</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2750</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB96</BillingCode><Name>Hemipelvis – Whole</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>9452</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA15</BillingCode><Name>Cortical Cancellous Block</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1674</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA66</BillingCode><Name>Morsellised Bone (Freeze Dried) (1-5cc)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2432</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QQ321</BillingCode><Name>Grafton DBF</Name><SupplierCode>40151</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>449685</ARTG></ARTGs><ChangeExplanation>New listing</ChangeExplanation><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>581</HumanTissueAmount><ActionFlag>Insert</ActionFlag><CycleStartDate>2024-08-08</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT68</BillingCode><Name>Milled Bone 20g</Name><Size>20g</Size><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>7805</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT11</BillingCode><Name>Cartilage - costal segments</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>318</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB55</BillingCode><Name>Femoral Shaft - Third</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2183</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB68</BillingCode><Name>Tendon - Patellar with machined conical bone plug</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3528</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB05</BillingCode><Name>Bone Plug/Dowel - Cancellous</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1632</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA43</BillingCode><Name>Femur – Proximal Super Critical Fluid CO2 Treated (Freeze Dried)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3969</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA52</BillingCode><Name>Femur – Proximal (Freeze Dried) - various sizes</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3996</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD22</BillingCode><Name>Pre-Shaped Hyaline Cartilage Segment</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2750</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB43</BillingCode><Name>Malleable Bone Segments</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2587</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA14</BillingCode><Name>Morsellised Bone (10-20 cc/g)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2707</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB45</BillingCode><Name>Patella Tendon with Pre-Shaped Bone Block Super Critical Fluid CO2 Treated</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3526</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB94</BillingCode><Name>Morsellised Bone Super Critical Fluid CO2 Treated (5-9g)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2482</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD30</BillingCode><Name>Freeze Dried Cortico-Cancellous Bone Granules 5-9cc</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2800</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA75</BillingCode><Name>Anterior Tibialis Tendon</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3125</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB79</BillingCode><Name>Tibia – Whole</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>7921</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA89</BillingCode><Name>Humerus – Distal Segment</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3075</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB34</BillingCode><Name>Femoral Head – Whole</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3773</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB12</BillingCode><Name>Patella Tendon with Bone Blocks - Whole</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3804</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA05</BillingCode><Name>Tendon Patch Super Critical Fluid CO2 Treated</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4000</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA59</BillingCode><Name>Patella Tendon with Bone Block – Whole with Quads – Super Critical Fluid CO2 Treated</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3879</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA68</BillingCode><Name>Malleable Bone Segments Super Critical Fluid CO2Treated</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2400</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB87</BillingCode><Name>Hemipelvis – Segment Super Critical Fluid CO2 Treated</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1708</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD10</BillingCode><Name>Demineralized Bone Fibres / Cortico-Cancellous Granules (FD) 5-9cc</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3800</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD34</BillingCode><Name>Acellular Dermal Matrix &lt;25cm² Thickness &lt;2.5mm</Name><Size>&lt;25cm² Thickness &lt;2.5mm</Size><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>408663</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2036</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA16</BillingCode><Name>Humeral Head – Whole (Freeze Dried) - various sizes</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2188</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA51</BillingCode><Name>Posterior Tibialis Tendon, Freeze Dried, Non-Irradiated</Name><Size>Various</Size><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>299298</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3350</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC63</BillingCode><Name>Cortical Strut Super Critical Fluid CO2 Treated (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2574</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA65</BillingCode><Name>Bone Dowel / Plug Super Critical Fluid CO2 Treated (Frozen) various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1663</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA43</BillingCode><Name>Quadriceps Tendon, without Bone Block, Frozen, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3172</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCA05</BillingCode><Name>Compressible Cancellous Block (FD)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3500</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC89</BillingCode><Name>Demineralized Bone Fibres (FZ) 5-9g</Name><Size>5-9g</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3800</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC51</BillingCode><Name>HTO Wedge (Freeze Dried) - Various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1610</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA09</BillingCode><Name>Peroneus Longus Tendon Super Critical Fluid CO2 Treated (Frozen)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2967</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA21</BillingCode><Name>Patella Bone-Tendon-Bone, Whole with Quadriceps, Frozen, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>5917</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA29</BillingCode><Name>Humerus – Proximal Super Critical Fluid CO2 Treated</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4061</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA43</BillingCode><Name>Femoral Ring Super Critical CO2 Treated (Freeze Dried)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2112</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA54</BillingCode><Name>Cancellous Cube</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1718</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB20</BillingCode><Name>Posterior Tibialis Tendon</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3125</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB02</BillingCode><Name>Malleable Bone Segments Super Critical Fluid CO2Treated (Freeze Dried)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2400</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA18</BillingCode><Name>Achilles Tendon, with Calcaneus, Frozen, Non-Irradiated</Name><Size>Various</Size><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>299298</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3557</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC16</BillingCode><Name>Femur – Distal Super Critical Fluid CO2 Treated  (Frozen)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3775</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC28</BillingCode><Name>Cortical Segment Super Critical Fluid CO2 Treated (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3206</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA26</BillingCode><Name>Humerus – Whole Super Critical Fluid CO2 Treated  (Frozen)</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4530</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA23</BillingCode><Name>Cortical Sheet Super Critical Fluid CO2 Treated (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1623</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC80</BillingCode><Name>Compressible Cancellous Strip (FZ)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3500</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC04</BillingCode><Name>Femoral Shaft (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2248</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA03</BillingCode><Name>Peroneus Longus Tendon, Frozen, Non-Irradiated</Name><Size>Various</Size><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>299298</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3152</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA32</BillingCode><Name>AlloPatchHD Acellular Human Dermis, ≤ 25cm² ≤1.7mm thick, Hydrated, Non- Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2391</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC05</BillingCode><Name>Fibular Ring (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1910</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC81</BillingCode><Name>Freeze Dried Cortico-Cancellous Bone Granules 2-4cc</Name><Size>2-4cc</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2450</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC15</BillingCode><Name>Cancellous Cube – Super Critical Fluid CO2 Treated (Freeze Dried) 3cm3 cubes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1663</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC20</BillingCode><Name>Cervical Spacers – Lordotic Super Critical Fluid CO2Treated (Frozen) 5mm – 9mm</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2065</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA07</BillingCode><Name>Anterior Tibialis Tendon, Freeze Dried, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3029</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>MVS23</BillingCode><Name>Autologous Skull Flap</Name><SupplierCode>40304</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1396</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA80</BillingCode><Name>Femoral Condyle Half – Super Critical Fluid CO2 Treated (Freeze Dried)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3086</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB61</BillingCode><Name>Bone - Cancellous Crunch 30cc</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2131</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB65</BillingCode><Name>Bone - Cortico-Cancellous Crunch (40/60) 15cc</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1169</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT21</BillingCode><Name>Femoral Hemi-condyle</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3528</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QBB01</BillingCode><Name>Tendon - Achilles with/without bone block</Name><SupplierCode>40287</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>231769</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4054</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT18</BillingCode><Name>Femur - Entire head removed</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>8480</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QBB77</BillingCode><Name>2-10g Milled Cancellous Bone (Various Grades), Frozen</Name><Size>Less than 15g</Size><SupplierCode>40287</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>231769</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2741</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA27</BillingCode><Name>Achilles Tendon with Pre-Shaped Bone Block Super Critical Fluid CO2 Treated</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4001</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA36</BillingCode><Name>Cortical Ring</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1840</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD18</BillingCode><Name>Pre-Shaped Cancellous/Cortical Block (Various Sizes)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3200</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB05</BillingCode><Name>Fibula – Whole</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>8780</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA85</BillingCode><Name>Cortical Segment</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3449</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB59</BillingCode><Name>Fascia Lata</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3923</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB44</BillingCode><Name>Humerus – Shaft</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4453</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA77</BillingCode><Name>Cancellous Plug</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1718</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB32</BillingCode><Name>Unicortical Cancellous Wedge (Freeze Dried)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1522</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA08</BillingCode><Name>Radius – Whole</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3541</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB56</BillingCode><Name>Morsellised Bone (Freeze Dried)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2211</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD36</BillingCode><Name>Acelluar Dermal Matrix &lt;25cm², Thickness &gt;2.5mm</Name><Size>&lt;25cm², Thickness &gt;2.5mm</Size><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>408663</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2505</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB27</BillingCode><Name>Achilles Tendon Super Critical Fluid CO2 Treated</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4001</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB83</BillingCode><Name>Humerus – Whole</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4530</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD16</BillingCode><Name>Patella Quadriceps Tendon with Patellar Bone</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3902</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB11</BillingCode><Name>Posterior Tibialis Tendon Super Critical Fluid CO2 Treated</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3187</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB86</BillingCode><Name>Morsellised Bone (5-9 cc/g)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2432</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA58</BillingCode><Name>Cervical Spacers - Lordotic</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1840</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA86</BillingCode><Name>Morsellised Bone – Super Critical Fluid CO2 Treated (1-4g)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2314</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD33</BillingCode><Name>Demineralized Bone Matrix/Cortico-Cancellous Granules 1-4cc</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2700</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA09</BillingCode><Name>Femoral Condyle Half – Super Critical Fluid CO2 Treated</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3016</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD23</BillingCode><Name>Cortical – Demineralized Bone Matrix 1-4g/1-4cc</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2676</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD01</BillingCode><Name>Demineralized Bone Fibres (FZ) 5-9g</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3800</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB14</BillingCode><Name>HTO Wedge</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1694</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB78</BillingCode><Name>Femoral Ring Super Critical Fluid CO2 Treated</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2112</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB68</BillingCode><Name>Femur – Proximal</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3996</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB50</BillingCode><Name>Unicortical Cancellous Block</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1674</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA50</BillingCode><Name>Ulna – Whole</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4008</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA78</BillingCode><Name>Cervical Spacers - Parallel Super Critical Fluid CO2Treated 5mm-9mm</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2065</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA99</BillingCode><Name>Unicortical Cancellous Wedge Super Critical Fluid CO2 Treated (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1623</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA12</BillingCode><Name>Cortical Strut (Freeze Dried) - various sizes</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2700</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC24</BillingCode><Name>Achilles Tendon with Pre-Shaped Bone Block Super Critical Fluid CO2 Treated  (Frozen)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3707</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA22</BillingCode><Name>ENHANCE® Demineralized Cortical Fiber, 5cc, Dehydrated, Non-Irradiated</Name><Size>5cc</Size><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>299298</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2845</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA11</BillingCode><Name>Revision Core, Various Sizes, Freeze Dried, Non-Irradiated</Name><Size>10-16mm Diameter  ≤36mm Length</Size><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>299298</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2960</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC32</BillingCode><Name>Humerus – Shaft Super Critical Fluid CO2 Treated (Frozen) - various sizes</Name><Size>See attached documents</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4453</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCA14</BillingCode><Name>Patella Quadriceps Tendon with Patellar Bone</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3902</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA04</BillingCode><Name>Cortical Ring Super Critical Fluid CO2 Treated (Freeze Dried) 5mm – 9mm</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1947</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA31</BillingCode><Name>AlloPatchHD Acellular Human Dermis, ≤ 25cm² ≤ 1.7mm, Dehydrated, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2391</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA81</BillingCode><Name>Fibular Ring (Freeze Dried) - various sizes</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2024</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA79</BillingCode><Name>Morsellised Bone (frozen) 15-30g</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2531</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC45</BillingCode><Name>Femoral Condyle Whole (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3473</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA45</BillingCode><Name>Fascia Lata, ≤ 60cm², Frozen, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2110</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA47</BillingCode><Name>Femoral Head Whole Super Critical Fluid CO2 Treated (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3499</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCA07</BillingCode><Name>Pre-Shaped Hyaline Cartilage Segment</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2750</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA91</BillingCode><Name>Hemi Patella Tendon with Bone Block Super Critical Fluid CO2 Treated  (Frozen)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3596</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA35</BillingCode><Name>Tricortical Cancellous Wedge Super Critical Fluid CO2 Treated (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1623</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA57</BillingCode><Name>Meniscus for Interpositional Arthroplasty, Frozen, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3067</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA17</BillingCode><Name>ENHANCE® Demineralized Cortical Fiber, 2.5cc, Dehydrated, Non-Irradiated</Name><Size>2.5cc</Size><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>299298</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2446</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QBB69</BillingCode><Name>Tendon – Various small (Tibialis Posterior/Anterior, EHL, Gracilis, Semitendinosus, Peroneus longus)</Name><SupplierCode>40287</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>231769</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3327</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB18</BillingCode><Name>Fibula - Entire</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>8052</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT02</BillingCode><Name>Tendon - Patellar split with bone plugs</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3445</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC10</BillingCode><Name>Cortical Cancellous Block (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1592</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA85</BillingCode><Name>Unicortical Cancellous Wedge Super Critical Fluid CO2 Treated (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1623</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC30</BillingCode><Name>Femoral Shaft Super Critical Fluid CO2 Treated (Frozen) - various sizes</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3598</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA36</BillingCode><Name>Patella Bone-Tendon-Bone, Hemi without Quadriceps, Frozen, Non-irradiated</Name><Size>Various</Size><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>299298</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4233</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA87</BillingCode><Name>Cancellous Block Super Critical Fluid CO2 Treated (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1663</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA50</BillingCode><Name>Humerus – Proximal Super Critical Fluid CO2 Treated  (Frozen)</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4061</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC29</BillingCode><Name>Hemipelvis – Segment Super Critical Fluid CO2 Treated (Freeze Dried)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1623</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCA03</BillingCode><Name>Unicortical Cancellous Block</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1674</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC84</BillingCode><Name>Semitendonosis Tendon</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3125</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA31</BillingCode><Name>Humerus – Distal Segment Super Critical Fluid CO2 Treated (Freeze Dried)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3206</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC23</BillingCode><Name>Malleable Bone Segments (Freeze Dried) various sizes</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3541</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC12</BillingCode><Name>Patella Tendon with Pre-Shaped Bone Block Super Critical Fluid CO2 Treated  (Frozen)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3596</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA48</BillingCode><Name>Tricortical Cancellous Wedge – Super Critical Fluid CO2 Treated  (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1623</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA46</BillingCode><Name>MPJ Arthrodesis Lengthening Graft Segment, Frozen, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2721</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA67</BillingCode><Name>Unicortical Cancellous Wedge  (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1592</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA66</BillingCode><Name>Morsellised Bone 7.5mg - 15mg</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2326</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QQ322</BillingCode><Name>Grafton DBF Inject</Name><SupplierCode>40151</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>449685</ARTG></ARTGs><ChangeExplanation>New listing</ChangeExplanation><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>581</HumanTissueAmount><ActionFlag>Insert</ActionFlag><CycleStartDate>2024-08-08</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QQ320</BillingCode><Name>Grafton DBF</Name><SupplierCode>40151</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>449685</ARTG></ARTGs><ChangeExplanation>New listing</ChangeExplanation><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1539</HumanTissueAmount><ActionFlag>Insert</ActionFlag><CycleStartDate>2024-08-08</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB19</BillingCode><Name>Cancellous Block</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1718</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD04</BillingCode><Name>Demineralized Bone Fibres / Cortico-Cancellous Granules (FZ) 5-9g</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3800</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC53</BillingCode><Name>Cervical Spacers - Lordotic (Frozen) 5mm – 9mm</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1910</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA72</BillingCode><Name>Tibia – Distal Super Critical Fluid CO2 Treated (Freeze Dried)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3541</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC91</BillingCode><Name>Demineralized Bone Fibres / Cortico-Cancellous Granules (FD) 5-9cc</Name><Size>5-9cc</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3800</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA24</BillingCode><Name>Cotton Wedge, Freeze dried, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2326</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA56</BillingCode><Name>Meniscus with Hemi Plateau, Lateral, Frozen, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>6047</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA54</BillingCode><Name>Fascia Lata, ≤ 60cm², Freeze Dried, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1821</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA44</BillingCode><Name>Fascia Lata, ≥ 60cm² - ≤100cm² ≥, Freeze Dried, Non-Irradiated</Name><Size>2.5cm x 25cm  5cm x 15cm</Size><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>299298</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2714</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC75</BillingCode><Name>Pre-Shaped Cancellous/Cortical Block (Various Sizes)</Name><Size>Various</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3200</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC96</BillingCode><Name>Bone allograft kit (Demineralized and Mineralized Bone Matrix) 1-4g / 1-4cc </Name><Size>1-4g / 1-4cc </Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4376</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC41</BillingCode><Name>Morsellised Bone Super Critical Fluid CO2 Treated  (Freeze Dried) Packs of 15 – 30cc</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2580</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC58</BillingCode><Name>Humerus – Strut (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2525</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>MVS05</BillingCode><Name>Femoral Head</Name><SupplierCode>40304</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2370</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA21</BillingCode><Name>Tibia – Proximal Super Critical Fluid CO2 Treated (Freeze Dried)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3466</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC02</BillingCode><Name>Cortical Cancellous Block Super Critical Fluid CO2Treated (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1623</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA29</BillingCode><Name>AlloPatchHD Acellular Human Dermis, ≥ 25cm² ≤ 1.7mm, Hydrated, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2591</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD26</BillingCode><Name>Moulded Demineralized Fibres (Large)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3750</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA52</BillingCode><Name>Semitendonosis Tendon</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3126</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA79</BillingCode><Name>Humeral Head – Whole Super Critical Fluid CO2 Treated</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2029</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB09</BillingCode><Name>Cervical Spacers - Lordotic (Freeze Dried)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1840</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD19</BillingCode><Name>Engineered Cancellous Block with DBM Component (Various Sizes)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3200</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA40</BillingCode><Name>Patella Tendon with Bone Block – Whole Super Critical Fluid CO2 Treated</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3879</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB39</BillingCode><Name>HTO Wedge – Super Critical Fluid CO2  Treated (Freeze Dried)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1571</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>RNB01</BillingCode><Name>Femoral Head</Name><SupplierCode>40306</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229914</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3000</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QBB48</BillingCode><Name>Tendon - Patella with bone block</Name><SupplierCode>40287</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>231769</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3798</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB37</BillingCode><Name>Tibia - Whole</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>5418</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB51</BillingCode><Name>Humeral Shaft - Half</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2162</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT20</BillingCode><Name>Femur - Proximal (shaft, trochanter, neck)</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>5210</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA34</BillingCode><Name>AlloPatchHD Acellular Human Dermis, ≤25cm² ≥1.8mm, Hydrated, Non-Irradiated</Name><Size>≤25cm²   ≥1.8mm Thick</Size><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>299299</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3578</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA75</BillingCode><Name>Humeral Head – Whole Super Critical Fluid CO2 Treated (Frozen)</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2029</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCA01</BillingCode><Name>Cancellous Plug</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1718</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA01</BillingCode><Name>Ulna – Whole Super Critical Fluid CO2 Treated  (Frozen)</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4008</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QQ323</BillingCode><Name>Grafton DBF Inject</Name><SupplierCode>40151</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>449685</ARTG></ARTGs><ChangeExplanation>New listing</ChangeExplanation><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1539</HumanTissueAmount><ActionFlag>Insert</ActionFlag><CycleStartDate>2024-08-08</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD14</BillingCode><Name>Compressible Cancellous Strip (FD)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3500</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB64</BillingCode><Name>Anterior Tibialis Tendon Super Critical Fluid CO2 Treated</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3187</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD07</BillingCode><Name>Demineralized Bone Fibres (FD) 5-9cc</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3800</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA19</BillingCode><Name>Cortical Sheet</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1522</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB35</BillingCode><Name>Fibular Ring</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2024</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD06</BillingCode><Name>Demineralized Bone Fibres (FD) 2-4cc</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2750</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV37</BillingCode><Name>Humeral Head</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3205</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>SYN09</BillingCode><Name>DBX Putty - 2.5cc</Name><SupplierCode>39932</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1800</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QBB43</BillingCode><Name>Humerus - Whole</Name><SupplierCode>40287</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>231769</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4606</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB66</BillingCode><Name>Tri Cortical Osteotomy</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1563</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>SYN11</BillingCode><Name>Bone, Cancellous Granules - 15cc</Name><SupplierCode>39932</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1250</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QBB08</BillingCode><Name>Tibia – Whole or Half (Proximal/Distal) with/without Patella</Name><SupplierCode>40287</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>231769</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4037</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>MAA10</BillingCode><Name>Grafton Demineralized Bone Matrix: Matrix Strips, 1cm x 20cm x 0.8cm (2)</Name><SupplierCode>40151</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229636</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1978</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV10</BillingCode><Name>Bone - Chips/cubes 80cc</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3071</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV34</BillingCode><Name>Hemipelvis - Tricortical iliac wedge</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2241</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV59</BillingCode><Name>Tendon - Peroneus Longus</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4116</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV62</BillingCode><Name>Bone – Cancellous Bone Matrix Lyophilised 20cc</Name><Size>20cc</Size><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2966</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA06</BillingCode><Name>Bone Dowel / Plug Super Critical Fluid CO2 Treated (Freeze Dried) various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1663</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>MAA02</BillingCode><Name>Grafton Plus Demineralized Bone Matrix: Paste, 1-5cc</Name><SupplierCode>40151</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229635</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>581</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>SYN13</BillingCode><Name>Bone, Cancellous Granules - 30cc</Name><SupplierCode>39932</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1700</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV17</BillingCode><Name>Cartilage - costal segments</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1214</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>MAA08</BillingCode><Name>Grafton Demineralized Bone Matrix: Flex, &gt;5cc to 10cc</Name><SupplierCode>40151</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229634</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1539</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV47</BillingCode><Name>Tibia - Condyles only</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3217</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AUB07</BillingCode><Name>Spinal Ring</Name><SupplierCode>40310</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1854</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV22</BillingCode><Name>Femur - Distal (Shaft &amp; Condyles)</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>6673</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC76</BillingCode><Name>Cortical – Demineralized Bone Matrix 5-10g/5-10cc</Name><Size>5-10g/5-10cc</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3100</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AUB09</BillingCode><Name>Tendon - Achilles with bone plug</Name><SupplierCode>40310</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2228</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV33</BillingCode><Name>Hemipelvis - iliac crest</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4863</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV31</BillingCode><Name>Hemipelvis - Acetabulum</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>5314</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AUB03</BillingCode><Name>Femoral Head</Name><SupplierCode>40310</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2354</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV08</BillingCode><Name>Cancellous Wedge</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1783</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA84</BillingCode><Name>Cortical Plate Super Critical Fluid CO2 Treated (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1623</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC86</BillingCode><Name>Demineralized Bone Fibres (FD) 2-4cc</Name><Size>2-4cc</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2750</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA86</BillingCode><Name>Tendon Patch (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3636</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC50</BillingCode><Name>Humerus – Proximal Super Critical Fluid CO2 Treated (Freeze Dried)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3762</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC88</BillingCode><Name>Demineralized Bone Fibres (FZ) 1-4g</Name><Size>1-4g</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2750</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA38</BillingCode><Name>Quadriceps Tendon, with 10.0mm Shaped Bone Blocks, Frozen, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2900</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC65</BillingCode><Name>Femoral Ring (Freeze Dried) - various sizes</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2277</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA08</BillingCode><Name>Cortical Sheet (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1592</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA64</BillingCode><Name>Tendon Patch Super Critical Fluid CO2 Treated (Frozen)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3707</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA26</BillingCode><Name>Proximal Metatarsal Lengthening Graft Segment, Freeze Dried, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2374</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA42</BillingCode><Name>Quadriceps Tendon, with Bone Block, Frozen, Non-Irradiated</Name><Size>various</Size><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>299298</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3791</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA74</BillingCode><Name>Cortical Ring (Freeze Dried)  5mm – 9mm</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1910</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA01</BillingCode><Name>Semitendinosis, Tendon, Frozen, Non-Irradiated</Name><Size>Various</Size><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>299298</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3591</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA27</BillingCode><Name>AlloPatchHD Acellular Human Dermis, ≤ 25cm²  ≥ 1.8mm, Dehydrated, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2733</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA23</BillingCode><Name>ENHANCE® Demineralized Cortical Fiber, 10cc, Dehydrated, Non-Irradiated</Name><Size>10cc</Size><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>299298</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3155</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC14</BillingCode><Name>Tibial Strut (Freeze Dried) - various sizes</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3515</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA19</BillingCode><Name>Cortical Plate (Frozen) various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1592</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA49</BillingCode><Name>Achilles Tendon, with Calcaneus, Freeze Dried, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3121</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>MAA06</BillingCode><Name>Grafton Demineralized Bone Matrix: Orthoblend, 10cc</Name><SupplierCode>40151</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229633</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1539</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA83</BillingCode><Name>Tibial Shaft</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>5416</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB52</BillingCode><Name>Femur – Distal</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3743</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD12</BillingCode><Name>Compressible Cancellous Block (FD)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3500</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA02</BillingCode><Name>Femoral Ring</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2277</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA92</BillingCode><Name>Bone Dowel / Plug (Freeze Dried)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1562</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB38</BillingCode><Name>Achilles Tendon with Pre-Shaped Bone Block</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3923</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA73</BillingCode><Name>Tricortical Cancellous Wedge</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1674</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA32</BillingCode><Name>Cervical Spacers - Parrallel</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1840</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB45</BillingCode><Name>Tibia - Ring</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1874</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT06</BillingCode><Name>Cortical Struts 10-15cm</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4075</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB99</BillingCode><Name>Demineralized Bone Fibres (FZ) 1-4g</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2750</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA87</BillingCode><Name>Femoral Condyle Whole</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3743</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA62</BillingCode><Name>Humeral Head – Whole</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2188</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB15</BillingCode><Name>Humerus – Proximal</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3620</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA35</BillingCode><Name>Cancellous Plug Super Critical Fluid CO2 Treated (Freeze Dried)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1593</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA51</BillingCode><Name>Cortical Plate Super Critical Fluid CO2 Treated (Freeze Dried)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1553</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB09</BillingCode><Name>Fascia Lata</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1229</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT29</BillingCode><Name>Hemipelvis - Acetabulum</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3339</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT28</BillingCode><Name>Fibula - Segment</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4013</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB07</BillingCode><Name>Ulna</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3714</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB63</BillingCode><Name>Patella Tendon with Pre-Shaped Bone Block Super Critical Fluid CO2 Treated</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3879</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT24</BillingCode><Name>Femoral Rings</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1908</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QBB23</BillingCode><Name>Bone – Cortical Segment (Incl. Tibial and Femoral), Frozen</Name><SupplierCode>40287</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>231769</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3598</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT44</BillingCode><Name>Tibia - Proximal with Patella &amp; Tendon</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229915</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>6173</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QBB25</BillingCode><Name>Femur – Whole or Half (Proximal/Distal)</Name><SupplierCode>40287</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>231769</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4808</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA16</BillingCode><Name>Peroneus Longus Tendon Super Critical Fluid CO2 Treated</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3187</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB67</BillingCode><Name>Tendon - Tibialis Anterior</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2911</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD29</BillingCode><Name>Freeze Dried Cortico-Cancellous Bone Granules 2-4cc</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2450</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD44</BillingCode><Name>Meniscus</Name><Size>one unit</Size><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2895</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD17</BillingCode><Name>Spinal Anterior Longitudonal Ligament Patch</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4023</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD32</BillingCode><Name>Bone allograft kit (Demineralized and Mineralized Bone Matrix) 1-4g / 1-4cc</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4376</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB18</BillingCode><Name>Humerus – Strut Super Critical Fluid CO2 Treated (Freeze Dried)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2504</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA63</BillingCode><Name>Bone Dowel / Plug Super Critical Fluid CO2 Treated</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1752</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA90</BillingCode><Name>Morsellised Bone (1-4 cc/g)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2268</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD20</BillingCode><Name>Bone allograft kit (Demineralized and Mineralized Bone Matrix) 5-10g / 5-10cc</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>6193</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB93</BillingCode><Name>Gracilis Tendon</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2398</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB97</BillingCode><Name>Achilles Tendon with Bone Block Super Critical Fluid CO2 Treated</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4001</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB10</BillingCode><Name>Fibular Ring Super Critical Fluid CO2 Treated (Freeze Dried)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1877</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD27</BillingCode><Name>Demineralized Bone Matrix/Cortico-Cancellous Granules 5-9cc</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3800</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB69</BillingCode><Name>Cortical Sheet Super Critical Fluid CO2 Treated (Freeze Dried)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1553</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB88</BillingCode><Name>Cancellous Block Super Critical Fluid CO2 Treated (Freeze Dried)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1593</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA71</BillingCode><Name>Semitendonosis Tendon Super Critical Fluid CO2 Treated</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3188</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB92</BillingCode><Name>Achilles Tendon</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3923</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB74</BillingCode><Name>Patella Tendon with Pre-Shaped Bone Blocks</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3804</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA95</BillingCode><Name>Achilles Tendon with Bone Block</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3923</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC49</BillingCode><Name>Cortical Segment (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3145</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA02</BillingCode><Name>Semitendinosus Tendon, Freeze Dried, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2910</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA51</BillingCode><Name>Posterior Tibialis Tendon Super Critical Fluid CO2 Treated (Frozen)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2967</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC46</BillingCode><Name>Femoral Head – Hemi (Freeze Dried) - various sizes</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3773</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA23</BillingCode><Name>Femur – Whole</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>9013</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA41</BillingCode><Name>Posterior Tibialis Tendon, Frozen, Non-Irradiated</Name><Size>Various</Size><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>299298</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3499</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA63</BillingCode><Name>Gracilis Tendon (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2250</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA14</BillingCode><Name>Brachymetatarsal Lengthening Graft Segment, Freeze Dried, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2404</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC09</BillingCode><Name>HTO Wedge Super Critical Fluid CO2 Treated  (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1641</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA60</BillingCode><Name>Femoral Condyle Whole (Frozen) - various sizes</Name><Size>See attached documents</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3743</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA62</BillingCode><Name>Unicortical Cancellous Wedge (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1592</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA28</BillingCode><Name>Fascia Lata Super Critical Fluid CO2 Treated  (Frozen)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1253</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC61</BillingCode><Name>Hemipelvis – Segment (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1592</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB91</BillingCode><Name>Fascia Lata Super Critical Fluid CO2 Treated</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4001</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD35</BillingCode><Name>Acellular Dermal Matrix &gt;26cm², Thickness &lt;2.5mm</Name><Size>&gt;26cm², Thickness &lt;2.5mm</Size><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>408663</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3257</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA06</BillingCode><Name>Peroneus Longus Tendon</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3125</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QBB75</BillingCode><Name>Demineralised Bone Matrix 0.5-2cc, Freeze Dried</Name><Size>2g</Size><SupplierCode>40287</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>231769</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2197</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB64</BillingCode><Name>Bone - Cortico-Cancellous Crunch (40/60) 30cc</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2131</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV48</BillingCode><Name>Tibia - Distal</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4030</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV36</BillingCode><Name>Humerus - Proximal</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4962</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV64</BillingCode><Name>Bone - Cancellous Bone Matrix Lyophilised 1 - 5cc</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1900</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV45</BillingCode><Name>Tibia - Proximal 16-25cm</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4489</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV55</BillingCode><Name>Bone - Demineralised Bone Matrix, Lyophilised 10cc</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3737</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>RNB02</BillingCode><Name>Autologous Skull Flap</Name><SupplierCode>40305</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1470</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>MAA07</BillingCode><Name>Grafton Demineralized Bone Matrix: Flex, 1.5cm x 1.5cm x 0.25cm</Name><SupplierCode>40151</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229634</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>581</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA83</BillingCode><Name>Cortical Sheet Super Critical Fluid CO2 Treated (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1623</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA19</BillingCode><Name>Achilles Tendon, with Shaped Bone Blocks, Frozen, Non-Irradiated</Name><Size>Various</Size><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>299298</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4080</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AUB04</BillingCode><Name>Bone – Cortico-Cancellous Crunch &lt;30g</Name><SupplierCode>40310</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2070</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV12</BillingCode><Name>Bone - Milled 80cc</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4831</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>SYN10</BillingCode><Name>Bone, Cancellous Chips - 15cc</Name><SupplierCode>39932</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1250</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV46</BillingCode><Name>Femoral Hemi-condyle</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2501</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV65</BillingCode><Name>Tendon - Patella with Quadriceps</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4213</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA25</BillingCode><Name>Patella Tendon with Bone Block – Whole with Quads</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3804</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB57</BillingCode><Name>Femoral Shaft</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3598</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA84</BillingCode><Name>Tibia – Distal</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3743</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD03</BillingCode><Name>Demineralized Bone Fibres / Cortico-Cancellous Granules (FZ) 1-4g</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2750</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT32</BillingCode><Name>Hemipelvis - Tricortical iliac wedge</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1590</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>PBT15</BillingCode><Name>Fascia Lata - Large (15cm x 10cm)</Name><SupplierCode>40289</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1685</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA37</BillingCode><Name>Humerus – Strut</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2700</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB08</BillingCode><Name>Femoral Condyle Half</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3253</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA57</BillingCode><Name>Gracilis Tendon Super Critical Fluid CO2 Treated</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2445</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD25</BillingCode><Name>Moulded Demineralized Fibres (Small)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3000</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD13</BillingCode><Name>Compressible Cancellous Block (FZ)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3500</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD40</BillingCode><Name>Acellular Dermal Matrix &gt;26cm² Thickness &gt;2.5mm</Name><Size>&gt;26cm² Thickness &gt;2.5mm</Size><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>408663</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>6514</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV09</BillingCode><Name>Bone - Chips/cubes 40cc</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1770</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA97</BillingCode><Name>Cortical Cancellous Block Super Critical Fluid CO2Treated (Freeze Dried)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1553</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD15</BillingCode><Name>Compressible Cancellous Strip (FZ)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3500</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA88</BillingCode><Name>Tendon Patch</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3923</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV39</BillingCode><Name>Meniscus with Ligaments</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3984</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV54</BillingCode><Name>Bone - Demineralised Bone Matrix, Lyophilised 1-5cc</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2328</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV43</BillingCode><Name>Rib (5cm)</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1367</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV61</BillingCode><Name>Tendon - Tibialis Posterior</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4116</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AUB06</BillingCode><Name>Tibia – Proximal third</Name><SupplierCode>40310</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2562</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV24</BillingCode><Name>Femoral Shaft - Middle Third</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3967</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV30</BillingCode><Name>Fibular Shaft</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4058</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV57</BillingCode><Name>Tendon - Tibialis Anterior</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4116</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA27</BillingCode><Name>Cancellous Block Super Critical Fluid CO2 Treated (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1663</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC37</BillingCode><Name>Cervical Spacers - Parallel Super Critical Fluid CO2 Treated (Freeze Dried) 5mm – 9mm</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2065</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC25</BillingCode><Name>Humerus – Strut Super Critical Fluid CO2 Treated  (Frozen)</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2574</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC13</BillingCode><Name>Cancellous Cube (Freeze Dried) 3cm3 cubes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1632</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA15</BillingCode><Name>Femoral Condyle Half (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3027</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC95</BillingCode><Name>Moulded Demineralized Fibres (Small) </Name><Size>Small</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3000</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CAA55</BillingCode><Name>Fascia Lata,  ≥ 120cm² ≤ 180cm², Freeze-Dried, Non-Irradiated</Name><SupplierCode>40003</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2259</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC42</BillingCode><Name>Hemipelvis – Segment (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1592</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV51</BillingCode><Name>Femur - Proximal with femoral head</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>6451</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>MAA09</BillingCode><Name>Grafton Demineralized Bone Matrix: Matrix PLF, 2.5cm x 5cm x 0.8cm (2)</Name><SupplierCode>40151</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229636</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1539</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV23</BillingCode><Name>Femur - Entire</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>10772</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV26</BillingCode><Name>Femoral head</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4387</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>MAA03</BillingCode><Name>Grafton Demineralized Bone Matrix: Orthoblend, 15cc</Name><SupplierCode>40151</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229633</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1978</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>MAA05</BillingCode><Name>Grafton Demineralized Bone Matrix: Orthoblend, 5cc</Name><SupplierCode>40151</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229633</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>581</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>CSA01</BillingCode><Name>Femoral Head</Name><Size>Single, whole femoral head</Size><SupplierCode>40244</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>233823</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3367</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV35</BillingCode><Name>Humerus - Proximal with rotator cuff</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4771</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV19</BillingCode><Name>Radius</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>5508</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>SYN01</BillingCode><Name>Bone - Demineralised Bone Matrix, DBX Putty, 5cc</Name><SupplierCode>39932</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2650</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV06</BillingCode><Name>Tendon - Achilles with bone block</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4131</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AUB10</BillingCode><Name>Tendon</Name><SupplierCode>40310</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2184</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV41</BillingCode><Name>Patella</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2209</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>MAA11</BillingCode><Name>Grafton Demineralized Bone Matrix: Matrix Strips, 1cm x 10cm x 0.8cm (2)</Name><SupplierCode>40151</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229636</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1539</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NBB72</BillingCode><Name>Tendon - Patellar with Quads</Name><SupplierCode>40292</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2911</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV42</BillingCode><Name>Tendon - Patellar with bone plugs</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4200</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB28</BillingCode><Name>Cervical Spacers – Lordotic Super Critical Fluid CO2Treated 5mm-9mm</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2065</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV60</BillingCode><Name>Tendon - EHL</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4116</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV05</BillingCode><Name>Tendon - Achilles</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2483</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>MAA01</BillingCode><Name>Grafton Plus Demineralized Bone Matrix: Paste, 10cc</Name><SupplierCode>40151</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229635</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1539</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV40</BillingCode><Name>Meniscus</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2466</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC08</BillingCode><Name>Femoral Head – Whole Super Critical Fluid CO2 Treated  (Frozen) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3499</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA82</BillingCode><Name>HTO Wedge (Frozen) - various sizes</Name><Size>Please see attachments</Size><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1694</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA88</BillingCode><Name>Humerus – Shaft Super Critical Fluid CO2 Treated  (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4198</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV38</BillingCode><Name>Ligament - Medial</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3406</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV44</BillingCode><Name>Tibia - Proximal 7-15cm</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4637</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NAA39</BillingCode><Name>Bone Dowel / Plug (Freeze Dried) - various sizes</Name><SupplierCode>39929</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1632</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AUB02</BillingCode><Name>Bone - Milled Femoral Head</Name><SupplierCode>40310</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2457</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV49</BillingCode><Name>Humerus - Distal</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4130</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB80</BillingCode><Name>Cortical Ring Super Critical Fluid CO2 Treated (Freeze Dried)</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1877</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>MAA13</BillingCode><Name>Grafton Demineralized Bone Matrix: Flex, 2.5cm x 5cm</Name><SupplierCode>40151</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>229634</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1099</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>SYN02</BillingCode><Name>Bone - Demineralised Bone Matrix, DBX Putty, 10cc</Name><SupplierCode>39932</SupplierCode><CategoryID>107576</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3400</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>TBV20</BillingCode><Name>Ulna</Name><SupplierCode>40307</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>238244</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>5125</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ABB26</BillingCode><Name>Cortical Plate</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1522</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>AAA70</BillingCode><Name>Hemi Patella Tendon with Bone Block Super Critical Fluid CO2 Treated</Name><SupplierCode>40311</SupplierCode><CategoryID>107576</CategoryID><ARTGs><ARTG>277310</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3879</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QEB02</BillingCode><Name>Sclera – Whole</Name><SupplierCode>40287</SupplierCode><CategoryID>107577</CategoryID><ARTGs><ARTG>375315</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>650</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>LEM04</BillingCode><Name>Cornea for Endothelial Lamellar Keratoplasty</Name><SupplierCode>40299</SupplierCode><CategoryID>107577</CategoryID><ARTGs><ARTG>234997</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4000</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>MAB03</BillingCode><Name>Cornea - Lamellar </Name><SupplierCode>40287</SupplierCode><CategoryID>107577</CategoryID><ARTGs><ARTG>375315</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2610</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC73</BillingCode><Name>Cornea For Lamellar</Name><SupplierCode>39929</SupplierCode><CategoryID>107577</CategoryID><ARTGs><ARTG>232298</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>1682</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC71</BillingCode><Name>Cornea</Name><SupplierCode>39929</SupplierCode><CategoryID>107577</CategoryID><ARTGs><ARTG>232298</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2801</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>LEM01</BillingCode><Name>Cornea</Name><SupplierCode>40299</SupplierCode><CategoryID>107577</CategoryID><ARTGs><ARTG>234997</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3200</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QEB01</BillingCode><Name>Cornea</Name><SupplierCode>40287</SupplierCode><CategoryID>107577</CategoryID><ARTGs><ARTG>375315</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3161</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>LEW02</BillingCode><Name>Sclera</Name><SupplierCode>40301</SupplierCode><CategoryID>107577</CategoryID><ARTGs><ARTG>239107</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>295</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>LEW01</BillingCode><Name>Cornea</Name><SupplierCode>40301</SupplierCode><CategoryID>107577</CategoryID><ARTGs><ARTG>239107</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2950</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>LEM02</BillingCode><Name>Sclera</Name><SupplierCode>40299</SupplierCode><CategoryID>107577</CategoryID><ARTGs><ARTG>234997</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>500</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>SAA03</BillingCode><Name>Sclera</Name><SupplierCode>40284</SupplierCode><CategoryID>107577</CategoryID><ARTGs><ARTG>235477</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>300</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>LAB01</BillingCode><Name>FROZEN CORNEA</Name><Size>one corneo-scleral disc - frozen</Size><SupplierCode>40298</SupplierCode><CategoryID>107577</CategoryID><ARTGs><ARTG>239107</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>550</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>MAB01</BillingCode><Name>Cornea for Endothelial Keratoplasty</Name><Size>Variable</Size><SupplierCode>40287</SupplierCode><CategoryID>107577</CategoryID><ARTGs><ARTG>375315</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3777</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>MAB04</BillingCode><Name>Sclera - Patch</Name><SupplierCode>40287</SupplierCode><CategoryID>107577</CategoryID><ARTGs><ARTG>375315</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>434</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>SAA01</BillingCode><Name>Cornea</Name><SupplierCode>40284</SupplierCode><CategoryID>107577</CategoryID><ARTGs><ARTG>235477</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2950</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>LEW03</BillingCode><Name>Cornea for Endothelial Keratoplasty</Name><SupplierCode>40301</SupplierCode><CategoryID>107577</CategoryID><ARTGs><ARTG>239107</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3525</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>LEM05</BillingCode><Name>Cornea Preloaded for Endothelial Keratoplasty</Name><Size>N/A -  DMEK tissue itself is 12 microns thick and trephined to 8mm</Size><SupplierCode>40299</SupplierCode><CategoryID>107577</CategoryID><ARTGs><ARTG>234997</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>4800</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC72</BillingCode><Name>Sclera</Name><SupplierCode>39929</SupplierCode><CategoryID>107577</CategoryID><ARTGs><ARTG>232298</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>420</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>SAA02</BillingCode><Name>Cornea for Endothelial Keratoplasty</Name><SupplierCode>40284</SupplierCode><CategoryID>107577</CategoryID><ARTGs><ARTG>235477</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3525</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC74</BillingCode><Name>Cornea for Endothelial Keratoplasty</Name><SupplierCode>39929</SupplierCode><CategoryID>107577</CategoryID><ARTGs><ARTG>232298</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3300</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>SYN03</BillingCode><Name>Skin &lt; 25cm² - acellular dermal matrix allograft from human origin</Name><SupplierCode>39932</SupplierCode><CategoryID>107578</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2200</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC66</BillingCode><Name>Skin</Name><Size>&lt;50 cm²</Size><SupplierCode>39929</SupplierCode><CategoryID>107578</CategoryID><ARTGs><ARTG>303206</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>206</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD41</BillingCode><Name>Acellular Dermal Matrix 121 to 180cm²</Name><Size>121 to 180cm²</Size><SupplierCode>40311</SupplierCode><CategoryID>107578</CategoryID><ARTGs><ARTG>408663</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>8142</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD38</BillingCode><Name>Acellular Dermal Matrix 26 to 60cm²</Name><Size> 26 to 60cm²</Size><SupplierCode>40311</SupplierCode><CategoryID>107578</CategoryID><ARTGs><ARTG>408663</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3257</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC67</BillingCode><Name>Skin</Name><Size>51 to 80 cm²</Size><SupplierCode>39929</SupplierCode><CategoryID>107578</CategoryID><ARTGs><ARTG>303206</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>330</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>SYN05</BillingCode><Name>Skin 61 to 120cm² - acellular dermal matrix allograft from human origin</Name><SupplierCode>39932</SupplierCode><CategoryID>107578</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>5700</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>SYN07</BillingCode><Name>Skin &gt; 300cm² - acellular dermal matrix allograft from human origin</Name><SupplierCode>39932</SupplierCode><CategoryID>107578</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>27000</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>SYN04</BillingCode><Name>Skin 26 to 60cm² - acellular dermal matrix allograft from human origin</Name><SupplierCode>39932</SupplierCode><CategoryID>107578</CategoryID><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>3500</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC70</BillingCode><Name>Skin</Name><Size>151 to 200 cm²</Size><SupplierCode>39929</SupplierCode><CategoryID>107578</CategoryID><ARTGs><ARTG>303206</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>826</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>SYN14</BillingCode><Name>Skin 121 to 180cm² - acellular dermal matrix allograft from human origin</Name><SupplierCode>39932</SupplierCode><CategoryID>107578</CategoryID><ARTGs><ARTG>211608</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>9900</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>QBB73</BillingCode><Name>Skin 50-200cm² (graft from human origin, multiple sizes), Frozen</Name><SupplierCode>40287</SupplierCode><CategoryID>107578</CategoryID><ARTGs><ARTG>230058</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>933</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD43</BillingCode><Name>Acellular Dermal Matrix 181 to 300cm²</Name><Size>181 to 300cm²</Size><SupplierCode>40311</SupplierCode><CategoryID>107578</CategoryID><ARTGs><ARTG>408663</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>13028</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC68</BillingCode><Name>Skin</Name><Size>81 to 110 cm²</Size><SupplierCode>39929</SupplierCode><CategoryID>107578</CategoryID><ARTGs><ARTG>303206</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>454</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>NCC69</BillingCode><Name>Skin</Name><Size>111 to 150 cm²</Size><SupplierCode>39929</SupplierCode><CategoryID>107578</CategoryID><ARTGs><ARTG>303206</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>619</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>SYN06</BillingCode><Name>Skin 181 to 300cm² - acellular dermal matrix allograft from human origin</Name><SupplierCode>39932</SupplierCode><CategoryID>107578</CategoryID><ARTGs><ARTG>211608</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>14000</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD42</BillingCode><Name>Acellular Dermal Matrix 61 to 120cm² Dermal Matrix 61 to 120cm²</Name><Size>61cm² to 120cm²</Size><SupplierCode>40311</SupplierCode><CategoryID>107578</CategoryID><ARTGs><ARTG>408663</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>5428</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD39</BillingCode><Name>Acellular Dermal Matrix &gt; 300cm²</Name><Size>&gt; 300cm²</Size><SupplierCode>40311</SupplierCode><CategoryID>107578</CategoryID><ARTGs><ARTG>408663</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>23569</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Human tissue</ItemType><BillingCode>ADD37</BillingCode><Name>Acellular Dermal Matrix &lt;25cm²</Name><Size>&lt;25cm²</Size><SupplierCode>40311</SupplierCode><CategoryID>107578</CategoryID><ARTGs><ARTG>408663</ARTG></ARTGs><MinimumBenefit>0</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>2036</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL087</BillingCode><Name>Ventilation tube</Name><Description>PacifiC Ventilation tube</Description><Size>Various sizes</Size><SupplierCode>40122</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><Suffix>Antibiotic</Suffix><ARTGs><ARTG>146612</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL090</BillingCode><Name>Ventilation tube</Name><Description>HydroxylVent tube</Description><Size>Various sizes</Size><SupplierCode>40122</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><Suffix>Antibiotic</Suffix><ARTGs><ARTG>146612</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL086</BillingCode><Name>Ventilation Tube</Name><Description>Ultrasil Silicon Ventilation tube</Description><Size>Various sizes</Size><SupplierCode>40122</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><Suffix>Antibiotic</Suffix><ARTGs><ARTG>146612</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CK011</BillingCode><Name>Exmoor Plastics Ear Vent Drains - Teflon Shephards Drain with wire grasping feature</Name><Description>Teflon Shephards Drain with wire</Description><Size>0.97 mm lumen dia x 2.08 mm inner flange dia x 2.08 mm outer flange dia x 1.42 inter flange. 2.41 mm total length</Size><SupplierCode>39965</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><ARTGs><ARTG>133977</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BQ004</BillingCode><Name>Ventilation Tubes / Grommet</Name><Description>a) Tubingen Gold Type 
b) Tubingen Titanium Type 
c) T Tube 
d) Reuter Bobbin Type 
e) Paparella Type
f) Collar Button Type 
g) Star Tube 
h) Bevel Buttton Tube
i) Straight Tube 
j) Armstrong Type 
k) Shepard Type 
l) Donaldson Type
m) Angular Type
n) Myringotomy Tube with Trocar
o) Ventilation Tubes with Eyelets
p) Minimal Type</Description><Size>a) I.D.  1.25mm w/w, I.D.1.25mm wo/w, I.D. 1.5mm wo/w 
b) one size only 
c) L- 6, 7.5, 12 
d) I.F.O.D 2.5mm, 2.7mm 
e) one size only  
f) one side only 
g) one size only 
h) one size only 
i) i.d.-0.9mm,1.1mm,1.15mm 
j) L-3.8mm, 3.7mm, 10mm 
k) L- 2.2mm w/t, 2.2mm wo/t,2.4mm w/t 
l) S- one size only, F one size only
m) one size only
n) Silver or Titanium
o) one or two
p) one size only</Size><SupplierCode>40058</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><ARTGs><ARTG>120972</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CK007</BillingCode><Name>Exmoor Plastics Ear Vent Drains  -  Collar Button</Name><Description>Teflon </Description><Size>1.14 mm lumen dia x 3.0 mm inner flange dia x 3.0 mm outer flange dia x 1.27 inter flange. 1.78 mm total length</Size><SupplierCode>39965</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><ARTGs><ARTG>133977</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RC009</BillingCode><Name>Ventilation Tubes - Silicone</Name><Description>Armstrong Grommet, Donaldson w &amp; w/o Tab, Paparella 1 and Paparella 2 (1.5mm)</Description><Size>1.1mm &amp; 1.5mm lumen</Size><SupplierCode>39997</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><ARTGs><ARTG>182921</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CK009</BillingCode><Name>Exmoor Plastics Ear Vent Drains - Collar Button </Name><Description>Teflon </Description><Size>1.75 mm lumen dia x 2.85 mm inner flange dia x 2.85 mm outer flange dia x 0.95 inter flange. 1.46 mm total length</Size><SupplierCode>39965</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><ARTGs><ARTG>133977</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET076</BillingCode><Name>Triune Vent Tube</Name><Description>A tympanostomy (myringotomy) tube</Description><Size>Lumen size 0.76mm - 1.35mm</Size><SupplierCode>40085</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><ARTGs><ARTG>170820</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ309</BillingCode><Name>KURZ Ventilation Tubes / Grommet</Name><Description>KURZ Ventilation Tube Tuebingen Type Gold Platinum, 1.25mm / Size 1 MR Conditional
KURZ Ventilation Tube Tuebingen Type with Retention Wire Gold Platinum, 1.25mm / Size 1 MR Unsafe
KURZ Ventilation Tube Tuebingen Type Gold Platinum, 1.50mm / Size 2 MR Conditional
KURZ Ventilation Tube Tuebingen Type with Retention Wire Gold Platinum, 1.50mm / Size 2 MR Unsafe
KURZ Ventilation Tube Tuebingen Type Gold-plated Ag, 1.25mm / Size 1 MR Conditional
KURZ Ventilation Tube Tuebingen Type with Retention Wire Gold-plated Ag, 1.25mm / Size 1 MR Unsafe
KURZ Ventilation Tube Tuebingen Type Gold-plated Ag, 1.50mm / Size 2 MR Conditional
KURZ Ventilation Tube Tuebingen Type with Retention Wire Gold-plated Ag, 1.50mm / Size 2 MR Unsafe
KURZ Ventilation Tube Tuebingen Type Titanium, 1.25mm / Size 1 MR Conditional
KURZ Ventilation Tube Tuebingen Type with Retention Wire Titanium, 1.25mm / Size 1 MR Unsafe
KURZ Ventilation Tube Tuebingen Type Titanium, 1.50mm / Size 2 MR Conditional
KURZ Ventilation Tube Tuebingen Type with Retention Wire Titanium, 1.50mm / Size 2 MR Unsafe
KURZ Ventilation Tube Tuebingen Type Titanium, 1.00mm / Size 0 MR Conditional
KURZ Ventilation Tube Beveled Type Gold Platinum, 0.75mm / Size 0 MR Conditional
KURZ Ventilation Tube Beveled Type Gold Platinum, 1.25mm / Size 1 MR Conditional
KURZ Ventilation Tube Beveled Type Gold Platinum, 1.50mm / Size 2 MR Conditional
KURZ Ventilation Tube Long-Term, 1 Eye Gold Platinum, 1.50mm MR Conditional
KURZ Ventilation Tube Long-Term, 2 Eyes Gold Platinum, 1.50mm MR Conditional
KURZ Ventilation Tube Minimal Gold-plated Ag, 0.60mm MR Unsafe
KURZ Ventilation Tube Trocar Gold-plated Silver, 1.25mm / Size 1 MR Conditional
KURZ Ventilation Tube Trocar Titanium, 1.25mm / Size 1 MR Conditional</Description><Size>0.60mm, 0.75mm, 1.00mm, 1.25mm, 1.50mm</Size><SupplierCode>40260</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><ARTGs><ARTG>345901</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI078</BillingCode><Name>Medtronic Ventilation Tubes</Name><Description>Medium to Long term vent tube</Description><Size>0.76-1.52mm x0.9-12.0mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><ARTGs><ARTG>126695</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL085</BillingCode><Name>Ventilation tubes</Name><Description>Silicon Ventilation tubes</Description><Size>Various sizes</Size><SupplierCode>40122</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><ARTGs><ARTG>146612</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL083</BillingCode><Name>Ventilation tubes</Name><Description>Titanium ventilation tubes</Description><Size>Various sizes</Size><SupplierCode>40122</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><ARTGs><ARTG>146612</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL082</BillingCode><Name>Ventilation tubes</Name><Description>Fluoroplastics Ventilation tubes</Description><Size>Various sizes</Size><SupplierCode>40122</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><ARTGs><ARTG>146612</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CK012</BillingCode><Name>Exmoor Plastics Ear Vent Drains - Donaldson Grommet</Name><Description>With tab, silicone rubber</Description><Size>1.1 mm lumen dia x 2.25 mm inner flange dia x 2.25 mm outer flange dia x 0.76 inter flange. 2.25 mm total length</Size><SupplierCode>39965</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><ARTGs><ARTG>133977</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CK005</BillingCode><Name>Exmoor Plastics Ear Vent Drains -  Reuter Bobbin </Name><Description>Without hole, teflon</Description><Size>1.14 mm lumen dia x 2.54 mm inner flange dia x 2.54 mm outer flange dia x 0.76 inter flange. 1.52mm total length</Size><SupplierCode>39965</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><ARTGs><ARTG>133977</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CK006</BillingCode><Name>Exmoor Plastics Ear Vent Drains -  Collar Button</Name><Description>Teflon </Description><Size>1.14 mm lumen dia x 2.24 mm inner flange dia x 2.24 mm outer flange dia x 1.27 inter flange. 1.78 mm total length</Size><SupplierCode>39965</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><ARTGs><ARTG>133977</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RC006</BillingCode><Name>Ventilation Tubes - Shepherd</Name><Description>Teflon, w or w/o wire</Description><Size>1.15mm lumen</Size><SupplierCode>39997</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><ARTGs><ARTG>182921</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC268</BillingCode><Name>Medtronic Vent Tubes</Name><Description>Fluoroplastic</Description><Size>0.76 - 1.52mm x 2.1 - 9.5mm x 1.0 - 12.0mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><ARTGs><ARTG>126695</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI077</BillingCode><Name>Medtronic  Ventilation Tube</Name><Description>Medium to long term, antimicrobial vent tube</Description><Size>1.02 - 1.52mm x 1.3-12.0mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><Suffix>Antibiotic</Suffix><ARTGs><ARTG>126695</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC269</BillingCode><Name>Medtronic Vent Tubes</Name><Description>Activent Antimicrobial Ventilation Tube</Description><Size>1.02 - 1.27mm x 0.9 - 2.4mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><Suffix>Antibiotic</Suffix><ARTGs><ARTG>126695</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC927</BillingCode><Name>Medtronic Vent Tube</Name><Description>.</Description><Size>1.02 - 1.52mm x 1.3 - 12.0mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><ARTGs><ARTG>126695</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL084</BillingCode><Name>Ventilation Tube</Name><Description>Stainless Steel Ventilation tube</Description><Size>Various sizes</Size><SupplierCode>40122</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><ARTGs><ARTG>146612</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CK008</BillingCode><Name>Exmoor Plastics Ear Vent Drains  -  Collar Button</Name><Description>Teflon </Description><Size>1.4 mm lumen dia x 2.55 mm inner flange dia x 2.55 mm outer flange dia x 0.85 inter flange. 1.35 mm total length</Size><SupplierCode>39965</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><ARTGs><ARTG>133977</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RC003</BillingCode><Name>Ventilation Tubes - Collar Button</Name><Description>Teflon, w/o wire</Description><Size>1.10mm, 1.25mm, 1.50mm lumen</Size><SupplierCode>39997</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><ARTGs><ARTG>182921</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RC002</BillingCode><Name>Ventilation tube</Name><Description>Ventilation tube - Silicone - T-tube, T-tube grommet</Description><Size>1.1mm; 1.27mm lumen</Size><SupplierCode>39997</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><ARTGs><ARTG>182921</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RC007</BillingCode><Name>Ventilation Tubes - Shepherd</Name><Description>Titanium, w/o wire</Description><Size>1.00mm, 1.25mm lumen</Size><SupplierCode>39997</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><ARTGs><ARTG>182921</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RC004</BillingCode><Name>Ventilation Tubes - Collar Button</Name><Description>Teflon w/wire, and titanium w/o wire</Description><Size>0.76mm, 1.00mm, 1.25mm, 1.50mm lumen</Size><SupplierCode>39997</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><ARTGs><ARTG>182921</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CK010</BillingCode><Name>Exmoor Plastics Ear Vent Drains - Shepards Drain</Name><Description>Teflon Shephards Drain</Description><Size>1.14 mm lumen dia x 2.36 mm inner flange dia x 2.36 mm outer flange dia x 1.42 inter flange. 2.41 mm total length</Size><SupplierCode>39965</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107830</GroupID><ARTGs><ARTG>133977</ARTG></ARTGs><MinimumBenefit>18</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO089</BillingCode><Name>Osia System</Name><Description>Piezoelectric bone conduction implant system consisting of: the Osia implant with piezoelectric transducer, osseointegrated titanium self-tapping BI300, the Osia sound processor with 2-way digital link, surgical components and software, for hearing loss up to 55dB.</Description><Size>Osia implant: One size  BI300: 3mm and 4mm  Osia sound processor: One size</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107832</GroupID><ARTGs><ARTG>304387</ARTG><ARTG>305024</ARTG><ARTG>355711</ARTG><ARTG>358293</ARTG><ARTG>124177</ARTG><ARTG>123984</ARTG><ARTG>305019</ARTG><ARTG>375450</ARTG><ARTG>375451</ARTG><ARTG>389472</ARTG></ARTGs><MinimumBenefit>14369</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO021</BillingCode><Name>Nucleus Freedom Implant with Contour Advance Electrode</Name><Description>Model C124RE (CA), Generation 4 Cochlear implant with perimodiolar electrode array.  Titanium casing, removable magnet, 22 half-banded platinum electrodes, moulded in a durable silicone seal</Description><Size>one size only</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107835</GroupID><ARTGs><ARTG>117025</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>12892</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Insert</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO057</BillingCode><Name>Cochlear™ Nucleus® CI422 cochlear implant with Straight Electrode</Name><Description>Model CI422, 4th generation cochlear implant with straight array.  Titanium casing, removable magnet.  22 half banded platinum intracochlear electrodes moulded with a silicone elastomer carrier and spaced over a 20mm active array.  The electrode diameter is 0.6mm at the badal end, tapering to 0.3mm at the apical electrode band.</Description><Size>One size</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107835</GroupID><ARTGs><ARTG>389694</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>12892</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Insert</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BD020</BillingCode><Name>HiRes90K Advantage Cochlear Implant with HiFocus 1j Electrode</Name><Description>The HiRes90K Advantage Cochlear Implant  with HiFocus 1j Electrode is the implanted component of the HiResolution Bionic Ear System. It receives information through an RF transmission coil, processes the information and then sends the resulting signal to an electrode array implanted in the cochlear. It consists of receiving/transmitting coil, Stimulator electrodes and HiFocus 1j Electrode array</Description><Size>Implant Size: 56mm (L) x 28mm (w x5.7mm (thickness). Electrode size: Active length 17mm, Tip diameter 0.4mm, Basal diameter 0.8mm. Total length of electrode array 25mm</Size><SupplierCode>40052</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107835</GroupID><ARTGs><ARTG>220306</ARTG></ARTGs><MinimumBenefit>12892</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO083</BillingCode><Name>Cochlear™ Nucleus® Profile Plus Series (CI632) Cochlear Implant with Slim Modiolar Electrode</Name><Description>Profile Plus Series CI632, 6th generation cochlear implant with Slim Modiolar electrode array. Sheath, titanium casing, removable magnet, 22 half-banded platinum electrodes, moulded in a durable tapered silicone seal, compatible with 1.5T and 3T static magnetic field.</Description><Size>One size</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107835</GroupID><ARTGs><ARTG>389693</ARTG></ARTGs><MinimumBenefit>12892</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO085</BillingCode><Name>Cochlear™ Nucleus® Profile Plus Series (CI622) Cochlear Implant with Slim Straight Electrode</Name><Description>Profile Plus Series CI622, 6th generation cochlear implant with Slim Straight electrode array. Titanium casing, removable magnet, 22 half-banded platinum electrodes, moulded in a durable tapered silicone seal, compatible with 1.5T and 3T static magnetic field.</Description><Size>One size</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107835</GroupID><ARTGs><ARTG>389668</ARTG></ARTGs><MinimumBenefit>12892</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BD029</BillingCode><PriorBillingCodes><PriorBillingCode>BD024</PriorBillingCode><PriorBillingCode>BD026</PriorBillingCode></PriorBillingCodes><Name>HiRes Ultra Cochlear Implant</Name><Description>The HiRes Ultra Cochlear Implant  with HiFocus is the implanted component of the HiResolution Bionic Ear System. It receives information through an RF transmission coil, processes the information and then sends the resulting signal to an electrode array implanted in the cochlear. It consists of receiving/transmitting coil, Stimulator electrodes and either HiFocus Mid-Scala Electrode array or HiFocus SlimJ electrode array</Description><Size>Implant Size: 56.2mm (L) x 28.5mm (w) x 4.5mm (thickness).     HiFocus Mid-Scala Electrode: Active length 15mm, Tip diameter 0.5mm, Basal diameter 0.7mm. Total length of electrode array 23.7mm.  HiFocus SlimJ Electrode: Electrode size: Active length 20mm, Tip diameter 0.26mm, Basal electrode diameter 0.56mm. Total length of electrode array 23.7mm</Size><SupplierCode>40052</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107835</GroupID><ARTGs><ARTG>301320</ARTG><ARTG>295250</ARTG></ARTGs><MinimumBenefit>12892</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO078</BillingCode><Name>Cochlear™ Nucleus® CI532 Cochlear Implant with Slim Modiolar Electrode</Name><Description>Model CI532, 5th generation cochlear implant with slim modiolar electrode array. Sheath, titanium casing, removable magnet, 22 half-banded platinum electrodes, moulded in a durable tapered silicone seal. Compatible with 1.5T static magnetic field.</Description><Size>One size</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107835</GroupID><ARTGs><ARTG>389476</ARTG></ARTGs><MinimumBenefit>12892</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO024</BillingCode><Name>Nucleus Freedom Implant with Straight Electrode</Name><Description>Model CI24RE (ST), Generation 4 Cochlear Implant with straight array electrode</Description><Size>One size only</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107835</GroupID><ARTGs><ARTG>389475</ARTG></ARTGs><MinimumBenefit>12892</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>US012</BillingCode><Name>Mi1200 SYNCHRONY Cochlear Implant / Mi1200 SYNCHRONY PIN Cochlear Implant</Name><Description>Ultra small titanium implant with flexible atraumatic electrode arrays provide complete cochlea coverage. Removable and self-aligning magnet is MRI safe at 3.0 Tesla (without magnet removal)</Description><Size>Stimulator Housing: L 17.3mm, W 25.4mm, Thin 4.5mm, Weight 7.6g.  Electrode: Standard (26.4mm), Compressed (12.1mm), Medium (20.9mm), FLEX24 (20.9mm), FLEX26 (20.9mm), FLEXsoft (26.4mm), FLEX28 (23.1mm), FORM19 (14.3mm), FORM24 (18.7mm), FLEX20 (15.4mm)</Size><SupplierCode>40167</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107835</GroupID><ARTGs><ARTG>389013</ARTG><ARTG>389012</ARTG></ARTGs><MinimumBenefit>12892</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OI035</BillingCode><Name>Neuro Zti Cochlear Implant</Name><Description>The Neuro Zti is a multi-channel cochlear implant. It is designed to be surgically implanted and consists of the receiver/stimulator implanted under the skin on the temporal aspect of the skull and a multichannel electrode designed to be inserted within the Scala Tympani of the cochlea. These electrodes will provide electrical stimulation to the auditory nerve, leading to activation of user’s auditory pathway, and perception of sound percept.</Description><Size>Two variants exist for the Neuro Zti:
EVO (atraumatic) Insertion length 25mm 
CLA (classic) Insertion length 26mm</Size><SupplierCode>40034</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107835</GroupID><ARTGs><ARTG>284148</ARTG><ARTG>284150</ARTG></ARTGs><MinimumBenefit>12892</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BD022</BillingCode><Name>HiRes90K Advantage Cochlear Implant with the HiFocus Mid-Scala Electrode</Name><Description>The HiRES90K Advantage Cochlear Implant with HiFocus Mid-Scala electrode is the implanted component of the HiResolution Bionic Ear System. It receives information through an RF transmission coil, processes the information and then sends the resulting signal to an electrode array implanted in the cochlea. It consists of receiving/transmitting coil, Stimulator electrodes and HiFocus Mid-Scala Electrode array</Description><Size>Implant Size: 56mm (L) x 28mm (w) x 5.7mm (thickness. Electrode size: Active length 15mm, Tip diameter 0.5mm, Basal diameter 0.7mm. Total length of electrode array 23.7mm</Size><SupplierCode>40052</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107835</GroupID><ARTGs><ARTG>220306</ARTG></ARTGs><MinimumBenefit>12892</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>US028</BillingCode><Name>Mi1250 SYNCHRONY 2 Cochlear Implant /   Mi1250 SYNCHRONY 2 PIN Cochlear Implant</Name><Description>Ultra small titanium implant with symmetrical central and flexible atraumatic electrode arrays provide complete cochlea coverage.  Removable and self-aligning magnet is conditionally MRI  safe for 3.0 Tesla MRI scans (without magnet removal).</Description><Size>Stimulator Housing: L 47.3 mm, W 24 mm, Thin 4.5 mm, Weight 7.7g    Electrode: Standard (26.4mm), Medium (20.9mm), Compressed (12.1mm), FLEXsoft (26.4mm), FLEX28 (23.1mm),  FLEX26 (20.9mm), FLEX24 (20.9mm), FLEX20 (15.4mm), FORM24 (18.7mm), FORM19 (14.3mm)</Size><SupplierCode>40167</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107835</GroupID><ARTGs><ARTG>389051</ARTG><ARTG>389052</ARTG></ARTGs><MinimumBenefit>12892</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO046</BillingCode><Name>Cochlear™ Nucleus® CI512 Cochlear Implants with Contour Advance Electrode</Name><Description>Model CI512, 5th generation cochlear implant with perimodiloar electrode array. Titanium casing, removable magnet, 22 half-banded platinum electrodes, moulded in a durable silicone seal.</Description><Size>One Size</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107835</GroupID><ARTGs><ARTG>389667</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>12892</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO084</BillingCode><Name>Cochlear™ Nucleus® Plus Series (CI612) Cochlear Implant with Contour Advance Electrode</Name><Description>Profile Plus Series CI612, 6th generation cochlear implant with Contour Advance electrode array. Titanium casing, removable magnet, 22 half-banded platinum electrodes, moulded in a durable tapered silicone seal, compatible with 1.5T and 3T static magnetic field.</Description><Size>One size</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107835</GroupID><ARTGs><ARTG>389471</ARTG></ARTGs><MinimumBenefit>12892</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BD030</BillingCode><Name>HiRes Ultra 3D Cochlear Implant</Name><Description>The HiRes Ultra 3D Cochlear Implant is the implanted component of the HiResolution Bionic Ear System. It receives information through an RF transmission coil, processes the information and then sends the resulting signal to an electrode array implanted in the cochlear. It consists of receiving/transmitting coil, Stimulator electrodes and two electrode variations HiFocus MidScala or HiFocus SlimJ Electrode array</Description><Size>Implant Size: 56.2mm (L) x 28.5mm (w) x 4.5mm (thickness).   HiFocus MidScala Electrode: Active length 15mm, Tip diameter 0.5mm, Basal diameter 0.7mm. Total length of electrode array 23.7mm  HiFocus SlimJ Electrode: Electrode size: Active length 20mm, Tip diameter 0.26mm, Basal electrode diameter 0.56mm. Total length of electrode array 23.7mm</Size><SupplierCode>40052</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107835</GroupID><ARTGs><ARTG>375483</ARTG></ARTGs><MinimumBenefit>12892</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO074</BillingCode><Name>Cochlear Nucleus CI522 Cochlear Implant with Slim Straight Electrode</Name><Description>Model CI522, 5th generation cochlear implant with straight electrode array. Titanium casing, removable magnet, 22 half-banded platinum electrodes, moulded in a durable tapered silicone seal.</Description><Size>One size</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107835</GroupID><ARTGs><ARTG>389477</ARTG></ARTGs><MinimumBenefit>12892</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI151</BillingCode><Name>ALAR Nasal Valve Stent</Name><Description>Nasal valve stent for repair of nasal vestibular stenosis and nasal valve collapse.</Description><Size>20mm long x 16mm wide</Size><SupplierCode>40151</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107580</SubCategoryID><GroupID>107839</GroupID><ARTGs><ARTG>218121</ARTG></ARTGs><MinimumBenefit>172</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ215</BillingCode><Name>LATERA Nasal Implant System</Name><Description>The LATERA Absorbable Nasal Implants supports the upper and lower lateral cartilage by anchoring above the maxilla to provide cantilever support. Two implants are provided. The LATERA delivery device is specifically designed and intended to deliver the LATERA absorbable nasal implant in the lateral nasal wall.</Description><Size>24mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107580</SubCategoryID><GroupID>107840</GroupID><ARTGs><ARTG>346524</ARTG><ARTG>389271</ARTG></ARTGs><MinimumBenefit>1500</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RC013</BillingCode><Name>Septal Button, silicone, sterile</Name><Description>For non-surgical closure of septal perforation  · Silicone prevents adhesion  · Soft material for easy insertion and removal  · No scabbing, epistaxis or other septal perforation symptoms  · Surface with Lotus leaf effect prevents adhesion of secretions / tissue</Description><Size>3.2cm - 1mm thick, one-piece  3.2cm - 1mm thick , two-piece</Size><SupplierCode>39997</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107580</SubCategoryID><GroupID>107841</GroupID><ARTGs><ARTG>338464</ARTG></ARTGs><MinimumBenefit>135</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL026</BillingCode><Name>Septal Button</Name><Description>Plastipore</Description><Size>One size only</Size><SupplierCode>40122</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107580</SubCategoryID><GroupID>107841</GroupID><ARTGs><ARTG>143266</ARTG></ARTGs><MinimumBenefit>135</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC264</BillingCode><Name>Septal Button </Name><Description>Silicone</Description><Size>3cm </Size><SupplierCode>40151</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107580</SubCategoryID><GroupID>107841</GroupID><ARTGs><ARTG>169825</ARTG></ARTGs><MinimumBenefit>135</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PT002</BillingCode><Name>Blom-Singer® Classic, Rapid Response Indwelling Voice Prostheses</Name><Description>A range of valved silicone voice prostheses that are placed into a tracheoesophageal puncture at the time of surgery. The Prosthesis resides between the back wall of the trachea into the esophageal wall to enable tracheosophageal speech.

Benefit: Voice is produced by temporarily blocking the stoma so that exhaled pulmonary air can be directed from the trachea, through the prosthesis into the oesophagus, producing voice in the TEP segment. Fluent, conversational speech may be acquired within just a few days.

Blom-Singer Rapid Response VP’s are available with extended tracheal and oesophageal flanges to overcome peripheral valve leakage. In addition, valve weighting can be adjusted to manage reflux and central valve leakage. This range of valves is also available in special lengths.</Description><Size>16 French and 20 French diameters, 4-20mm length (2mm increments)</Size><SupplierCode>40185</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107581</SubCategoryID><GroupID>107842</GroupID><ARTGs><ARTG>278705</ARTG></ARTGs><MinimumBenefit>92</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BQ010</BillingCode><Name>Tracheal Speaking Valve</Name><Description>Provox a) Two b) Vega c) Vega Puncture Set</Description><Size>a) 4.5, 6, 8, 10, 12.5, 15mm
b) 17, 20, 22.5fr in 4, 6, 8, 10, 12.5, 15mm
c) 17, 20, 22.5fr in 4, 6, 8, 10, 12.5, 15mm</Size><SupplierCode>40058</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107581</SubCategoryID><GroupID>107842</GroupID><ARTGs><ARTG>120197</ARTG><ARTG>236026</ARTG></ARTGs><MinimumBenefit>92</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BQ007</BillingCode><Name>ProTrach DualCare Set</Name><Description>ProTrach DualCare is attached to a tracheostomy tube and is designed to eliminate the necessity of finger occlusion, enabling the tracheostomised patient to speak easily and more clearly. It combines a speaking valve with an HME, and this way both enabling hands-free speech and helping to keep the lungs healthy by providing the important humidification of the inhaled air. The Set includes: 180pc HME Regular, 1pc Speaking Valve, 1pc ProTrach HME DigiTop, 1 Removal Aid and 1 connection strap.</Description><Size>15mm  22mm</Size><SupplierCode>40058</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107581</SubCategoryID><GroupID>107842</GroupID><ARTGs><ARTG>275618</ARTG></ARTGs><MinimumBenefit>628</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BQ008</BillingCode><Name>ProTrach DualCare Speaking Valve</Name><Description>ProTrach DualCare System is attached to a tracheostomy tube and is designed to eliminate the necessity of finger occlusion, enabling the tracheostomised patient to speak easily and more clearly. It combines a speaking valve with a HME and in this way enabling speaking and supporing your lungs with important heating and moisturising. The Set includes: 1pc Speaking Valve, 1pc ProTrach HME DigiTop, 1 Removal Aid and 1 connection strap.ProTrach DualCare Speaking Valve, 1 HME DigiTop, 1 removal aid and 1pc Connection Strap</Description><Size>15mm
22mm</Size><SupplierCode>40058</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107581</SubCategoryID><GroupID>107842</GroupID><ARTGs><ARTG>275618</ARTG></ARTGs><MinimumBenefit>92</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PT001</BillingCode><Name>Blom-Singer® Dual Valve and Advantage Voice Prosthesis</Name><Description>A range of valved silicone voice prostheses with specific anti-fungal and anti-leakage attributes, that are placed into a tracheoesophageal puncture at the time of surgery. The Prosthesis resides between the back wall of the trachea into the esophageal wall to enable tracheosophageal speech.</Description><Size>Dual Valve: 16 French and 20 French diameters 4-14mm length 
Advantage: 20 French diameter 6-14mm length
(2mm increments)</Size><SupplierCode>40185</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107581</SubCategoryID><GroupID>107842</GroupID><ARTGs><ARTG>278705</ARTG></ARTGs><MinimumBenefit>92</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PT003</BillingCode><PriorBillingCodes><PriorBillingCode>BQ009</PriorBillingCode></PriorBillingCodes><Name>Tracheal Speaking Valve</Name><Description>Passy Muir Tracheal Speaking Valve</Description><Size>one size</Size><SupplierCode>40185</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107581</SubCategoryID><GroupID>107842</GroupID><ARTGs><ARTG>279056</ARTG></ARTGs><MinimumBenefit>92</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PT004</BillingCode><PriorBillingCodes><PriorBillingCode>BQ001</PriorBillingCode></PriorBillingCodes><Name>Vocal Chord Medialisation Implant</Name><Description>Montgomery Laryngeal Keel</Description><Size>12, 14, 16 - Clear and Radiopaque</Size><SupplierCode>40185</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107581</SubCategoryID><GroupID>107843</GroupID><ARTGs><ARTG>119029</ARTG></ARTGs><MinimumBenefit>248</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL072</BillingCode><Name>Vocal Cord Medialisation Implant</Name><Description>Vocom Shim for Medial Implant - Hydroxylapatite</Description><Size>1mm - 3mm Offset</Size><SupplierCode>40122</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107581</SubCategoryID><GroupID>107843</GroupID><ARTGs><ARTG>143279</ARTG></ARTGs><MinimumBenefit>248</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL071</BillingCode><Name>Vocal Cord Medialisation Implant</Name><Description>Vocom Larynx Medial Implant - Hydroxylapatite</Description><Size>3 - 7mm Head</Size><SupplierCode>40122</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107581</SubCategoryID><GroupID>107843</GroupID><ARTGs><ARTG>143279</ARTG></ARTGs><MinimumBenefit>248</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JI007</BillingCode><Name>Aerstent</Name><Description>Nitinol Self Expanding Tracheal and Bronchial Stent. Nitinol Mesh, Silicone </Description><Size>Straight, J or Y Shaped, (10-24) mm diameter</Size><SupplierCode>40458</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107581</SubCategoryID><GroupID>107844</GroupID><Suffix>Nitinol</Suffix><ARTGs><ARTG>297568</ARTG></ARTGs><MinimumBenefit>1814</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JI008</BillingCode><Name>GSS &amp; Dumon</Name><Description>Silicone tracheal and bronchial stents, Straight and Y Shape</Description><Size>10 - 20mm diameter, 20 - 110mm length  </Size><SupplierCode>40458</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107581</SubCategoryID><GroupID>107844</GroupID><Suffix>Silicone</Suffix><ARTGs><ARTG>143612</ARTG></ARTGs><MinimumBenefit>903</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PT007</BillingCode><PriorBillingCodes><PriorBillingCode>BQ005</PriorBillingCode></PriorBillingCodes><Name>Thyroplasty</Name><Description>Montgomery Thyroplasty Implant System</Description><Size>male - 8,9,10,11,12,13  female - 6,7,8,9,10</Size><SupplierCode>40185</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107581</SubCategoryID><GroupID>107845</GroupID><ARTGs><ARTG>117683</ARTG></ARTGs><MinimumBenefit>1057</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PT005</BillingCode><PriorBillingCodes><PriorBillingCode>BQ003</PriorBillingCode></PriorBillingCodes><Name>Intra-tracheal Cannula</Name><Description>Montgomery Safe-T-Tubes Clear and Radiopaque except c)   a) Paediatric   b) Standard   c) Hebeler    d) Thoracic    e) Extra-Long    f) Tapered   g) Montgomery Salivary Bypass Tube   h) Har-el Pharyngeal Tube   i) Montgomery Esophageal Tube  j) Trachael Fenestrator  k) Moore Trache</Description><Size>a) 6, 7, 8, 9   b) 10, 11, 12, 13, 14. 15, 16  c) 12, 15, 18   d) 10, 11, 12, 13, 14, 15, 16   e) 10, 11, 12, 13, 14, 15, 16   f) 8/10, 10/13   g) 8, 10, 12, 14, 16, 18, 20   h) one size only   i) one size only  j) size 6, 8 and 10  k) size 6 and 8</Size><SupplierCode>40185</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107581</SubCategoryID><GroupID>107846</GroupID><Suffix>Intra-tracheal</Suffix><ARTGs><ARTG>119736</ARTG><ARTG>119737</ARTG></ARTGs><MinimumBenefit>425</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PT006</BillingCode><PriorBillingCodes><PriorBillingCode>BQ006</PriorBillingCode></PriorBillingCodes><Name>Extra-tracheal Cannula</Name><Description>a) Montgomery Short-Term Cannula   b) Montgomery Long-Term Cannula</Description><Size>a) 4, 6, 8, 10 b) 4, 6, 8, 10 for Stoma Sizes 17-25, 25-33, 33-41, 41-49, 49-57, 57-65mm</Size><SupplierCode>40185</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107581</SubCategoryID><GroupID>107846</GroupID><Suffix>Extra-tracheal</Suffix><ARTGs><ARTG>119737</ARTG></ARTGs><MinimumBenefit>269</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET040</BillingCode><Name>Vox Implants</Name><Description>Vox Implants are solid, irregularly textured, medical grade Polydimethylsiloxane Elastomer implants suspended in a hydrogel carrier</Description><Size>One size only</Size><SupplierCode>40085</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107581</SubCategoryID><GroupID>107847</GroupID><ARTGs><ARTG>146733</ARTG></ARTGs><MinimumBenefit>7401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VX001</BillingCode><PriorBillingCodes><PriorBillingCode>SE001</PriorBillingCode></PriorBillingCodes><Name>SIR-Spheres including Delivery Apparatus</Name><Description>Biocompatible microspheres 20-60mm (microns) in diameter containing yttrium-90. Delivery apparatus is PVC tubing, ABS stopcocks, acrylic holders and stainless steel needles with PE hubs</Description><Size>One size only</Size><SupplierCode>40468</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107588</SubCategoryID><GroupID>107941</GroupID><ARTGs><ARTG>149332</ARTG><ARTG>149343</ARTG></ARTGs><MinimumBenefit>8090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KI010</BillingCode><Name>Corflo Max 20fg PEG Kit "Pull Type"</Name><Description>Sterile enteral feeding tube with  accessories</Description><Size>20fg</Size><SupplierCode>40351</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107950</GroupID><ARTGs><ARTG>196774</ARTG></ARTGs><MinimumBenefit>161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FK016</BillingCode><Name>Freka Trelumina, ENFit</Name><Description>Transanasal, 3-lumen polyurethane tube for early jejunal feeding and gastric decompression in ICU patients</Description><Size>Intestinal feeding lumen: 9 Fr, length 150 cm   Gastric decompression lumen: 16 Fr, length 95 cm  Gastric ventilation valve: internal diameter 1.2 mm, length 95 cm</Size><SupplierCode>40376</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107952</GroupID><Suffix>Port</Suffix><ARTGs><ARTG>405292</ARTG></ARTGs><MinimumBenefit>451</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FK009</BillingCode><Name>Freka Intestinal Tube, ENFit</Name><Description>Intestinal extension tube for the gastric Freka PEG FR 15 or FR 20. Made with integrated Teflon-coated wire with fitted Y-Connector and blue fixation screw, radio-opaque strip, interval markings every 10 cm, distal pigtail bend tip, 4 lateral outlet ports, straight open flexible tube with small antenna end</Description><Size>9 Fr x 120 cm 
12 Fr x 120 cm</Size><SupplierCode>40376</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107952</GroupID><Suffix>Port</Suffix><ARTGs><ARTG>126461</ARTG></ARTGs><MinimumBenefit>451</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FK010</BillingCode><Name>Freka FCJ Set FR 9, ENFit</Name><Description>System consisting of Freka polyurethrane tube, Freka ENfit Connector, Freka fixation plate, Freka tube clamp, long cannula with blunt steel mandrin for catheterisation of the jejenum, and short cannula for puncturing the abdominal wall</Description><Size>9 Fr, length 75 cm</Size><SupplierCode>40376</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107952</GroupID><Suffix>Port</Suffix><ARTGs><ARTG>126461</ARTG></ARTGs><MinimumBenefit>451</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FK015</BillingCode><Name>Freka EasyIn, ENFit</Name><Description>Double lumen feeding and decompression tube for the early jejunal feeding and gastric decompression for ICU patients</Description><Size>Intestinal tube: 8 Fr, 270 cm  Gastric tube: 16 Fr, 100 cm</Size><SupplierCode>40376</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107952</GroupID><Suffix>Port</Suffix><ARTGs><ARTG>405292</ARTG></ARTGs><MinimumBenefit>451</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FK014</BillingCode><Name>Freka Endolumina, ENFit</Name><Description>Single lumen feeding tube for the early jejunal feeding for ICU patients</Description><Size>8 Fr, length 270 cm</Size><SupplierCode>40376</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107952</GroupID><Suffix>Port</Suffix><ARTGs><ARTG>125846</ARTG></ARTGs><MinimumBenefit>451</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KI017</BillingCode><PriorBillingCodes><PriorBillingCode>KI009</PriorBillingCode><PriorBillingCode>KI008</PriorBillingCode></PriorBillingCodes><Name>MIC* &amp; MIC-KEY* Balloon Jejunal Feeding Tubes</Name><Description>MIC* Standard Balloon Jejunal Feeding Tube and MIC-KEY* Low-Profile Balloon Feeding Tube are designed for the delivery of enteral nutrition and medication into the distal duodenum or proximal jejunum. They have a medical grade silicone construction with a single access port labeled 'Jejunal'. Wide range of sizes available.</Description><Size>MIC*: 12 - 24 French, 2-3ml Balloon (12Fr) 7-10ml Balloon volume (14-24Fr)  MIC-KEY*: 14 &amp; 18 French, 0.8cm - 4.5cm stoma length, 5ml balloon (max fill volume 10ml)</Size><SupplierCode>40351</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107952</GroupID><Suffix>Port</Suffix><ARTGs><ARTG>248294</ARTG></ARTGs><MinimumBenefit>451</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KI014</BillingCode><Name>MIC* Jejunostomy Feeding Tube</Name><Description>Sterile Jejunal Enteral Feeding Tube with Suture Wings (2 eaches per case)</Description><Size>14fg / 9fg</Size><SupplierCode>40351</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107952</GroupID><Suffix>Port</Suffix><ARTGs><ARTG>248294</ARTG></ARTGs><MinimumBenefit>451</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KI016</BillingCode><PriorBillingCodes><PriorBillingCode>KI006</PriorBillingCode><PriorBillingCode>KI015</PriorBillingCode></PriorBillingCodes><Name>MIC* &amp; MIC-KEY* Gastric-Jejunal Feeding Tubes, ENFit</Name><Description>MIC* Standard Gastric-Jejunal Feeding Tube: Medical Grade Silicone Construction, Inflatable Internal Retention Balloon, Gastric Decompression/Drainage Port, Multiple Gastric &amp; Jejunal Exit Ports, Tungsten Weighted Jejunal Portion, SECUR-LOK* External Retention Ring.    MIC-KEY* Low-Profile Gastric-Jejunal Feeding Tube: Low-profile Design, Medical Grade Silicone Construction, Inflatable Internal Retention Balloon, Gastric Decompression/Drainage Port, Multiple Gastric &amp; Jejunal Exit Ports, Tungsten Weighted Jejunal Portion, SECUR-LOK* Connection Mechanism for Extension Sets</Description><Size>MIC*: 16 - 22 French, 15cm - 45cm Jejunal Length  MIC-KEY*: 14 - 22 French, 15cm - 45cm Jejunal Length, 1cm - 7cm Stoma Length</Size><SupplierCode>40351</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107952</GroupID><Suffix>Port</Suffix><ARTGs><ARTG>248294</ARTG></ARTGs><MinimumBenefit>451</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC098</BillingCode><Name>Cook Jejunostomy Catheters</Name><Description>Composition - Catheter Radiopaque Stripe, includes Wireguide, Airplug, Fixation Device</Description><Size>12fr, length 66cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107952</GroupID><ARTGs><ARTG>139342</ARTG></ARTGs><MinimumBenefit>154</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC099</BillingCode><Name>Cook Jejunostomy Catheters</Name><Description>Composition - Catheter Radiopaque Stripe, includes Wireguide, Airplug, Fixation Device</Description><Size>9fr, Length 60cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107952</GroupID><ARTGs><ARTG>139342</ARTG></ARTGs><MinimumBenefit>154</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC197</BillingCode><Name>Cook Irrigation Catheter</Name><Description>Chait Percutaneous Cecostomy Catheter</Description><Size>10fr, Standard or Extra Long</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107953</GroupID><ARTGs><ARTG>138361</ARTG></ARTGs><MinimumBenefit>320</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AA008</BillingCode><Name>Bioring Gastric Band Replacement Port</Name><Description>Bioring gastric band access port with catheter and connector</Description><Size>Diameter 34mm; height 10.4mm</Size><SupplierCode>40043</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107591</SubCategoryID><GroupID>107972</GroupID><ARTGs><ARTG>163167</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH413</BillingCode><Name>Miband Access Port (replacement)</Name><Description>A device, metallic or non- metallic, implanted in a patient for a short or long-term delivery of fluid or medications to the vascular system  or other anatomical region. The device consists of a housing, self-sealing septum and a catheter connection mechanism. The device may be implanted in a variety of anatomical locations.</Description><Size>Port Size - 10.6mm High, 24.7mm Base width- One Size only</Size><SupplierCode>40192</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107591</SubCategoryID><GroupID>107972</GroupID><ARTGs><ARTG>153863</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GQ002</BillingCode><PriorBillingCodes><PriorBillingCode>RS003</PriorBillingCode></PriorBillingCodes><Name>MiniMizer gastric band (injection port)</Name><Description>Adjustable Silicone band which is placed around the upper part of the stomach to reduce the volume and speed of intake of food. The injection port is used to inflate or deflate the gastric band therefore adjusting the diameter of the band.</Description><Size>Small or medium sized port.</Size><SupplierCode>40254</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107591</SubCategoryID><GroupID>107972</GroupID><ARTGs><ARTG>205914</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ444</BillingCode><Name>Ethicon Endo-Surgery Gastric band sutureless port and applier</Name><Description>Implantable infusion port &amp; locking connector for adjustable gastric band. Replacement port &amp; locking connector for use with adjustable gastric band.</Description><Size>One size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107591</SubCategoryID><GroupID>107972</GroupID><ARTGs><ARTG>94734</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET056</BillingCode><Name>Soft Basket Band. INFUSION PORT.</Name><Description>TITANIUM PORT</Description><Size>9.8CMS/13.3CMS</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107591</SubCategoryID><GroupID>107972</GroupID><ARTGs><ARTG>148776</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER683</BillingCode><Name>RapidPort EZ Access Port Kit (replacement port)</Name><Description>Access Port Kit for LAP-BAND RapidPort EZ system, inclusive of accessories, i.e: needle-Band priming; needle- access port flushing (5”); molded end plug- Lap-Band; connector, tubing; tubin-silicone, 6% BaSO4; access port needle (3.5”).  </Description><Size>one size</Size><SupplierCode>40067</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107591</SubCategoryID><GroupID>107972</GroupID><ARTGs><ARTG>375519</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET081</BillingCode><Name>A.M.I. B-Band</Name><Description>Adjustable gastric banding implant for stabilising the gastroenterostomy stoma. The A.M.I B-Band is a soft gastric bypass band which serves as a restrictive component in gastric bypass surgery. Restriction is achieved by placing the device around the remaining stomach pouch in order to prevent long term dilation of the gastrojejunostomy and to ensure a controlled emptying of the stomach pouch.</Description><Size>Adjustable band length: 4.0cm - 7.5cm. Band height: 10mm</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107591</SubCategoryID><GroupID>107974</GroupID><ARTGs><ARTG>96737</ARTG></ARTGs><MinimumBenefit>2073</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GQ008</BillingCode><Name>Minimizer Ring</Name><Description>Adjustable Gastric Ring</Description><Size>One size ranging from 6.5cm to a 8.0cm diameter</Size><SupplierCode>40254</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107591</SubCategoryID><GroupID>107974</GroupID><ARTGs><ARTG>379010</ARTG></ARTGs><MinimumBenefit>2073</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GQ001</BillingCode><PriorBillingCodes><PriorBillingCode>RS001</PriorBillingCode></PriorBillingCodes><Name>Minimizer Ring</Name><Description>Adjustable Gastric Ring</Description><Size>One size ranging from 6.5cm to a 8.0cm diameter</Size><SupplierCode>40254</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107591</SubCategoryID><GroupID>107974</GroupID><ARTGs><ARTG>203396</ARTG></ARTGs><MinimumBenefit>2073</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH527</BillingCode><Name>MIDCAL Ring</Name><Description>Adjustable Gastric Ring</Description><Size>65-80 mm circumference</Size><SupplierCode>40192</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107591</SubCategoryID><GroupID>107974</GroupID><ARTGs><ARTG>229709</ARTG></ARTGs><MinimumBenefit>2073</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ832</BillingCode><Name>Swedish Adjustable Gastric Band</Name><Description>Silicone</Description><Size>One size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107591</SubCategoryID><GroupID>107975</GroupID><ARTGs><ARTG>94766</ARTG></ARTGs><MinimumBenefit>2791</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ831</BillingCode><Name>Ethicon Endo-Surgery curved adjustable gastric band with sutureless port and applier</Name><Description>Silicone</Description><Size>One size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107591</SubCategoryID><GroupID>107975</GroupID><ARTGs><ARTG>94766</ARTG></ARTGs><MinimumBenefit>2791</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH003</BillingCode><Name>Adjustable Peri Gastric Belt-Midband</Name><Description>Silicon moulded peri gastric band and implantable chamber</Description><Size>Peri gastric band - 2.2 x 17.5 x 0.8cm, Implantable chamber - one size only</Size><SupplierCode>40192</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107591</SubCategoryID><GroupID>107975</GroupID><ARTGs><ARTG>145372</ARTG></ARTGs><MinimumBenefit>2791</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AA010</BillingCode><Name>Adhesix Bioring Gastric Band</Name><Description>Adjustable gastric band system with mesh fixation of port</Description><Size>Small, Large and Extra Large</Size><SupplierCode>40043</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107591</SubCategoryID><GroupID>107975</GroupID><ARTGs><ARTG>181215</ARTG></ARTGs><MinimumBenefit>2791</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER682</BillingCode><Name>ReShape Lap-Band AP with RapidPort EZ</Name><Description>Lap-Band AP with RapidPort EZ-small or large, inclusive of accessories, i.e.: needle for band priming; needle for access port flushing (5”); moulded end plug- Lap-Band; connector tubing; access port needle (3.5”).  </Description><Size>small/large</Size><SupplierCode>40067</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107591</SubCategoryID><GroupID>107975</GroupID><ARTGs><ARTG>375520</ARTG></ARTGs><MinimumBenefit>2791</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GQ003</BillingCode><PriorBillingCodes><PriorBillingCode>RS002</PriorBillingCode></PriorBillingCodes><Name>MiniMizer gastric band.</Name><Description>Adjustable Silicone band which is placed around the upper part of the stomach to reduce the volume and speed of intake of food.</Description><Size>The gastric band comes in two sizes: Regular and Large</Size><SupplierCode>40254</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107591</SubCategoryID><GroupID>107975</GroupID><ARTGs><ARTG>203396</ARTG></ARTGs><MinimumBenefit>2791</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GQ009</BillingCode><Name>MiniMizer gastric band.</Name><Description>Adjustable Silicone band which is placed around the upper part of the stomach to reduce  the volume and speed of intake of food.</Description><Size>Regular, large and extra large</Size><SupplierCode>40254</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107591</SubCategoryID><GroupID>107975</GroupID><ARTGs><ARTG>379010</ARTG></ARTGs><MinimumBenefit>2791</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET042</BillingCode><Name>Soft Gastric Banding System</Name><Description>Sterile long term implant for the treatment of obesity.  Supplied in kit format with catheter, port and huber needles</Description><Size>One size only</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107591</SubCategoryID><GroupID>107975</GroupID><ARTGs><ARTG>96737</ARTG></ARTGs><MinimumBenefit>2791</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PV001</BillingCode><PriorBillingCodes><PriorBillingCode>DV024</PriorBillingCode></PriorBillingCodes><Name>Haemorrhage Occluder Pin with applicator</Name><Description>Designed to control severe presacral bleeding during pelvic surgery.</Description><Size>Two sizes: 10mm and 14mm</Size><SupplierCode>40110</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107978</GroupID><ARTGs><ARTG>133897</ARTG></ARTGs><MinimumBenefit>286</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BF024</BillingCode><Name>NexStat</Name><Description>The Topical Hemostatic powder consists of purified potato starch polysaccharide. These products are sterile packed and intended for single use.</Description><Size>3grams</Size><SupplierCode>40171</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107979</GroupID><ARTGs><ARTG>280607</ARTG></ARTGs><MinimumBenefit>132</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX345</BillingCode><PriorBillingCodes><PriorBillingCode>AB079</PriorBillingCode></PriorBillingCodes><Name>PerClot Laparascopic</Name><Description>PerClot Polysaccharide Hemostatic System</Description><Size>3 grams</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107979</GroupID><ARTGs><ARTG>164507</ARTG></ARTGs><MinimumBenefit>132</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA261</BillingCode><Name>Arista AH</Name><Description>Arista Absorbable Haemostatic Particles</Description><Size>3g</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107979</GroupID><ARTGs><ARTG>233611</ARTG></ARTGs><MinimumBenefit>132</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA260</BillingCode><Name>Arista AH</Name><Description>Arista Absorbable Haemostatic Particles</Description><Size>1g</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107979</GroupID><ARTGs><ARTG>233611</ARTG></ARTGs><MinimumBenefit>45</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA262</BillingCode><Name>Arista AH</Name><Description>Arista Absorbable Haemostatic Particles</Description><Size>5g</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107979</GroupID><MinimumBenefit>217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA301</BillingCode><Name>Avitene MCH</Name><Description>Avitene MCH Flour is a Microfibrillar 100% bovine collagen, topical haemostat which does not contain Thrombin. Flour is defined as a loose fibrous which can be manipulated to conform to any shape or surface. Avitene™ (MCH), in contact with a bleeding surface, attracts platelets which adhere to the fibrils  and undergo the release phenomenon to trigger aggregation of platelets into thrombi in the interstices of the fibrous mass.</Description><Size>0.5 gram  1.0 gram  5.0 gram</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107979</GroupID><ARTGs><ARTG>332522</ARTG></ARTGs><MinimumBenefit>45</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SV054</BillingCode><Name>Starsil Haemostat</Name><Description>Plant based haemostatic powder</Description><Size>2g</Size><SupplierCode>40412</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107979</GroupID><ARTGs><ARTG>230577</ARTG></ARTGs><MinimumBenefit>90</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SV053</BillingCode><Name>Starsil Haemostat</Name><Description>Plant based haemostatic powder</Description><Size>1g</Size><SupplierCode>40412</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107979</GroupID><ARTGs><ARTG>230577</ARTG></ARTGs><MinimumBenefit>45</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AB083</BillingCode><Name>HaemoCer Haemostatic Powder</Name><Description>Absorbable Polysaccharide Haemostat</Description><Size>5gms</Size><SupplierCode>40053</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107979</GroupID><ARTGs><ARTG>205062</ARTG></ARTGs><MinimumBenefit>217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SV055</BillingCode><Name>Starsil Haemostat</Name><Description>Plant based haemostatic powder</Description><Size>5g</Size><SupplierCode>40412</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107979</GroupID><ARTGs><ARTG>230577</ARTG></ARTGs><MinimumBenefit>217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN234</BillingCode><Name>Surgicel Powder</Name><Description>Absorbable Haemostatic Powder</Description><Size>3.0grams</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107979</GroupID><ARTGs><ARTG>296463</ARTG></ARTGs><MinimumBenefit>132</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AB084</BillingCode><PriorBillingCodes><PriorBillingCode>DE605</PriorBillingCode></PriorBillingCodes><Name>HaemoCer Haemostatic Powder</Name><Description>Absorbable Polysaccharide Haemostat</Description><Size>2gms</Size><SupplierCode>40053</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107979</GroupID><ARTGs><ARTG>205062</ARTG></ARTGs><MinimumBenefit>90</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ636</BillingCode><Name>Spongostan Absorbable Haemostatic Gelatin Powder</Name><Description>1 g Porcine Absorbable Haemostatic Gelatin Powder</Description><Size>1 gram</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107979</GroupID><ARTGs><ARTG>144853</ARTG></ARTGs><MinimumBenefit>45</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH408</BillingCode><Name>Geli Putty(Powder, 1g)</Name><Description>Geli Putty is a single- use, water insoluble, fully bioabsorbable gelatin powder comprising milled sponges (Gelita-Spon) made from 100% pharmaceutical grade porcine gelatin mixed with sterile liquid (e.g. saline or antibiotic solution) prior to use.</Description><Size>1 gram</Size><SupplierCode>40192</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107979</GroupID><ARTGs><ARTG>155091</ARTG></ARTGs><MinimumBenefit>45</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX347</BillingCode><PriorBillingCodes><PriorBillingCode>AB081</PriorBillingCode></PriorBillingCodes><Name>PerClot Standard &amp; XL - 3 grams</Name><Description>PerClot Polysaccharide Hemostatic System</Description><Size>3 grams</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107979</GroupID><ARTGs><ARTG>162991</ARTG><ARTG>275318</ARTG></ARTGs><MinimumBenefit>132</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX336</BillingCode><Name>OSTENE Bone Haemostasis material 2.5g</Name><Description>OSTENE is a water soluble polymer which provides immediate bone haemostasis, ie a bone haemostasis material, in surgical procedures</Description><Size>2.5g per stick</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107979</GroupID><ARTGs><ARTG>229426</ARTG></ARTGs><MinimumBenefit>107</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX346</BillingCode><Name>PerClot Standard &amp; XL - 1 gram</Name><Description>PerClot Polysaccharide Hemostatic System</Description><Size>1 gram</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107979</GroupID><ARTGs><ARTG>275318</ARTG><ARTG>162991</ARTG></ARTGs><MinimumBenefit>45</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX337</BillingCode><Name>Ostene 3.5g Bone Haemostasis material</Name><Description>OSTENE is a water soluble polymer which provides immediate bone haemostasis, ie a bone haemostasis material, in surgical procedures</Description><Size>3.5g</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107979</GroupID><ARTGs><ARTG>229426</ARTG></ARTGs><MinimumBenefit>158</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX348</BillingCode><Name>PerClot Standard</Name><Description>PerClot Polysaccharide Hemostatic System</Description><Size>5 gram</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107979</GroupID><ARTGs><ARTG>162991</ARTG></ARTGs><MinimumBenefit>217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BF021</BillingCode><Name>SealFoam, High Density</Name><Description>SealFoam is an absorbable Polysaccharide Haemostat</Description><Size>60mm x 40mm x 2mm
60mm x 40mm x 4mm
120mm x 25mm x 4mm (2/pack)</Size><SupplierCode>40171</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107983</GroupID><ARTGs><ARTG>194564</ARTG></ARTGs><MinimumBenefit>93</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW582</BillingCode><Name>NasoPore</Name><Description>Nasopore is intended for use in patients undergoing nasal/sinus surgery as a temporary wound dressing to provide tissue support, minimise edema and prevent adhesion formation between mucosal surfaces. This is necessary to prevent some of the most common complications after FESS i.e., lateralization of the middle turbinate, synechiae (adhesions) or restenosis which leads to occlusion of the sinus drainage pathway. It should only be used by physicians who have received appropriate training in treating nasal cavity disorders.</Description><Size>4cm and 8cm</Size><SupplierCode>40329</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107983</GroupID><ARTGs><ARTG>274616</ARTG></ARTGs><MinimumBenefit>93</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL083</BillingCode><Name>Nasastent</Name><Description>Dissolvable intranasal splint made from CMC that absorbs nasal fluids, it turns into a hydrocolloidal gel that naturally drains from the nasal cavity</Description><Size>5cm</Size><SupplierCode>40406</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107983</GroupID><ARTGs><ARTG>212973</ARTG></ARTGs><MinimumBenefit>93</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL081</BillingCode><Name>STAMMBERGER SINU-FOAM</Name><Description>Viscous CMC-based dissolvable foam for the nasal cavity</Description><Size>One size</Size><SupplierCode>40406</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107983</GroupID><ARTGs><ARTG>212973</ARTG></ARTGs><MinimumBenefit>93</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ME230</BillingCode><Name>NexPak X</Name><Description>Intranasal splint</Description><Size>8cms</Size><SupplierCode>40363</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107983</GroupID><ARTGs><ARTG>328036</ARTG></ARTGs><MinimumBenefit>93</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET101</BillingCode><Name>ARCHIMEDES Biodegradable Pancreaticobiliary Stent</Name><Description>A polymeric stent with a fluted, cross-sectional profile and containing two channels which spiral in a double helix down the length of the stent. The Archimedes BPS is designed to fit the natural curvature of the common bile duct and pancreatic duct. The ends of the Archimedes are tapered to allow insertion through the papilla. The Archimedes comes in three degradation profiles of slow, medium, and fast. The minimal strength retention time of the Archimedes BPS is 11 weeks, 20 days, and 12 days respectively.</Description><Size>Stent Diameters: 2.0mm, 2.6mm, 3.4mm. Stent Length: 40mm, 60mm, 80mm, 100mm, 125mm, 150mm, 175mm, 200mm, 225mm.</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><Suffix>Biodegradable</Suffix><ARTGs><ARTG>335505</ARTG><ARTG>335506</ARTG><ARTG>335504</ARTG></ARTGs><MinimumBenefit>1500</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UK008</BillingCode><Name>HANAROSTENT</Name><Description>HANAROSTENT Colon/Rectum, Colon/Rectum TTS, Colon/Rectum Asymmetric, Colon/Rectum Lasso, Intestine, Intestine Asymmetric, TwynLay Colon/Rectum.  Self-expanding nitinol colon/rectum stent.  </Description><Size>Diameter: 16-24mm,  Length: 40-180 mm</Size><SupplierCode>40267</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107986</GroupID><Suffix>Self Expanding</Suffix><ARTGs><ARTG>272681</ARTG><ARTG>336711</ARTG></ARTGs><MinimumBenefit>2762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE692</BillingCode><PriorBillingCodes><PriorBillingCode>PY023</PriorBillingCode></PriorBillingCodes><Name>Niti-S Colorectal D-Type Stent</Name><Description>Niti-S Colorectal D-Type self-expanding Stent</Description><Size>Diameters: 18 to 30mm   Lengths: 60 to 150mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107986</GroupID><Suffix>Self Expanding</Suffix><ARTGs><ARTG>130747</ARTG></ARTGs><MinimumBenefit>2762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE693</BillingCode><PriorBillingCodes><PriorBillingCode>PY024</PriorBillingCode></PriorBillingCodes><Name>Niti-S Colorectal Stent</Name><Description>Niti-S Colorectal self-expanding metal stent made from Nitinol.  Stent PTFE covered and uncovered OTW or TTS with string for ease of removal.</Description><Size>Diameter:  18mm to 30mm  Length: 30mm to 160mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107986</GroupID><Suffix>Self Expanding</Suffix><ARTGs><ARTG>130747</ARTG></ARTGs><MinimumBenefit>2762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS071</BillingCode><Name>Ultraflex Precision Colonic Stent</Name><Description>Nitinol, self expanding stent</Description><Size>Diameters up to 30mm &amp; lengths up to 150mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107986</GroupID><Suffix>Self Expanding</Suffix><ARTGs><ARTG>119517</ARTG></ARTGs><MinimumBenefit>2762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC271</BillingCode><Name>Geenen Sof-Flex Pancreatic Stent</Name><Description>Straight plastic pancreatic stent with or without ductal flaps</Description><Size>Diameter 3 - 10 Fr; length 2 - 15cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107988</GroupID><ARTGs><ARTG>142998</ARTG></ARTGs><MinimumBenefit>77</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC212</BillingCode><Name>Zimmom Pancreatic Stent</Name><Description>Single pigtail radio-opaque Polyethylene Stent with or without ductal flaps</Description><Size>Diameter 3 - 7 FR, Length 3 - 18cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107988</GroupID><ARTGs><ARTG>142998</ARTG></ARTGs><MinimumBenefit>77</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC079</BillingCode><Name>Zimmon Pancreatic Stent</Name><Description>Single pigtail with radio-opaque band</Description><Size>Diameter 4 - 10FR, Length 2 - 18cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107988</GroupID><ARTGs><ARTG>142998</ARTG></ARTGs><MinimumBenefit>77</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC123</BillingCode><Name>Geenen Pancreatic Stent</Name><Description>Straight plastic pancreatic stent with or without ductal flaps</Description><Size>Diameter 3 - 11.5 FR, length 2 - 20cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107988</GroupID><ARTGs><ARTG>142998</ARTG></ARTGs><MinimumBenefit>77</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS290</BillingCode><Name>Advanix Plastic Stent and Pusher Kit</Name><Description>Plastic stent manufactured, indicated for the treatment of pancreatic strictures.
Delivery System in form of a pusher (short wire or long wire system specific).
</Description><Size>2 - 18cm length / 3 - 10 FR diameter</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107988</GroupID><Suffix>Pusher</Suffix><ARTGs><ARTG>226891</ARTG></ARTGs><MinimumBenefit>131</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS289</BillingCode><Name>Advanix Plastic Stent</Name><Description>Plastic stent manufactured individually, indicated for the treatment of pancreatic strictures.</Description><Size>2 - 18cm length / 3 - 10 FR diameter</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107988</GroupID><ARTGs><ARTG>226891</ARTG></ARTGs><MinimumBenefit>77</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC268</BillingCode><Name>Evolution Enteral Metal Stent</Name><Description>Enteral Metal Stent</Description><Size>Diameter 22 to 25mm body; 27 to 30mm flanges. Length: 6 to 12cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107989</GroupID><ARTGs><ARTG>157191</ARTG><ARTG>157192</ARTG></ARTGs><MinimumBenefit>3159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS337</BillingCode><Name>WallFlex Soft Enteral Stent (Duodenal/Colonic)</Name><Description>Nitinol, self expanding stent with Anchor Lock Delivery System</Description><Size>Diameters up to 27mm &amp; lengths up to 120mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107989</GroupID><ARTGs><ARTG>119517</ARTG></ARTGs><MinimumBenefit>3159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE689</BillingCode><PriorBillingCodes><PriorBillingCode>PY017</PriorBillingCode></PriorBillingCodes><Name>Niti-S Pyloric/Duodenal Stent</Name><Description>Niti-S Pyloric self-expanding stent, covered and uncovered, OTW or TTS</Description><Size>Diameter:  16 to 28mm   Length: 40 to 160mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107989</GroupID><ARTGs><ARTG>130746</ARTG></ARTGs><MinimumBenefit>3159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UK010</BillingCode><Name>HANAROSTENT</Name><Description>HANAROSTENT Duodenum/Pylorus Kim’s Flare, Duodenum/Pylorus Lasso, Duodenum/Pylorus Lasso, TwynLay Duodenum/Pylorus.  Self-expanding nitinol duodenum/pylorus stent  </Description><Size>Diameter 18-24mm, Length 60-180mm</Size><SupplierCode>40267</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107989</GroupID><ARTGs><ARTG>272682</ARTG></ARTGs><MinimumBenefit>3159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS090</BillingCode><Name>WallFlex Enteral Stent (Duodenal/Colonic)</Name><Description>Nitinol, self expanding stent</Description><Size>Diameters up to 30mm &amp; lengths up to 150mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107989</GroupID><ARTGs><ARTG>119517</ARTG></ARTGs><MinimumBenefit>3159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AK010</BillingCode><Name>Oesophageal Tracheal Stents</Name><Description>self expanding nitinol stent, covered and uncovered, straight and J shape</Description><Size>multiple sizes</Size><SupplierCode>39961</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107990</GroupID><ARTGs><ARTG>173875</ARTG></ARTGs><MinimumBenefit>1805</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AK009</BillingCode><Name>Oesophageal Tracheal Stents</Name><Description>Nitinol wire expandable stents, covered and non covered, Y shaped</Description><Size>multiple sizes</Size><SupplierCode>39961</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107990</GroupID><ARTGs><ARTG>173875</ARTG></ARTGs><MinimumBenefit>1805</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UK019</BillingCode><PriorBillingCodes><PriorBillingCode>BS311</PriorBillingCode></PriorBillingCodes><Name>HANAROSTENT</Name><Description>HANAROSTENT Trachea/Bronchial.  Covered trachea/bronchium stent, self-expanding nitinol</Description><Size>Length 30-80mm, Diameter 12-20mm</Size><SupplierCode>40267</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107990</GroupID><ARTGs><ARTG>272686</ARTG></ARTGs><MinimumBenefit>2708</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE695</BillingCode><PriorBillingCodes><PriorBillingCode>PY048</PriorBillingCode></PriorBillingCodes><Name>Niti-S Tracheal and Bronchial Stents</Name><Description>Niti-S Tracheal and Bronchial Stents</Description><Size>Diameter:  10mm to 24mm  Length:  30mm to 100mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107990</GroupID><ARTGs><ARTG>130533</ARTG><ARTG>130534</ARTG></ARTGs><MinimumBenefit>2708</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OW004</BillingCode><Name>AERO®, AERO DV® and AEROmini®</Name><Description>Trachobronchial Stent</Description><Size>6-20mm stent diameter, stent length 10-80mm</Size><SupplierCode>40178</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107990</GroupID><ARTGs><ARTG>177098</ARTG></ARTGs><MinimumBenefit>2708</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS047</BillingCode><Name>Ultraflex Tracheobronchial Stent</Name><Description>Nitinol, self expanding stent</Description><Size>Diameters up to 25mm &amp; lengths up to 80mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107990</GroupID><ARTGs><ARTG>149594</ARTG></ARTGs><MinimumBenefit>2708</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG002</BillingCode><Name>NeuraGen</Name><Description>NeuraGen is a semi-permeable Type 1 collagen tube for peripheral nerve repair. It provides a protective environment and conduit for axonal regrowth across a nerve gap.  It is biocompatible and completely resorbed. The open collagen structure facilitates suture placement. It has a resilient structure that maintains an open lumen throughout the process of axonal growth.</Description><Size>2mm x 2cm, 3mm x 2cm, 4mm x 2cm, 5mm x 2cm, 6mm x 2cm, 7mm x 2cm, 1.5mm x 3cm, 2mm x 3cm, 3mm x 3cm, 4mm x 3cm, 5mm x 3cm, 6mm x 3cm, 7mm x 3cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107991</GroupID><ARTGs><ARTG>158870</ARTG></ARTGs><MinimumBenefit>1354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG003</BillingCode><Name>NeuraWrap</Name><Description>NeuraWrap nerve protector is designed to provide an interface between the nerve and the surrounding tissues. NeuraWrap remains in place during the active phase of tissue healing and is completely resorbed after tissue response has resolved. The porous outer layer of NeuraWrap comprises a tubular matrix that mechanically resists compression from surrounding tissue and excludes scar tissue ingrowth. The semi-permeable inner membrane allows passage of small molecules (ie water, ions, metabolites, nutrients) but prevents the escape of endogenous growth factors (Nerve Growth Factor). NeuraWrap provides a new alternative for the treatment of peripheral nerve injuries.</Description><Size>3mm x 2cm, 3mm x 4cm, 5mm x 2cm, 5mm x 4cm, 7mm x 2cm, 7mm x 4cm, 10mm x 2cm, 10mm x 4cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107991</GroupID><ARTGs><ARTG>158924</ARTG></ARTGs><MinimumBenefit>1354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM335</BillingCode><Name>Nerve Capping Device</Name><Description>A peripheral bioresorbable nerve capping device</Description><Size>30mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107991</GroupID><ARTGs><ARTG>285368</ARTG></ARTGs><MinimumBenefit>1354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM080</BillingCode><Name>Neurolac</Name><Description>A bioresorbable tension-less Nerve repair guide</Description><Size>1.5mm x 3cm to 10.0mm x 3cm</Size><SupplierCode>40194</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107991</GroupID><ARTGs><ARTG>139653</ARTG></ARTGs><MinimumBenefit>1354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VQ002</BillingCode><Name>Remplir</Name><Description>A resorbable collagen barrier membrane intended for use in peripheral nerve repair.</Description><Size>15mm x 20mm, 20mm x 30mm, 30mm x 40mm, 40mm x 50mm</Size><SupplierCode>40240</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107991</GroupID><ARTGs><ARTG>385752</ARTG></ARTGs><MinimumBenefit>1354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL081</BillingCode><Name>IBV Valve in Cartridge</Name><Description>A one-way valve placed in the lung airway intended to treat diseased lung in emphysematous patients or damaged lung resulting in air leaks by limiting airflow to selected areas.</Description><Size>5mm, 6mm, 7mm and 9mm</Size><SupplierCode>40122</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107993</GroupID><ARTGs><ARTG>188455</ARTG></ARTGs><MinimumBenefit>5686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PX001</BillingCode><Name>Pulmonx</Name><Description>Valve intended to improve lung function in patients with heterogeneous emphysema by controlling air flow with a one-way valve and to treat patients with pulmonary air leak.</Description><Size>4.0 (4 to 7 mm) and 5.5 (5.5 to 8.5mm)</Size><SupplierCode>40095</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107993</GroupID><ARTGs><ARTG>165980</ARTG></ARTGs><MinimumBenefit>5686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FN003</BillingCode><PriorBillingCodes><PriorBillingCode>ZQ008</PriorBillingCode></PriorBillingCodes><Name>Denver Ascites Shunt, (PAK), Double-valved</Name><Description>Ascite Shunt - Double Valved Percutaneous Access Kit (PAK). A fenestrated peritoneal catheter, a venous catheter, and a flexible pump chamber containing two miter valves, provided with a Percutaneous Access Kit.</Description><Size>Double-valved, 42-2050</Size><SupplierCode>40272</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107994</GroupID><ARTGs><ARTG>163267</ARTG></ARTGs><MinimumBenefit>1986</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FN004</BillingCode><PriorBillingCodes><PriorBillingCode>ZQ009</PriorBillingCode></PriorBillingCodes><Name>Denver Ascites Shunt, (PAK), Single-valved</Name><Description>Ascites Shunt - Single Valved Percutaneous Access Kit (PAK). A fenestrated peritoneal catheter, a veneous catheter, and a flexible pump chamber containing one miter valve, provided with a Percutaneous Access Kit (PAK).</Description><Size>Single valved, 42-2055</Size><SupplierCode>40272</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107994</GroupID><ARTGs><ARTG>163266</ARTG></ARTGs><MinimumBenefit>1986</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER197</BillingCode><Name>Anastoclips</Name><Description>Vessel Closure System (VCS) (8 and 15 cm shaft)</Description><Size>Small, Medium, Large, Extra Large</Size><SupplierCode>40067</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108001</GroupID><ARTGs><ARTG>120976</ARTG></ARTGs><MinimumBenefit>402</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER283</BillingCode><Name>AnastoClip GC</Name><Description>AnastoClip GC</Description><Size>Medium
Large
Extra Large
Medium, with long applier
Large, with long applier
Extra Large, with long applier</Size><SupplierCode>40067</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108001</GroupID><ARTGs><ARTG>278601</ARTG></ARTGs><MinimumBenefit>402</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ602</BillingCode><Name>ULTRAPRO Plug</Name><Description>Partially Absorbable Synthetic Surgical Mesh Device</Description><Size>Small- Onlay patch plug: 12cm x 7.5cm, 5cm rim diameter, 3cm anchor diameter; Medium- Onlay patch plug: 12cm x 7.5cm, 5cm rim diameter, 4cm anchor diameter; Large- Onlay patch plug: 12cm x 7.5cm, 5cm rim diameter, 5cm anchor diameter</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108002</GroupID><ARTGs><ARTG>142608</ARTG></ARTGs><MinimumBenefit>238</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA061</BillingCode><Name>Bard Mesh </Name><Description>PerFix Plug, PerFix Light Plug </Description><Size>Small, Medium, Large, Extra Large</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108002</GroupID><ARTGs><ARTG>394752</ARTG><ARTG>400494</ARTG></ARTGs><MinimumBenefit>238</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>II001</BillingCode><Name>Omnipod DASH® Insulin Management System - Personal Diabetes Manager (PDM) &amp; Software only</Name><Description>An insulin pump system for the continuous subcutaneous delivery of insulin at set and variable rates that receives and stores external glucose information via a rechargeable Personal Diabetes Manager (PDM). The PDM wirelessly activates/deactivates, controls, directs and monitors operation of a tubeless wearable waterproof Pod via secure Bluetooth Low Energy communication, as well as serves as a bolus calculator. The PDM provides audio alarms, alerts and reminders related to insulin delivery and the Pod. The PDM handles all processes for operation of the system and displays up to 90 days of information including basal rates, bolus doses, carbohydrates, alarms and blood glucose entries that are entered manually from any BGM meter. </Description><Size> The Personal Diabetes Manager (PDM)  is 6.3 cm wide x 13.0 cm long x 1.0 cm high) and weighs 106grams.                                                                                                                                                                                                                                           </Size><SupplierCode>40477</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107597</SubCategoryID><GroupID>108015</GroupID><ARTGs><ARTG>344290</ARTG></ARTGs><Note>The benefit for the device is payable no more frequently than once every 4 years.</Note><MinimumBenefit>8077</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO076</BillingCode><Name>HumanOptics Artificial Iris</Name><Description>One sterile, foldable Artificial Iris made of silicone, with or without fibre and custom made specific to the patient.</Description><Size>Custom made</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107633</SubCategoryID><GroupID>108414</GroupID><ARTGs><ARTG>225976</ARTG></ARTGs><MinimumBenefit>5607</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL002</BillingCode><Name>Model CZ70BD</Name><Description>Other:PMMA</Description><Size>Range of Powers: +10.0D to +30.0D</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108463</GroupID><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>126</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AO008</BillingCode><Name>HEALON PRO, Intraocular Viscoelastic Fluid</Name><Description>Sodium Hyaluronate 10mg/ml</Description><Size>0.55ml &amp; 0.85ml</Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><ARTGs><ARTG>413192</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ223</BillingCode><Name>OphteisBio 3.0</Name><Description>Viscoelastic solution for intraocular use - 3.0% sodium hyaluronate</Description><Size>1.1mL</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><ARTGs><ARTG>427865</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ235</BillingCode><Name>OphteisBio 1.8</Name><Description>Viscoelastic solution for intraocular use - 1.8% sodium hyaluronate</Description><Size>1.1 mL</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><ARTGs><ARTG>427856</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ247</BillingCode><Name>OphteisBio 1.6</Name><Description>Viscoelastic solution for intraocular use - 1.6% sodium hyaluronate</Description><Size>1.1 mL</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><ARTGs><ARTG>427855</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ221</BillingCode><Name>Ophteis FR Pro</Name><Description>Viscoelastic solution for intraocular use - 2.0% sodium hyaluronate and 4.0% sorbitol</Description><Size>1.2 mL</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><ARTGs><ARTG>427870</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG035</BillingCode><Name>Methylvisc 2.0%</Name><Description>Hydroxypropyl Methylcellulose, viscoelastic solution for intraocular application. Pre-loaded in single-use sterile syringe with single-use injection cannula.</Description><Size>2mL</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><ARTGs><ARTG>366798</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LN016</BillingCode><Name>AJL CELL</Name><Description>AJL CELL 2% is made up of 2% hydroxypropyl methylcellulose (HPMC) in a phosphate-buffered saline solution that is administered into the anterior chamber of the eye during intraocular surgery using a prepared sterile syringe and cannula suitable for the surgical technique.</Description><Size>2mL</Size><SupplierCode>40187</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><ARTGs><ARTG>413398</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LN009</BillingCode><Name>Viscos HPMC</Name><Description>Hydroxypropylmethylcellulose, viscoelastic solution for intraocular application. Pre-loaded in single-use sterile syringe with single-use injection cannula.</Description><Size>2 mL</Size><SupplierCode>40187</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><ARTGs><ARTG>300480</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE787</BillingCode><Name>CAPSULGel</Name><Description>Isotonic, clear, viscoelastic and  sterile HPMC solution for intraocular application</Description><Size>2.0ml prefilled, single-use, glass syringe.</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><ARTGs><ARTG>383098</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL006</BillingCode><Name>PROVISC VISCOELASTIC SOLUTION</Name><Description>PROVISC contains sodium hyaluronate</Description><Size>0.85mL pack</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><ARTGs><ARTG>310195</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL015</BillingCode><Name>Cellugel Ophthalmic Viscosurgical Device</Name><Description>2% Hydroxypropyl Methylcellulose (HPMC)</Description><Size>1ml</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><ARTGs><ARTG>115487</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL029</BillingCode><Name>DisCoVisc Ophthalmic Viscosurgical Device</Name><Description>Sodium hyaluronate 17 mg/mL and chondroitin sulfate 40mg/mL</Description><Size>1.0 mL</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><ARTGs><ARTG>141141</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL007</BillingCode><Name>VISCOAT Viscoelastic Fluid</Name><Description>Chondroitin sulfate and sodium hyaluronate</Description><Size>0.75mL</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><ARTGs><ARTG>141142</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DV273</BillingCode><Name>Oasis Visco Shield HPMC Viscoelastic</Name><Description>A sterile,  high molecular weight HPMC solution for use as a surgical aid in maintaining a deep anterior chamber during ophthalmic surgical procedures</Description><Size>2 ml syringe</Size><SupplierCode>39976</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><ARTGs><ARTG>373573</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL008</BillingCode><Name>Ocucoat Intraocular Fluid</Name><Description>20mg/mL hydroxypropylmethyl cellulose for intraocular use</Description><Size>1ml and 2ml Sterile</Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><ARTGs><ARTG>140513</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL015</BillingCode><Name>Amvisc Plus injection</Name><Description>15mg/mL Sodium Hyaluronate for intraocular use</Description><Size>0.5mL and 0.8mL</Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><ARTGs><ARTG>161187</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU029</BillingCode><Name>CrownGel</Name><Description>CrownGel is an isotonic, clear, viscoelastic and sterile solution for intraocular application. As an auxiliary device during surgery of the anterior segment of the eye, CrownGel maintains the depth of the anterior chamber and protects the surrounding intraocular tissue. CrownGel contains 2.0% hydroxypropyl methylcellulose and supports the intraocular manipulations due to its viscoelastic and moistening properties.</Description><Size>2.0% x 2.0mL</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><ARTGs><ARTG>413441</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU002</BillingCode><PriorBillingCodes><PriorBillingCode>IS050</PriorBillingCode></PriorBillingCodes><Name>Albomed Visco HPMC 2.0%</Name><Description>A superior viscoelastic solution based on hydroxylpropyl methylcellulose for intraocular use where it serves as a volume substitute for aqueous humor during intraocular surgery.</Description><Size>Supplied in a 2 ml syringe</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><ARTGs><ARTG>353332</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AO032</BillingCode><Name>Healon Endocoat</Name><Description>Viscoelastic</Description><Size>0.85ml</Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><ARTGs><ARTG>198813</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CZ012</BillingCode><Name>Z-HYALIN Viscoelastic</Name><Description>Cohesive Viscoelastic Solution - sodium hyaluronate 10mg/ml.  (previously called Ophthalin)</Description><Size>Volume 1.0ml</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><ARTGs><ARTG>150016</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CZ013</BillingCode><Name>Z-HYALIN Plus Viscoelastic</Name><Description>Cohesive Viscoelastic Solution - sodium hyaluronate 15mg/ml.  (previously called Opthalin Plus)</Description><Size>Volume 1.0ml</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><ARTGs><ARTG>150017</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CZ022</BillingCode><Name>VISTHESIA 1.5%</Name><Description>VISCOANAESTHETIC syringe contains sodium hyaluronate (NaHA, 1.5%) and lidocaine hydrochloride (1%). Also contains two topical ampoules with NaHA (0.3%) and lidocaine (2%)</Description><Size>0.8ml syringe &amp; 2x0.3ml ampoules</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><ARTGs><ARTG>198088</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IQ002</BillingCode><Name>Ocuvis and Ocumax 2% Hydroxypropylmethylcellulose</Name><Description>20mg/mL hydroxypropylmethyl cellulose for intraocular use. Pre-loaded in a sterile syringe with one cannula for injection, in a sterile Tyvek pouch</Description><Size>2mL sterile</Size><SupplierCode>40011</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><ARTGs><ARTG>104427</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AO010</BillingCode><Name>Healon GV PRO Intraocular Viscoelastic Fluid</Name><Description>Sodium Hyaluronate 18mg/mL</Description><Size>0.85ml</Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><Suffix>hmw</Suffix><ARTGs><ARTG>413673</ARTG></ARTGs><MinimumBenefit>64</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AO009</BillingCode><Name>Healon 5 Pro, Intraocular Viscoelastic Fluid</Name><Description>HEALON 5 PRO 2.3% Sodium hyaluronate </Description><Size>0.6ml</Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><Suffix>hmw</Suffix><ARTGs><ARTG>413672</ARTG></ARTGs><MinimumBenefit>64</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EG024</BillingCode><Name>RS-Blue</Name><Description>Trypan Blue for the reversible staining of human tissue during surgery</Description><Size>0.7ml Syringe</Size><SupplierCode>40068</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108467</GroupID><ARTGs><ARTG>252154</ARTG></ARTGs><MinimumBenefit>34</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IQ027</BillingCode><Name>Vioron</Name><Description>Trypan blue dye for ophthalmic applications</Description><Size>0.5ml syringe</Size><SupplierCode>40011</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108467</GroupID><ARTGs><ARTG>150061</ARTG></ARTGs><MinimumBenefit>34</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DV231</BillingCode><Name>Vision Blue</Name><Description>Trypan blue dye for ophthalmic applications</Description><Size>0.5ml syringe</Size><SupplierCode>39976</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108467</GroupID><ARTGs><ARTG>193085</ARTG></ARTGs><MinimumBenefit>34</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE775</BillingCode><Name>CAPSULBlue</Name><Description>Trypan blue solution for use in anterior segment ophthalmic surgery. </Description><Size>0.15ml prefilled glass syringe</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108467</GroupID><ARTGs><ARTG>343322</ARTG></ARTGs><MinimumBenefit>34</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LN015</BillingCode><Name>DyeBlue</Name><Description>Dyeblue is a sterile intraocular solution containing Trypan Blue without preservatives. Dyeblue is indicated for anterior capsule colouring during ophthalmic surgeries.</Description><Size>1 mL vial, 1.1 mL syringe  </Size><SupplierCode>40187</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108467</GroupID><ARTGs><ARTG>399953</ARTG></ARTGs><MinimumBenefit>34</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WP005</BillingCode><Name>AJL Blue</Name><Description>Trypan Blue STaining Dye</Description><Size>1 ml syringe</Size><SupplierCode>40395</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108467</GroupID><ARTGs><ARTG>392390</ARTG></ARTGs><MinimumBenefit>34</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LN012</BillingCode><Name>SIDA-BLUE</Name><Description>A sterile solution of trypan blue, a selective tissue-staining agent used in ophthalmic surgery.</Description><Size>1mL vial or 1mL glass pre-filled syringe (PFS)</Size><SupplierCode>40187</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108467</GroupID><ARTGs><ARTG>317719</ARTG></ARTGs><MinimumBenefit>34</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ328</BillingCode><Name>OCUBLU-TRY Trypan Blue</Name><Description>Ocublu-Try Trypan Blue is a sterile tissue dye for anterior segment surgery.</Description><Size>1mL</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108467</GroupID><ChangeExplanation>New listing</ChangeExplanation><MinimumBenefit>34</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Insert</ActionFlag><CycleStartDate>2024-08-08</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EG001</BillingCode><Name>Capsular Tension Rings Clear</Name><Description>PMMA Implant</Description><Size>10/08, 12/10, 13/11mm</Size><SupplierCode>40068</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107641</SubCategoryID><GroupID>108468</GroupID><ARTGs><ARTG>145740</ARTG></ARTGs><MinimumBenefit>99</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DV009</BillingCode><Name>Morcher Capsular Tension Ring</Name><Description>PMMA Implant</Description><Size>sizes 8 -12mm</Size><SupplierCode>39976</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107641</SubCategoryID><GroupID>108468</GroupID><ARTGs><ARTG>132347</ARTG></ARTGs><MinimumBenefit>99</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL039</BillingCode><Name>Preloaded Capsular Tension Ring</Name><Description>Capsular tension ring preloaded (acrylic)</Description><Size>11mm</Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107641</SubCategoryID><GroupID>108468</GroupID><Suffix>pl</Suffix><ARTGs><ARTG>281831</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LN001</BillingCode><Name>Inside CTR</Name><Description>Preloaded PMMA capsular tension ring</Description><Size>Type 14 (12.3mm open, 10.0mm compressed), Type 14C (13.0mm open, 11.0mm compressed), Type 14A ( 14.5mm open, 12.0mm compressed), Type 13 ( 12.3mm open, 10.0mm compressed), Type 13A ( 13.0mm open, 11.0mm compressed), Type 13B ( 14.5mm open, 12.0mm compressed), Type 19D (11.6 mm open, 10.0/9.5/9.0/8.5mm compressed), Type 10C ( 12.1mm open, 11.0mm compressed)Type 15A ( 13.0mm open, 11.0mm compressed), Type 15B ( 14.5mm open, 12.0mm compressed).</Size><SupplierCode>40187</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107641</SubCategoryID><GroupID>108468</GroupID><Suffix>pl</Suffix><ARTGs><ARTG>235092</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU001</BillingCode><PriorBillingCodes><PriorBillingCode>IS018</PriorBillingCode></PriorBillingCodes><Name>Jetring</Name><Description>Preloaded PMMA (polymethyl methacrylate) capsular tension ring.</Description><Size>JETRING 11ACB Right  Overall diameter:    13.0 mm  ±0.20 mm   Compressed diameter:   11,0 mm  ±0.20 mm   Haptic:     ø0.17 mm  ±0.02 mm   Haptic design:   straight, open modified C-loop    JETRING 12ACB Right  Overall diameter:    14.5 mm  ±0.20 mm   Compressed diameter:   12,0 mm  ±0.20 mm   Haptic:     ø0,20 mm  ±0.02 mm   Haptic design:    straight, open modified C-loop</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107641</SubCategoryID><GroupID>108468</GroupID><Suffix>pl</Suffix><ARTGs><ARTG>354770</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EG018</BillingCode><Name>RINGJECT</Name><Description>Preloaded Capsular tension ring</Description><Size>12/10, 13/11</Size><SupplierCode>40068</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107641</SubCategoryID><GroupID>108468</GroupID><Suffix>pl</Suffix><ARTGs><ARTG>145740</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DV029</BillingCode><Name>Eyejet CTR</Name><Description>Capsular tension ring made of PMMA per-load on disposable injector</Description><Size>10mm, 11mm, 12mm</Size><SupplierCode>39976</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107641</SubCategoryID><GroupID>108468</GroupID><Suffix>pl</Suffix><ARTGs><ARTG>132347</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WP004</BillingCode><Name>AJL Capsular Tension Ring</Name><Description>Preloaded PMAA Capsular Tension Ring</Description><Size>9mm, 10mm,11mm, 12mm (closed diameter) 10mm, 11mm, 12mm, 13mm, 14mm (open diameter)</Size><SupplierCode>40395</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107641</SubCategoryID><GroupID>108468</GroupID><Suffix>pl</Suffix><ARTGs><ARTG>392517</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DV010</BillingCode><Name>Morcher Complex Capsular Tension Ring</Name><Description>PMMA Implant</Description><Size>9.5mm, 10mm, 11mm, 12.5mm, 13mm</Size><SupplierCode>39976</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107641</SubCategoryID><GroupID>108469</GroupID><ARTGs><ARTG>132347</ARTG></ARTGs><MinimumBenefit>209</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ067</BillingCode><Name>PAUL® Glaucoma Implant        </Name><Description>Micro-sized tubed aqueous shunt glaucoma drainage device</Description><Size>Length 44.9mm  Width 23mm  Extraocular plate surface area of 342.1mm²</Size><SupplierCode>40063</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107642</SubCategoryID><GroupID>108470</GroupID><ARTGs><ARTG>303466</ARTG></ARTGs><MinimumBenefit>384</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VS001</BillingCode><PriorBillingCodes><PriorBillingCode>DV230</PriorBillingCode></PriorBillingCodes><Name>Molteno 3</Name><Description>Drainage implant for glaucoma, made of silicon</Description><Size>Small &amp; Large size</Size><SupplierCode>40237</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107642</SubCategoryID><GroupID>108470</GroupID><Suffix>v</Suffix><ARTGs><ARTG>128911</ARTG></ARTGs><MinimumBenefit>564</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LN002</BillingCode><Name>Ahmed Glaucoma Valve Model FP7</Name><Description>A sterile device designed to regulate  the flow of Fluid between the anterior chamber and the space around the conjunctiva of the eye be allowing flow when the pressure in the chamber is above a pre-set value (e.g., 8 to 10 mmHg). Made of medical grade silicone</Description><Size>one size</Size><SupplierCode>40187</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107642</SubCategoryID><GroupID>108470</GroupID><Suffix>v</Suffix><ARTGs><ARTG>242076</ARTG></ARTGs><MinimumBenefit>564</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AO012</BillingCode><Name>Baerveldt Glaucoma Implant BG 101-350, Baerveldt Glaucoma Implant BG 103-425, Baerveldt Glaucoma Implant BG 103-250</Name><Description>Non-valved artificial drainage device, composition silicone - smooth, tumble-polished finish</Description><Size>Surface area 250, 350, 425mm2</Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107642</SubCategoryID><GroupID>108470</GroupID><ARTGs><ARTG>168768</ARTG></ARTGs><MinimumBenefit>384</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO017</BillingCode><Name>FCI Ptose-up</Name><Description>Expanded PTFE</Description><Size>15cm long x 2 or 3mm wide x 0.35mm thick</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107643</SubCategoryID><GroupID>108474</GroupID><ARTGs><ARTG>146261</ARTG></ARTGs><MinimumBenefit>314</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO044</BillingCode><Name>FCI Mono-Canalicular Lacrimal Intubation Set</Name><Description>Silicone tubing with plug swaged, imbedded into or around malleable or flexible stainless steel probes or guides. PEEK thread. Introducer.</Description><Size>Probes: 40mm to 120mm x 0.7mm to 1.2mm.  Tube: 0.64mm to 1.18mm x 30mm to 350mm.  PEEK Thread: 0.2mm to 0.4mm x 500mm.  Plug Collar: 2mm to 4mm.</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107644</SubCategoryID><GroupID>108476</GroupID><Suffix>mc</Suffix><ARTGs><ARTG>143177</ARTG></ARTGs><MinimumBenefit>162</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO086</BillingCode><Name>Lacrijet</Name><Description>Self retaining mono-canalicular stent without nasal retrieval that is pre-loaded into a handpiece.</Description><Size>15mm to 50mm</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107644</SubCategoryID><GroupID>108476</GroupID><Suffix>mc/sr</Suffix><ARTGs><ARTG>143177</ARTG></ARTGs><MinimumBenefit>217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO050</BillingCode><Name>FCI Nunchaku</Name><Description>Self-retaining bicanalicular nasal intubation WITHOUT nasal retrieval</Description><Size>90mm to 105mm</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107644</SubCategoryID><GroupID>108476</GroupID><Suffix>sr</Suffix><ARTGs><ARTG>143177</ARTG></ARTGs><MinimumBenefit>176</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO043</BillingCode><Name>FCI Bi-Canalicular Lacrimal Intubation Set</Name><Description>Silicone tubing swaged, imbedded into or around malleable and flexible stainless steel probes. PEEK thread.</Description><Size>Probes: 40mm to 120mm x 0.7mm to 1.2mm.  Tube: 0.64mm to 1.18mm x 25mm to 400mm.  PEEK Thread: 0.2mm to 0.4mm x 500mm.</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107644</SubCategoryID><GroupID>108476</GroupID><ARTGs><ARTG>143177</ARTG></ARTGs><MinimumBenefit>122</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO021</BillingCode><Name>FCI Lacrimal Intubation Set</Name><Description>PVP Coated Silicone Tubing/PVP Coated Silicone Plug/Metal Probes/Polypropylene Thread</Description><Size>PVP Bika: 0.64mm O.D. Tube/80 x 0.8mm probes, PVP Differential Bika: 0.64 &amp; 1.18mm O.D. Tube/40 x 1.2mm probes, PVP Bika for DCR: 0.94mm O.D. Tube/50 x 0.8mm probes, PVP Infant Bika 0.64mm O.D. Tube/55 x 0.7mm probes, PVP Infant Bika II: 0.64mm O.D. Tube/</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107644</SubCategoryID><GroupID>108476</GroupID><ARTGs><ARTG>143177</ARTG></ARTGs><MinimumBenefit>122</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO049</BillingCode><Name>FCI Masterka</Name><Description>Self-retaining monocanalicular nasal intubation WITHOUT nasal retrieval</Description><Size>30mm to 40mm</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107644</SubCategoryID><GroupID>108476</GroupID><Suffix>mc/sr</Suffix><ARTGs><ARTG>143177</ARTG></ARTGs><MinimumBenefit>217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE799</BillingCode><Name>Olie Medical (Sidapharm) Lacrimal Intubation Set</Name><Description>This disposable device consists of two stainless steel malleable probes (with or without olive tip) attached to a silicon tube.</Description><Size>23G, 17.5 cm, Straight tip    23G, 11.0 cm, Olive tip</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107644</SubCategoryID><GroupID>108476</GroupID><ARTGs><ARTG>370527</ARTG></ARTGs><MinimumBenefit>122</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE191</BillingCode><Name>Canaliculus Intubation Sets </Name><Description>Silicone, SS &amp; Nylon</Description><Size>17.7 x .064 x 29cm, 15.5 x .051 x 33cm</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107644</SubCategoryID><GroupID>108476</GroupID><ARTGs><ARTG>182623</ARTG></ARTGs><MinimumBenefit>122</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO070</BillingCode><Name>Ophtacath Lacrimal Duct Balloon Catheter – Unilateral system</Name><Description>Unilateral balloon catheter kit containing balloon catheter &amp; inflation device</Description><Size>2mm and 3mm</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107644</SubCategoryID><GroupID>108478</GroupID><ARTGs><ARTG>212425</ARTG></ARTGs><MinimumBenefit>438</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO069</BillingCode><Name>Ophtacath Lacrimal Duct Balloon Catheter – Bilateral system</Name><Description>Bilateral balloon catheter kit containing balloon catheter &amp; inflation device</Description><Size>2mm and 3mm</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107644</SubCategoryID><GroupID>108478</GroupID><Suffix>bilateral</Suffix><ARTGs><ARTG>212425</ARTG></ARTGs><MinimumBenefit>793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO040</BillingCode><Name>FCI Orbital Implants</Name><Description>Silicone - Sterile</Description><Size>12mm to 22mm</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107645</SubCategoryID><GroupID>108479</GroupID><ARTGs><ARTG>143210</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE277</BillingCode><Name>Frontalis Suspension Set</Name><Description>Stainless steel needles with solid silicone rods and silicone tubing - packaged sterile</Description><Size>needles 0.90mm x 6.5cm, rod 40cm - 0.80mm, sleeve 10 x 2mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107645</SubCategoryID><GroupID>108481</GroupID><ARTGs><ARTG>125073</ARTG></ARTGs><MinimumBenefit>284</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO045</BillingCode><Name>FCI Ptosis Probes</Name><Description>Stainless steel needle probes swaged with silicone tubing.</Description><Size>80mm x 0.8mm needle probes, 280mm 0.64mm tubing.</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107645</SubCategoryID><GroupID>108481</GroupID><ARTGs><ARTG>146261</ARTG></ARTGs><MinimumBenefit>284</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO009</BillingCode><Name>FCI Scleral Buckling Devices</Name><Description>Band/strip: solid silicone</Description><Size>Band - 2.0 x 0.75mm Type 40, 3.5 x 0.75mm Type 41, 4.0 x 1.25mm Type 42, 2.5 x 0.6mm Type 240, Morin 3.5 x 0.6mm
Strip - 5.7mm Type 20, 7.2mm Type 31, 9.2mm Type 32, 6mm Type 219, 7.5mm Type 220, 8mm Type 225</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108482</GroupID><ARTGs><ARTG>143211</ARTG></ARTGs><MinimumBenefit>41</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG029</BillingCode><Name>Labtician Retinal Implants</Name><Description>Band/Strip: solid silicone</Description><Size>S 2950 Circling Band, S 2969 Circling Band, S 2978 Meridional Implant - Flat, S 2987 Circling Band, S 2988 Meridional Implant, S 2989 Boat, S 2992 Silicone Strip, S 2993 Pad, S 2998 Silicone Strip, S 3012 Boat, S 3013 Silicone Strip, S 3020 Meridional Implant, S 3021 Wedge, S 3022 Wedge, S 3083 Labtician Oval Sleeve, S 3084 Labtician Oval Sleeve, S 3093 Labtician Buckling Sleeve, S 3094 Labtician Buckling Sleeve, S 4050 Silicone Strip, S 4055 Silicone Strip, S 4060 Silicone Strip, S 4065 Silicone Strip</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108482</GroupID><ARTGs><ARTG>337137</ARTG></ARTGs><MinimumBenefit>41</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO011</BillingCode><Name>FCI Scleral Buckling Devices</Name><Description>Tire: Solid Silicone</Description><Size>Symmetrical: (2.5 mm Groove, 7 to 9mm wide), Biconvex: (2.5mm Groove, 7 to 10mm wide), Asymetrical: (2.5mm Groove, 7 to 10mm wide)</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108482</GroupID><ARTGs><ARTG>143211</ARTG></ARTGs><MinimumBenefit>41</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AP004</BillingCode><Name>Mira: Scleral Implants</Name><Description>Solid Silicone-Sleeve. Retinal Implant used in Scleral Buckling (Dimethylmethylvinyl Siloxane Copolymer)</Description><Size>Sleeves-Mira 70 Sleeve 1mm I.D., Mira 71 Sleeve 1mm I.D., Mira 72 McNutt Sleeve 1.57mm I.D., Mira 270 Sleeve 0.76mm I.D.</Size><SupplierCode>40030</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108482</GroupID><ARTGs><ARTG>143682</ARTG></ARTGs><MinimumBenefit>41</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AP006</BillingCode><Name>Mira: Scleral Implants</Name><Description>Solid Silicone-Band/Strip/Boat/Clip. Retinal Implant used in Scleral Buckling (Dimethylmethylvinyl Siloxane Copolymer)</Description><Size>Bands-Mira 40 Circling Band 2mm, Mira 240 Circling Band 2.5mm. Strips-Mira 41 Strip 3.5mm, Mira 42 Strip 4mm, Mira 20 Strip 4mm, Mira 219 Strip 4.5mm, Mira 31 Strip 4.5mm, Mira 32 Strip 5mm, Mira 225 Oval Strip 5mm, Mira 220 Strip 6mm. Boats-Mira 60 Boat 2mm, Mira 260 Boat 2.5mm. Clips-Mira 50 Double Tantalum Clip 2mm, Mira 250 Double Tantalum Clip 2.5mm, Mira 51 Singla Tantalum Clip 3.5mm, Mira 52 Joondeph Single Tantalum Clip 4mm</Size><SupplierCode>40030</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108482</GroupID><ARTGs><ARTG>143682</ARTG></ARTGs><MinimumBenefit>41</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO013</BillingCode><Name>FCI Scleral Buckling Devices</Name><Description>Strip: Solid Silicone</Description><Size>Strip: 1.4 x 4.4 x 100mm, Morin Strip: 7mm wide x 100mm long, Caputo Zip Strip: 7 to 9mm wide x 120mm long, Korobelnik Oval Strip: 2 x 5mm</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108482</GroupID><ARTGs><ARTG>143211</ARTG></ARTGs><MinimumBenefit>41</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AP003</BillingCode><Name>Mira: Scleral Implants</Name><Description>Solid Silicone-Tire/Meridional/Wedge/Pad. Retinal Implant used in Scleral Buckling (Dimethylmethylvinyl Siloxane Copolymer)</Description><Size>Tires-Mira 286 Wendel Symmetrical Oval Tire 6mm, Mira Symmetrical Oval Tire 7mm, Mira 287WG Murray wide (3.5mm) grooved symmetrical tire, 10mm wide, Mira 288 ross symmetrical grooved tire, low profile 10mm wide by 2.5mm, Mira 289 Symmetrical oval tire 10mm, Mira 277Symmetrical tire 7mm, Mira 279 Symmetrical tire 9mm, Mira 78G Grooved symmetrical tire 10mm, Mira 281 Symmetrical tire 12.5mm, Mira 275 Munsen Asymmetrical tire 6mm, Mira 276 Asymmetrical tire 7mm, Mira 278 Brockhurst asymmetrical tire 8.5mm, Mira 280LG Large grooved asymmetrical tire 10mm, Mira 77G Grooved hemisphere 26mm. Meridional- Mira 106 Meridional Implant 6mm by 10.5mm, Mira 112 Curved Meridional implant 12mm by 12mm, Mira 103 Meridional implant 4mm by 15mm. Wedge- Mira 135 Pruett maxi wedge 14mm, Mira Pruett midi wedge 12mm, Mira 190 Spencer sub-implant 5mm by 10mm. Pad- Mira 80 Pad 4mm by 8mm, Mira 22 Button 5mm by 5mm</Size><SupplierCode>40030</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108482</GroupID><ARTGs><ARTG>143682</ARTG></ARTGs><MinimumBenefit>41</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG028</BillingCode><Name>Labtician - Retinal Implants</Name><Description>Solid Silicone- Tire/Meridional/ Wedge/Pad. Retinal Implant used in Scleral Buckling (Dimethylmethylvinyl Siloxane Copolymer)</Description><Size>S 2965 Silicone Strip , S 2967 Silicone Strip , S 2968 Silicone Strip, S 2970 Silicone Strip , S 2971 Silicone Strip , S 2976 Silicone Button , S 2977 Silicone Tire 10mm , S 2986 Silicone Tire 7mm, S 2991 Silicone Tire 9mm, S 2994 Silicone Tire 6.0mm , S 2995 Silicone Tire 8.5mm , S 2996 Silicone Tire 10mm , S 2996 L Silicone Tire 10mm LG , S 2997 Silicone Tire 12.5mm, S 2999 Silicone Tire 7.0mm , S 2999 L Silicone Tire Wide Groove , S 3004 Silicone Tire 9mm , S 3010 Silicone Tire 6mm, S 3014 Silicone Tire 7mm , S 3014 L Silicone Tire 7mm WG , S 3016 Silicone Tire 10mm , S 3017 Silicone Tire , S 3018 Silicone Sleeve , S 3019 Silicone Sleeve, S 3025 Wong Meridional Implant , S 3071 Silicone Sleeve, S 5020 Silicone Lace™ 2mm , S 5025 Silicone Lace™ 2.5mm.</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108482</GroupID><ARTGs><ARTG>337137</ARTG></ARTGs><MinimumBenefit>41</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO010</BillingCode><Name>FCI Scleral Buckling Devices</Name><Description>Fixation Sleeve: Solid silicone</Description><Size>O.D: 1.65 to 2.41mm, Length 30mm</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108484</GroupID><ARTGs><ARTG>143211</ARTG></ARTGs><MinimumBenefit>23</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL035</BillingCode><Name>ISPAN Retinal Gases for Constellation® Vision System</Name><Description>Tamponade gases for retinal surgery C3F8 and SF6</Description><Size>125g cylinder, dispensed in single dose syringe</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108485</GroupID><ARTGs><ARTG>115487</ARTG></ARTGs><MinimumBenefit>67</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EG021</BillingCode><Name>GOT Multi</Name><Description>Tamponade gas for retinal surgery</Description><Size>75ml</Size><SupplierCode>40068</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108485</GroupID><ARTGs><ARTG>297730</ARTG></ARTGs><MinimumBenefit>67</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL036</BillingCode><Name>ISPAN retinal gases</Name><Description>Tamponade gases for retinal surgery C3F8 and SF6</Description><Size>125 g cylinder, dispensed in single dose syringe</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108485</GroupID><ARTGs><ARTG>115487</ARTG></ARTGs><MinimumBenefit>67</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE795</BillingCode><Name>Micromed Microgas</Name><Description>Single dose high molecular weight gases for replacement of vitreous humor during retinal surgery  </Description><Size>50cc aluminium canister with dispenser</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108485</GroupID><ARTGs><ARTG>382032</ARTG></ARTGs><MinimumBenefit>67</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DV270</BillingCode><Name>OcuGas </Name><Description>Tamponade gas for retinal surgery</Description><Size>OCUGAS SF6 (15 ml)  OCUGAS C2F6 (12 ml)  OCUGAS C3F8 (9 ml)</Size><SupplierCode>39976</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108485</GroupID><ARTGs><ARTG>408427</ARTG></ARTGs><MinimumBenefit>67</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IQ012</BillingCode><Name>EasyGas</Name><Description>Endotamponade Gases for Retinal Surgery, EasyGas SF6, C2F6 or C3F8, each supplied in a 60ml syringe, sterile</Description><Size>60ml dispensed in a single dose, sterile syringe</Size><SupplierCode>40011</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108485</GroupID><ARTGs><ARTG>197089</ARTG></ARTGs><MinimumBenefit>67</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IW007</BillingCode><PriorBillingCodes><PriorBillingCode>DE284</PriorBillingCode></PriorBillingCodes><Name>Single Dose Ophthalmic Gases</Name><Description>Single dose tamponading gas for retinal surgery</Description><Size>30ml</Size><SupplierCode>40471</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108485</GroupID><ARTGs><ARTG>99568</ARTG></ARTGs><MinimumBenefit>67</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL013</BillingCode><Name>Perfluoron Kits</Name><Description>Perfluoro-n-octane for use as a retinal surgery additive</Description><Size>5mL</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108486</GroupID><ARTGs><ARTG>327862</ARTG></ARTGs><MinimumBenefit>217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO054</BillingCode><Name>FCI - DECA, FCI - OCTA</Name><Description>FCI - DECA: Purified perflurodecalin, FCI - OCTA: Purified perfluoro-N-Octane</Description><Size>5ml / 7ml</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108486</GroupID><ARTGs><ARTG>143212</ARTG></ARTGs><MinimumBenefit>217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IQ008</BillingCode><Name>Octane &amp; Decalin</Name><Description>Perfluorocarbon retinal tamponade medium, intraoperative</Description><Size>5ml &amp; 7ml, Sterile</Size><SupplierCode>40011</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108486</GroupID><ARTGs><ARTG>152235</ARTG></ARTGs><MinimumBenefit>217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IW008</BillingCode><PriorBillingCodes><PriorBillingCode>DE204</PriorBillingCode></PriorBillingCodes><Name>Arcaline (Perfluorodecaline)</Name><Description>Liquid perfluorocarbon aid for retinal surgery, operative device for retinal surgery, in particular retinal detachment (RD), RD with giant tear etc.</Description><Size>3ml, 5ml, 7ml</Size><SupplierCode>40471</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108486</GroupID><ARTGs><ARTG>140539</ARTG></ARTGs><MinimumBenefit>217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL018</BillingCode><Name>DK Line 100% purified perfluorodecalin</Name><Description>Perfluorodecalin</Description><Size>7ml</Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108486</GroupID><ARTGs><ARTG>108429</ARTG></ARTGs><MinimumBenefit>217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL017</BillingCode><Name>Perfluo-octane (Oktaline) Okta-Line</Name><Description>Perfluorocarbon Liquid  for use as a retinal surgery additive</Description><Size>5mL</Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108486</GroupID><ARTGs><ARTG>108429</ARTG></ARTGs><MinimumBenefit>217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IW009</BillingCode><PriorBillingCodes><PriorBillingCode>DE205</PriorBillingCode></PriorBillingCodes><Name>Arcotane (Perfloro-N-Octane)</Name><Description>Liquid perfluoro-N-Octane aid for retinal surgery, pre-operative device for retinal surgery, in particular retinal detachment (RD), RD with giant tear, RD with proliferative vitreal retinopathy (PVR) etc.</Description><Size>5ml, 7ml</Size><SupplierCode>40471</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108486</GroupID><ARTGs><ARTG>140539</ARTG></ARTGs><MinimumBenefit>217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL014</BillingCode><Name>Perfluoron Kits</Name><Description>Perfluoro-n-octane for use as a retinal surgery additive</Description><Size>7mL</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108486</GroupID><ARTGs><ARTG>327862</ARTG></ARTGs><MinimumBenefit>217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EG022</BillingCode><Name>Perfluorocarbons</Name><Description>HPF8 Perfluoro-n-octane and HPF10 Perfluorodecalin</Description><Size>5ml and 7ml</Size><SupplierCode>40068</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108486</GroupID><ARTGs><ARTG>252153</ARTG></ARTGs><MinimumBenefit>217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DV244</BillingCode><Name>D.O.R.C. Eftiar</Name><Description>Eftiar Decaline and Octane</Description><Size>5ml, 7ml</Size><SupplierCode>39976</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108486</GroupID><ARTGs><ARTG>408574</ARTG></ARTGs><MinimumBenefit>217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IQ005</BillingCode><Name>Densiron</Name><Description>Heavy Tamponade Liquid Medium, Postoperative</Description><Size>10 ml, Sterile</Size><SupplierCode>40011</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108487</GroupID><Suffix>HO</Suffix><ARTGs><ARTG>152234</ARTG></ARTGs><MinimumBenefit>217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IW006</BillingCode><PriorBillingCodes><PriorBillingCode>DE701</PriorBillingCode></PriorBillingCodes><Name>ARCIOLANE 5500</Name><Description>Silicone Oil for Vitreoretinal Surgery</Description><Size>10ml</Size><SupplierCode>40471</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108487</GroupID><ARTGs><ARTG>171840</ARTG></ARTGs><MinimumBenefit>176</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IQ006</BillingCode><Name>Siluron 1000 &amp; Siluron 5000</Name><Description>Silicone Oils</Description><Size>10 ml, Sterile</Size><SupplierCode>40011</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108487</GroupID><ARTGs><ARTG>152234</ARTG></ARTGs><MinimumBenefit>176</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG030</BillingCode><Name>LSO Silicone Oil</Name><Description>Highly purified, sterile, transparent, silicone oil available in both a 1,000 cP and a 5,000 cP viscosity.</Description><Size>10mL vial, 10mL syringe</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108487</GroupID><ARTGs><ARTG>337138</ARTG></ARTGs><MinimumBenefit>176</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO022</BillingCode><Name>FCI Purified Silicone Oil (Solvent Free)</Name><Description>Viscosity: 1000 cst/5000 cst: solvent free purified silicone oil</Description><Size>10ml</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108487</GroupID><ARTGs><ARTG>143212</ARTG></ARTGs><MinimumBenefit>176</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WP006</BillingCode><Name>AJL SIOBAL Silicon Oil</Name><Description>High-purity silicone oil used as tamponade agent for retinal detachment.  1000/2000/5000 cSt</Description><Size>10ml prefilled syringe</Size><SupplierCode>40395</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108487</GroupID><ARTGs><ARTG>392371</ARTG></ARTGs><MinimumBenefit>176</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EG023</BillingCode><Name>RS-OIL</Name><Description>Highly purified Silicone Oil</Description><Size>10ml</Size><SupplierCode>40068</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108487</GroupID><ARTGs><ARTG>297730</ARTG></ARTGs><MinimumBenefit>176</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DV243</BillingCode><Name>D.O.R.C. Silicon Oil</Name><Description>D.O.R.C. Silicon Oil 1000/2000/5000-S</Description><Size>10ml</Size><SupplierCode>39976</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108487</GroupID><ARTGs><ARTG>408427</ARTG></ARTGs><MinimumBenefit>176</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IW005</BillingCode><PriorBillingCodes><PriorBillingCode>DE702</PriorBillingCode></PriorBillingCodes><Name>ARCIOLANE 1300</Name><Description>Silicone Oil for Vitreoretinal Surgery</Description><Size>10ml</Size><SupplierCode>40471</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108487</GroupID><ARTGs><ARTG>171840</ARTG></ARTGs><MinimumBenefit>176</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL024</BillingCode><Name>Oxane HD</Name><Description>Silicone oil - RMN3 mixture</Description><Size>10ml</Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108487</GroupID><ARTGs><ARTG>108429</ARTG></ARTGs><MinimumBenefit>176</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL016</BillingCode><Name>Oxane LMWC Fractioned Silicone Oil</Name><Description>Purified fractioned silicone oil</Description><Size>10mL</Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108487</GroupID><ARTGs><ARTG>108429</ARTG></ARTGs><MinimumBenefit>176</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI472</BillingCode><Name>Pectus Bar</Name><Description>Pectus Bar, Stainless Steel</Description><Size>80-432mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107647</SubCategoryID><GroupID>108488</GroupID><ARTGs><ARTG>149413</ARTG></ARTGs><MinimumBenefit>1193</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI483</BillingCode><Name>Pectus Bar</Name><Description>Stabilizer, Triangular or Elongated, Stainless Steel</Description><Size>One size only</Size><SupplierCode>40315</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107647</SubCategoryID><GroupID>108489</GroupID><ARTGs><ARTG>149413</ARTG></ARTGs><MinimumBenefit>480</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE622</BillingCode><Name>Park Bridge Stabiliser</Name><Description>Stablisation of Pectus Bar - optional use for multiple bar placement</Description><Size>3 sizes: 6 hole - 60mm, 8 hole 80mm, 10 hole - 100mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107647</SubCategoryID><GroupID>108489</GroupID><ARTGs><ARTG>224584</ARTG></ARTGs><MinimumBenefit>480</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE623</BillingCode><Name>Park Claw Fixator, Clip and Nut Stabiliser</Name><Description>Stabilisation of Pectus Bar</Description><Size>Park Claw Fixator - Small (20mm x 12mm), Medium (23mm x 15mm), Large (25mm x 18mm), Extra Large (30mm x 18mm).
Fixator Clip - 15mm.
Nut - 7mm.</Size><SupplierCode>39975</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107647</SubCategoryID><GroupID>108489</GroupID><ARTGs><ARTG>224584</ARTG></ARTGs><MinimumBenefit>480</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE624</BillingCode><Name>Chord-X</Name><Description>ePTFE chordal repair</Description><Size>Five (5) loop lengths -(0mm/adjustable, 12mm, 16mm, 20mm and 24mm),
Two (2) sutures (2-0 ePTFE or 3-0 ePTFE),
Two (2) needle shapes (1/2 circle and 3/8 circle),
Two (2) needle lengths (18mm and 22mm).</Size><SupplierCode>39975</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107648</SubCategoryID><GroupID>108490</GroupID><Suffix>No Suffix</Suffix><ARTGs><ARTG>262630</ARTG></ARTGs><MinimumBenefit>256</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ401</BillingCode><Name>HeartMate 3 Implant Kit</Name><Description>Left ventricular assist device</Description><Size>one size only</Size><SupplierCode>40062</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107649</SubCategoryID><GroupID>108491</GroupID><ARTGs><ARTG>300895</ARTG></ARTGs><MinimumBenefit>95000</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ066</BillingCode><Name>AtriClip Left Atrial Appendage Exclusion System</Name><Description>Gillinov-Cosgrove LAA Clip for open occlusion of the left atrial appendage mounted on a disposable applier</Description><Size>35mm, 40mm, 45mm, 50mm,</Size><SupplierCode>40063</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107651</SubCategoryID><GroupID>108498</GroupID><ARTGs><ARTG>308862</ARTG></ARTGs><MinimumBenefit>1097</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY688</BillingCode><Name>Sternal ZipFix System</Name><Description>Sternal Closure Tie with Needle</Description><Size>One Size</Size><SupplierCode>39932</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107652</SubCategoryID><GroupID>108499</GroupID><ARTGs><ARTG>187295</ARTG></ARTGs><MinimumBenefit>119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SA129</BillingCode><Name>Optiform</Name><Description>Mechanical Valve</Description><Size>19mm to 33mm</Size><SupplierCode>40189</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107654</SubCategoryID><GroupID>108502</GroupID><ARTGs><ARTG>150082</ARTG></ARTGs><MinimumBenefit>4962</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI124</BillingCode><Name>Open Pivot Heart Valve AP360 - Mitral</Name><Description>Supra-annular mechanical valve; Pyrolythic Carbon, Double Velour Polyester, Titanium</Description><Size>Mitral: 16, 18, 20, 22, 24, 26,  28 and 30 mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107654</SubCategoryID><GroupID>108502</GroupID><ARTGs><ARTG>219161</ARTG></ARTGs><MinimumBenefit>4962</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ317</BillingCode><Name>Regent Prosthetic Heart Valve</Name><Description>Standard Cuff</Description><Size>Standard cuff - 17-23mm/25mm-29mm, Flex cuff - 17-23mm/25mm-29mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107654</SubCategoryID><GroupID>108502</GroupID><ARTGs><ARTG>116294</ARTG></ARTGs><MinimumBenefit>4962</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC980</BillingCode><Name>Open Pivot Heart Valve (Model 500FA)
Open Pivot Heart Valve (Model 500DM)</Name><Description>Pyrolythic Carbon, Double Velour Polyester, Titanium</Description><Size>16-33mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107654</SubCategoryID><GroupID>108502</GroupID><ARTGs><ARTG>127478</ARTG><ARTG>127419</ARTG></ARTGs><MinimumBenefit>4962</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI125</BillingCode><Name>Open Pivot Heart Valve AP360 - Aortic</Name><Description>Supra-annular mechanical valve; Pyrolythic Carbon, Double Velour Polyester, Titanium</Description><Size>Aortic: 16, 18, 20, 22, 24, 26 and 28 mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107654</SubCategoryID><GroupID>108502</GroupID><ARTGs><ARTG>219162</ARTG></ARTGs><MinimumBenefit>4962</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ037</BillingCode><Name>Masters Series Heart Valve Mitral and Aortic - Expanded Cuff/Hemodynamic Plus</Name><Description>Aortic Expanded Cuff, Aortic Hemodynamic Plus Cuff, Mitral hemodynamic Cuff, Aortic &amp; Mitral Rotatable Cuff</Description><Size>Aortic Expanded 19 - 31mm, Aortic Hemodynamic 17 - 27mm, Mitral Hemodynamic 17 - 27mm, Rotable 17 - 33mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107654</SubCategoryID><GroupID>108502</GroupID><ARTGs><ARTG>129879</ARTG><ARTG>129926</ARTG><ARTG>129925</ARTG></ARTGs><MinimumBenefit>4962</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE607</BillingCode><Name>On-X Prosthetic Heart Valve</Name><Description>Bileaflet Mechanical Heart Valve</Description><Size>19-33mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107654</SubCategoryID><GroupID>108502</GroupID><ARTGs><ARTG>123500</ARTG><ARTG>123501</ARTG><ARTG>123503</ARTG><ARTG>123502</ARTG></ARTGs><MinimumBenefit>4962</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JS004</BillingCode><Name>Carbomedics Standard Mitral M700 - Prosthesis,  internal, valve, cardiac, artificial</Name><Description>Prosthesis, internal, valve, cardiac, artificial</Description><Size>16.2  18.8  21.8  23.8  25.8  27.8  29.8  31.8</Size><SupplierCode>39933</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107654</SubCategoryID><GroupID>108502</GroupID><ARTGs><ARTG>147290</ARTG></ARTGs><MinimumBenefit>4962</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC701</BillingCode><Name>Mosaic Cinch, Aortic, Mitral</Name><Description>Models 305cxx, 310cxx</Description><Size>19mm - 35mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107655</SubCategoryID><GroupID>108504</GroupID><ARTGs><ARTG>145761</ARTG><ARTG>145762</ARTG></ARTGs><MinimumBenefit>4750</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ136</BillingCode><Name>SJM Biocor Heart Valve</Name><Description>Stented Porcine tissue valve</Description><Size>Aortic Valves - Tissue Annulus Diameter - 21 - 29mm                                                                             Mitral Valves - Tissue Annulus Diameter - 25-35mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107655</SubCategoryID><GroupID>108504</GroupID><ARTGs><ARTG>155281</ARTG><ARTG>155282</ARTG></ARTGs><MinimumBenefit>4750</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC962</BillingCode><Name>Mosaic Cinch II</Name><Description>Aortic Bioprosthesis</Description><Size>19mm -29mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107655</SubCategoryID><GroupID>108504</GroupID><ARTGs><ARTG>145761</ARTG></ARTGs><MinimumBenefit>4750</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ201</BillingCode><Name>Epic FlexFit Supra</Name><Description>Triple-composite Bioprosthetic heart valve for supra-annular placement in the aortic position</Description><Size>Tissue Annulus Diameter - 19mm-23mm. Total Height 14mm-16mm.</Size><SupplierCode>40062</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107655</SubCategoryID><GroupID>108504</GroupID><ARTGs><ARTG>164943</ARTG></ARTGs><MinimumBenefit>4750</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC950</BillingCode><Name>Mosaic Ultra Cinch II</Name><Description>Small Aortic Root Bioprosthesis</Description><Size>19mm - 29mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107655</SubCategoryID><GroupID>108504</GroupID><ARTGs><ARTG>145761</ARTG></ARTGs><MinimumBenefit>4750</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ192</BillingCode><Name>Epic Flexfit</Name><Description>Triple-composite Bioprosthetic heart valve</Description><Size>Aortic Valves 21-29mm tissue annulus diameter, 14-20mm total height. Mitral Valves 25-33mm tissue annulus diameter, 15-20mm total height.</Size><SupplierCode>40062</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107655</SubCategoryID><GroupID>108504</GroupID><ARTGs><ARTG>164942</ARTG><ARTG>164941</ARTG></ARTGs><MinimumBenefit>4750</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EL064</BillingCode><Name>Edwards INSPIRIS RESILIA Aortic Valve, Model 11500A</Name><Description>A stented, trileaflet aortic valve, with leaflets comprised of RESILIA bovine pericardial tissue mounted on a flexible cobalt-chromium alloy frame (see Attachment 1 for product images).</Description><Size>INSPIRIS RESILIA is available in tissue annulus/stent diameter sizes 19, 21, 23, 25, 27, and 29 mm.</Size><SupplierCode>40072</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107655</SubCategoryID><GroupID>108504</GroupID><ARTGs><ARTG>308830</ARTG></ARTGs><MinimumBenefit>4750</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EL058</BillingCode><Name>Carpentier-Edwards PERIMOUNT Magna Ease Aortic Bioprosthesis (Model: 3300TFX)</Name><Description>Stented Bovine Pericardial Aortic Tissue Valve with a reduced profile height</Description><Size>19mm, 21mm, 23mm, 25mm, 27mm and 29mm</Size><SupplierCode>40072</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107655</SubCategoryID><GroupID>108504</GroupID><ARTGs><ARTG>156355</ARTG></ARTGs><MinimumBenefit>4750</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EL060</BillingCode><Name>Carpentier-Edwards PERIMOUNT Magna Mitral Ease Tissue Valve</Name><Description>The Carpentenier-Edwards PERIMOUNT Magna Mitral Ease Tissue is comprised of Bovine Pericardial Tissue and is bioengineered to withstand the higher pressures encountered in the mitral position, whilst maximising implantation ease.</Description><Size>25, 27, 29, 31, 33mm</Size><SupplierCode>40072</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107655</SubCategoryID><GroupID>108505</GroupID><ARTGs><ARTG>196126</ARTG></ARTGs><MinimumBenefit>4750</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ284</BillingCode><Name>Trifecta Valve</Name><Description>Tri-leaflet, stented pericardial valve.</Description><Size>19-29mm Annulus diameter and 15-20mm height</Size><SupplierCode>40062</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107655</SubCategoryID><GroupID>108505</GroupID><ARTGs><ARTG>190630</ARTG></ARTGs><MinimumBenefit>4750</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI289</BillingCode><Name>Avalus Aortic Valve Bioprosthesis</Name><Description>Next generation aortic valve bovine bioprosthesis</Description><Size>19-29mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107655</SubCategoryID><GroupID>108505</GroupID><ARTGs><ARTG>302460</ARTG></ARTGs><MinimumBenefit>4750</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EL031</BillingCode><Name>Carpentier-Edwards Perimount Pericardial Bioprosthesis - Models 2900/6900  Carpentier-Edwards Perimount Plus Pericardial Bioprosthesis Mitral - Model 6900P</Name><Description>Carpentier-Edwards Pericardial Bioprosthesis. Composition: Bovine Pericardium; Elgiloy Alloy; Silicone Rubber, Polytetrafluoroethylene</Description><Size>Models 2900/6900 19-33mm, Model 6900P 25, 27, 29, 31, 33mm</Size><SupplierCode>40072</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107655</SubCategoryID><GroupID>108505</GroupID><ARTGs><ARTG>154064</ARTG><ARTG>154073</ARTG></ARTGs><MinimumBenefit>4750</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC015</BillingCode><Name>Freestyle bioprosthesis</Name><Description>Models 995xx, 995MSxx</Description><Size>19 - 35mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107655</SubCategoryID><GroupID>108506</GroupID><Suffix>p</Suffix><ARTGs><ARTG>145752</ARTG></ARTGs><MinimumBenefit>4845</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ290</BillingCode><Name>Perceval PLUS sutureless aortic heart valve - Aortic heart valve bioprosthesis</Name><Description>PERCEVAL PLUS prosthesis is intended to replace a damaged native 
aortic heart valve or a malfunctioning aortic prosthesis via open heart 
surgery. It is indicated for use in adult patients:
- suffering from aortic valve stenosis or steno-insufficiency;
- with a previously implanted aortic valve prosthesis that is no longer functioning adequately and requires replacement</Description><Size>S (19-21), M (21-23), L (23-25), XL (25-27)</Size><SupplierCode>39933</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107655</SubCategoryID><GroupID>108522</GroupID><Suffix>b (bovine)</Suffix><ARTGs><ARTG>427401</ARTG></ARTGs><MinimumBenefit>8978</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JS001</BillingCode><PriorBillingCodes><PriorBillingCode>SA170</PriorBillingCode></PriorBillingCodes><Name>Perceval S Sutureless Aortic Heart Valve</Name><Description>Sutureless Aortic Pericardial Heart Valve</Description><Size>S (19-21mm), M (21-23mm), L(23-25mm), XL (25-27mm)</Size><SupplierCode>39933</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107655</SubCategoryID><GroupID>108522</GroupID><Suffix>b (bovine)</Suffix><ARTGs><ARTG>232485</ARTG></ARTGs><MinimumBenefit>8978</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EL062</BillingCode><Name>EDWARDS INTUITY Elite Aortic Valve System</Name><Description>Rapid Deployment Aortic Valve System</Description><Size>19mm - 27mm</Size><SupplierCode>40072</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107655</SubCategoryID><GroupID>108522</GroupID><Suffix>b (bovine)</Suffix><ARTGs><ARTG>261673</ARTG></ARTGs><MinimumBenefit>8978</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ036</BillingCode><Name>Coated Aortic Valved Graft</Name><Description>Coated Aortic Valved Graft </Description><Size>19mm - 33mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107656</SubCategoryID><GroupID>108524</GroupID><ARTGs><ARTG>429890</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Size</ChangeExplanation><MinimumBenefit>6603</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC979</BillingCode><Name>Open Pivot Aortic Valved Graft (Model 502AG)</Name><Description>Pyrolythic Carbon, Double Velour Polyester, Titanium</Description><Size>21- 33mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107656</SubCategoryID><GroupID>108524</GroupID><ARTGs><ARTG>206262</ARTG></ARTGs><MinimumBenefit>6603</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ104</BillingCode><Name>Masters Series Aortic Valved Prosthesis - VAVGJ</Name><Description>Mechanical Heart Valve sewn into the base of a woven polyester fibre graft which has been impregnated with bovine-derived gelatin</Description><Size>Annulus Diameter 19-29mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107656</SubCategoryID><GroupID>108524</GroupID><ARTGs><ARTG>429891</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Description</ChangeExplanation><MinimumBenefit>6603</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EL068</BillingCode><Name>KONECT RESILIA Aortic Valved Conduit</Name><Description>KONECT RESILIA Aortic Valved Conduit is developed specifically for  bio-Bentall procedures. Edwards Lifesciences’ integrity preservation technology  transforms bovine pericardial tissue into RESILIA tissue, effectively eliminating free aldehydes, while protecting and preserving the tissue.  RESILIA tissue is the first to deliver the combination of Improved anti-calcification properties, Improved sustained hemodynamic performance and  Stored dry and ready to use.</Description><Size>KONECT Valve   11060A 21 mm – 29 mm      Model Accessories  TRAY1190   Accessory tray  1190 Individual sizers 19 mm* – 29 mm  1190SET Sizer set  19 mm* – 29 mm  </Size><SupplierCode>40072</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107656</SubCategoryID><GroupID>108525</GroupID><Suffix>valve and conduit</Suffix><ARTGs><ARTG>387297</ARTG></ARTGs><MinimumBenefit>7642</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC012</BillingCode><Name>Medtronic Hancock Valved Conduit Model 150</Name><Description>Porcine bioprosthesis, dacron</Description><Size>12, 14, 16, 18, 20, 22, 25, 30mm.</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107656</SubCategoryID><GroupID>108525</GroupID><Suffix>p</Suffix><ARTGs><ARTG>145760</ARTG></ARTGs><MinimumBenefit>6460</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SA127</BillingCode><Name>AnnuloFlo Annuloplasty System</Name><Description>Annuloflex Ring or AnnuloFlo Ring</Description><Size>26-36mm</Size><SupplierCode>40189</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107657</SubCategoryID><GroupID>108531</GroupID><ARTGs><ARTG>155662</ARTG></ARTGs><MinimumBenefit>2090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC005</BillingCode><Name>Medtronic Duran Annuloplasty Ring; Duran Ancore Ring 620R; Duran Ancore Chordal Model 620RG</Name><Description>Annuloplasty Devices - Models 610R &amp; 620R Silicone / Barium Sulphate, Dacron.</Description><Size>Model 610R 25-35mm &amp; Model 620R 23-35mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107657</SubCategoryID><GroupID>108531</GroupID><ARTGs><ARTG>135737</ARTG></ARTGs><MinimumBenefit>2090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI181</BillingCode><Name>SIMULUS Flexible Annuloplasty Ring</Name><Description>Flexible mitral/tricuspid annuloplasty ring</Description><Size>Ring size (mm): 23, 25, 27, 29, 31, 33, 35, 37, 39</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107657</SubCategoryID><GroupID>108531</GroupID><ARTGs><ARTG>271813</ARTG></ARTGs><MinimumBenefit>2090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI510</BillingCode><Name>SimuPlus™ Annuloplasty Band</Name><Description>Flexible mitral/tricuspid annuloplasty band including accessories (tray, sizers and annuloplasty handles)</Description><Size>Ring size (mm): 26, 28, 30, 32, 34, 36, 38, 40, 42</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107657</SubCategoryID><GroupID>108531</GroupID><ARTGs><ARTG>394453</ARTG></ARTGs><MinimumBenefit>2090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ035</BillingCode><Name>SJM Tailor Annuloplasty Ring</Name><Description>Fully Flexible</Description><Size>25mm - 35mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107657</SubCategoryID><GroupID>108531</GroupID><ARTGs><ARTG>123490</ARTG></ARTGs><MinimumBenefit>2090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI192</BillingCode><Name>Duran Ancore Band 620B</Name><Description>Silicone / Barium Sulphate, Dacron</Description><Size>23-35mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107657</SubCategoryID><GroupID>108531</GroupID><ARTGs><ARTG>135738</ARTG></ARTGs><MinimumBenefit>2090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EL028</BillingCode><Name>Baxter Sterile Grafts, Implants &amp; Prostheses, Non-Animal Origin Annuloplasty: Ring-Mitral Ring with Holder; Mitral Cosgrove-Edwards Annuloplasty System Model 4600; Classic Annuloplasty Ring-Tricuspid</Name><Description>Carpentier-Edwards Classic Annuloplasty Ring. Composition: Titanium Alloy; Silicone Rubber; Polyester Fabric Carpentier-Edwards Physio Annuloplasty Ring. Composition: Elgiloy Bands; Polyester Film Strips; Silicone Rubber; Polyester Cloth, Cosgrove-Edwards Annuloplasty Band. Composition: Silicone Rubber; Polyester Cloth. Carpentier-Edwards Tricuspid Ring. Composition: Titanium Alloy; Silicone Rubber; Polyester Fabric</Description><Size>24mm-40mm</Size><SupplierCode>40072</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107657</SubCategoryID><GroupID>108531</GroupID><ARTGs><ARTG>158660</ARTG><ARTG>158663</ARTG><ARTG>158661</ARTG><ARTG>158662</ARTG></ARTGs><MinimumBenefit>2090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI182</BillingCode><Name>SIMULUS Flexible Annuloplasty Band</Name><Description>Flexible mitral/tricuspid annuloplasty band</Description><Size>Band size (mm): 23, 25, 27, 29, 31, 33, 35, 37, 39</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107657</SubCategoryID><GroupID>108531</GroupID><ARTGs><ARTG>271814</ARTG></ARTGs><MinimumBenefit>2090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI509</BillingCode><Name>SimuPlus™ Annuloplasty Ring</Name><Description>Flexible mitral annuloplasty ring including accessories (tray, sizers and annuloplasty handles)</Description><Size>Ring size (mm): 26, 28, 30, 32, 34, 36, 38, 40, 42</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107657</SubCategoryID><GroupID>108531</GroupID><ARTGs><ARTG>394452</ARTG></ARTGs><MinimumBenefit>2090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI184</BillingCode><Name>SIMULUS Semi-Rigid Annuloplasty Band</Name><Description>Semi-rigid mitral annuloplasty band</Description><Size>Band size (mm): 24, 26, 28, 30, 32, 34, 36, 38, 40</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107657</SubCategoryID><GroupID>108532</GroupID><ARTGs><ARTG>271815</ARTG></ARTGs><MinimumBenefit>2280</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI121</BillingCode><Name>Contour 3D Tricuspid Annuloplasty Ring</Name><Description>Annuloplasty Ring: Titanium core encapsulated with silicone, covered with polyester fabric</Description><Size>26, 28, 30 32, 34, 36mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107657</SubCategoryID><GroupID>108532</GroupID><ARTGs><ARTG>202774</ARTG></ARTGs><MinimumBenefit>2280</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EL050</BillingCode><Name>Edwards MC3 Tricuspid Ring Annuloplalsty System (Model: 4900)</Name><Description>3D rigid annuloplasty ring with a tricuspid specific design</Description><Size>26mm, 28mm, 30mm, 32mm, 34mm, 36mm</Size><SupplierCode>40072</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107657</SubCategoryID><GroupID>108532</GroupID><ARTGs><ARTG>118648</ARTG></ARTGs><MinimumBenefit>2280</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EL049</BillingCode><Name>McCarthy-Edwards IMR Etlogix Annuloplasty Ring (Model: 4100)</Name><Description>Rigid mitral annuloplasty ring with an assymetric design</Description><Size>24mm, 26mm, 28mm, 30mm, 32mm, 34mm, 36mm</Size><SupplierCode>40072</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107657</SubCategoryID><GroupID>108532</GroupID><ARTGs><ARTG>114193</ARTG></ARTGs><MinimumBenefit>2280</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ087</BillingCode><Name>St Jude Medical Rigid Saddle Ring</Name><Description>Rigid Annuloplasty Ring</Description><Size>24 - 34mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107657</SubCategoryID><GroupID>108532</GroupID><ARTGs><ARTG>124255</ARTG></ARTGs><MinimumBenefit>2280</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JS002</BillingCode><PriorBillingCodes><PriorBillingCode>SA189</PriorBillingCode></PriorBillingCodes><Name>Memo 4D Mitral/tricuspid annuloplasty ring</Name><Description>Memo 4D Mitral/tricuspid annuloplasty ring device is intended for correction of mitral insufficiencies or steno-insufficiencies. The use of the Memo 4D device is indicated for correction of congenital or acquired mitral insufficiencies with dilatation and deformation of the mitral annulus.</Description><Size>Sizes 24,26,28,30, 32,34, 36, 38, 40, 42 mm</Size><SupplierCode>39933</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107657</SubCategoryID><GroupID>108532</GroupID><ARTGs><ARTG>332851</ARTG></ARTGs><MinimumBenefit>2280</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JS003</BillingCode><PriorBillingCodes><PriorBillingCode>SA150</PriorBillingCode></PriorBillingCodes><Name>Memo 3D Mitral Semirigid Annuloplasty Ring</Name><Description>Memo 3D Semirigid Mitral Annuloplasty Ring with 3D flexibility and coated with Carbofilm with or without Rechord system</Description><Size>24mm, 26mm, 28mm, 30mm, 32mm, 34mm, 36mm, 38mm</Size><SupplierCode>39933</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107657</SubCategoryID><GroupID>108532</GroupID><ARTGs><ARTG>176450</ARTG></ARTGs><MinimumBenefit>2280</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI183</BillingCode><Name>SIMULUS Semi-Rigid Annuloplasty Ring</Name><Description>Semi-rigid mitral annuloplasty ring</Description><Size>Ring size (mm): 24, 26, 28, 30, 32, 34, 36, 38, 40</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107657</SubCategoryID><GroupID>108532</GroupID><ARTGs><ARTG>271812</ARTG></ARTGs><MinimumBenefit>2280</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EL059</BillingCode><Name>Carpentier-Edwards PHYSIO ll Mitral Annuloplasty Ring</Name><Description>PHYSIO II is a semi rigid mitral annuloplasty ring, with an improved saddle shape and global disease based design</Description><Size>24, 26, 28, 30, 32, 34, 36, 38, 40mm</Size><SupplierCode>40072</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107657</SubCategoryID><GroupID>108532</GroupID><ARTGs><ARTG>170274</ARTG></ARTGs><MinimumBenefit>2280</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC745</BillingCode><Name>CG Future Composite Ring</Name><Description>Semi-rigid mitral annuloplasty ring, with anterior flexibility</Description><Size>24, 26, 28, 30, 32, 34, 36 &amp; 38mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107657</SubCategoryID><GroupID>108532</GroupID><ARTGs><ARTG>136236</ARTG></ARTGs><MinimumBenefit>2280</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI191</BillingCode><Name>Colvin - Galloway Future Band Model 638B</Name><Description>Semi-rigid metal alloy core, silicone coating, polyester knit fabric</Description><Size>26-38mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107657</SubCategoryID><GroupID>108532</GroupID><ARTGs><ARTG>136235</ARTG></ARTGs><MinimumBenefit>2280</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC844</BillingCode><Name>Profile 3D Annuloplasty Ring</Name><Description>3D, rigid annuloplasty ring with physiologic mitral valve shape</Description><Size>Diameter (mm) 24 - 40mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107657</SubCategoryID><GroupID>108532</GroupID><ARTGs><ARTG>158457</ARTG></ARTGs><MinimumBenefit>2280</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EL061</BillingCode><Name>Carpentier-Edwards Physio Tricuspid Annuloplasty Ring</Name><Description>The Carpentier-Edwards Physio Tricuspid annuloplasty ring, model 6200 is intended for use in patients with tricuspid valvular insufficiency. Designed with selective flexibility and 3D waveform shape.</Description><Size>24,  26, 28, 30, 32, 34, 36mm</Size><SupplierCode>40072</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107657</SubCategoryID><GroupID>108532</GroupID><ARTGs><ARTG>196111</ARTG></ARTGs><MinimumBenefit>2280</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI511</BillingCode><Name>SimuForm™ Annuloplasty Ring</Name><Description>Semi-rigid mitral annuloplasty ring including accessories (tray, sizers and annuloplasty handles)</Description><Size>Ring size (mm): 24, 26, 28, 30, 32, 34, 36, 38, 40</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107657</SubCategoryID><GroupID>108532</GroupID><ARTGs><ARTG>394454</ARTG></ARTGs><MinimumBenefit>2280</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT122</BillingCode><Name>Preclude Pericardial Membrane</Name><Description>ePTFE</Description><Size>0.1mm Thickness 6 x 12cm</Size><SupplierCode>40435</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107659</SubCategoryID><GroupID>108537</GroupID><ARTGs><ARTG>153241</ARTG></ARTGs><MinimumBenefit>342</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT274</BillingCode><Name>Preclude Percardial Membrane</Name><Description>ePTFE</Description><Size>0.1mm Thickness, 12-16cm</Size><SupplierCode>40435</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107659</SubCategoryID><GroupID>108538</GroupID><ARTGs><ARTG>153241</ARTG></ARTGs><MinimumBenefit>611</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT125</BillingCode><Name>Preclude Pericardial Membrane</Name><Description>ePTFE</Description><Size>0.1mm Thickness 15 x 20cm</Size><SupplierCode>40435</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107659</SubCategoryID><GroupID>108539</GroupID><ARTGs><ARTG>153241</ARTG></ARTGs><MinimumBenefit>1382</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU036</BillingCode><Name>Gelweave Valsalva Graft</Name><Description>Woven vascular prosthesis, polyester, gelatin sealed</Description><Size>Diameter 24 - 34 mm, Overall length 18.4 - 19.6cm</Size><SupplierCode>40450</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107662</SubCategoryID><GroupID>108545</GroupID><ARTGs><ARTG>125606</ARTG></ARTGs><MinimumBenefit>2673</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GX028</BillingCode><PriorBillingCodes><PriorBillingCode>MQ041</PriorBillingCode></PriorBillingCodes><Name>Cardioroot</Name><Description>Woven polyester vascular prosthesis, gelatin sealed</Description><Size>Diameter 24mm - 34mm Length 15cm</Size><SupplierCode>39943</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107662</SubCategoryID><GroupID>108545</GroupID><ARTGs><ARTG>343016</ARTG></ARTGs><MinimumBenefit>2673</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU038</BillingCode><Name>Gelweave Graft</Name><Description>Straight/Curved Thoracic Graft, with anteflo side branch, Polyester, woven, gelatin sealed</Description><Size>20 -34 mm x 20-50 cm</Size><SupplierCode>40450</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107662</SubCategoryID><GroupID>108546</GroupID><ARTGs><ARTG>125606</ARTG></ARTGs><MinimumBenefit>1499</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU037</BillingCode><Name>Gelweave Graft</Name><Description>Multi Branched, for Aortic Arch reconstruction, Polyester, Woven, gelatin sealed</Description><Size>10 - 34 mm x 10 - 60 cm</Size><SupplierCode>40450</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107662</SubCategoryID><GroupID>108547</GroupID><ARTGs><ARTG>125606</ARTG></ARTGs><MinimumBenefit>2043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JY002</BillingCode><PriorBillingCodes><PriorBillingCode>IU001</PriorBillingCode></PriorBillingCodes><Name>E-vita OPEN NEO</Name><Description>The E-vita OPEN NEO is a hybrid aortic arch device for the repair and replacement of the thoracic aorta using the frozen elephant trunk procedure which provides an alternative for conventional open surgery. The device is a one-piece polyester fabric tube which combines a conventional vascular graft part and an endovascular stent graft part that allows the open surgical treatment of aneurysms or dissections in the aortic arch and the descending thoracic aorta with or without involvement of the ascending aorta. It is available in a range of sizes with varying diameters and lengths and comes in three different configurations for individual supra-aortic vessel management. One-piece polyester fabric tube which combines a conventional vascular graft part and an endovascular stent graft part, including a delivery system. The E-vita OPEN NEO implant consists of a self expanding stent graft part, a conventional vascular graft part, and the delivery system.</Description><Size>Stent graft, 20-40mm diameter, 120-180mm length : Vascular graft, 26-30mm diameter, 100mm length : Perfusion branch, 10mm diameter, 100mm length : Collar, 15mm width : Brachiocephalic trunk, 12 mm diameter, 100 mm length : Left common carotid artery, 8mm diameter, 100mm length : Left subclavian artery, 10mm diameter, 100mm length.</Size><SupplierCode>40391</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107662</SubCategoryID><GroupID>108549</GroupID><ARTGs><ARTG>374560</ARTG></ARTGs><MinimumBenefit>19430</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU068</BillingCode><Name>Thoraflex™ Hybrid</Name><Description>Thoraflex™ Hybrid device is a woven polyester prosthesis, with the addition of nitinol ring stents. 

The device is specifically designed for the treatment of aneurysm and/or dissection in the ascending thoracic aorta, aortic arch and descending thoracic aorta. Branches are provided to accommodate reconstruction of the major aortic branch vessels and intra-operative attachment of a perfusion cannula during cardio-pulmonary bypass where antegrade perfusion techniques are employed. 

The stented section of the graft enables treatment of the diseased descending thoracic aorta in a single-stage procedure without the need to anastamose a stented and unstented prostheses together.

Thoraflex Hybrid™ device has been impregnated with an absorbable protein. The aim of the impregnation is to provide a polyester vascular prosthesis which does not require pre-clotting. The protein is a bovine gelatin which has been cross-linked to a set level to control its rate of removal. It serves in place of fibrin, which seals the polyester prosthesis during normal pre-clotting. The gelatin is hydrolyzed within approximately 14 days and is replaced by normal tissue incorporation. Gelatin has been chosen as it is a non-toxic protein, a fact which is reflected by its extensive use as a safe plasma expander.</Description><Size>The stent graft comes in two nominal lengths (100mm or 150mm) with different inner vessel (ID) and outside vessel OD graft diameters (mm).  

There are 40 catalogue items with the above combinations


Overall length: 340-390 mm. 
Vascular graft length 240 mm; 
Stent graft length 100-150 mm; 
Stent graft diameter 20-40 mm; 
Collar width 12 mm;</Size><SupplierCode>40450</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107662</SubCategoryID><GroupID>108549</GroupID><ARTGs><ARTG>307356</ARTG><ARTG>307357</ARTG></ARTGs><MinimumBenefit>19430</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE612</BillingCode><Name>E-vita open plus stentgraft system (with or without collar)</Name><Description>Hybrid device consisting of a conventional vascular graft incorporated with and endovascular stent graft that allows treatment of the ascending aorta, the arch and the descending aorta, in one procedure.</Description><Size>Overall length: 100-160mm. Vascular graft length 50-70mm; Stent graft length 80-240mm; Stent graft diameter 20-40mm; Collar width 2-40mm.</Size><SupplierCode>39975</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107662</SubCategoryID><GroupID>108550</GroupID><ARTGs><ARTG>216894</ARTG></ARTGs><MinimumBenefit>19000</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JY001</BillingCode><PriorBillingCodes><PriorBillingCode>IU002</PriorBillingCode></PriorBillingCodes><Name>E-vita OPEN NEO</Name><Description>The E-vita OPEN NEO straight graft configuration is a hybrid aortic arch device for the repair and replacement of the thoracic aorta using the frozen elephant trunk procedure which provides an alternative for conventional open surgery. The device is a one-piece polyester fabric tube which combines a conventional vascular graft part and an endovascular stent graft part that allows the open surgical treatment of aneurysms or dissections in the aortic arch and the descending thoracic aorta with or without involvement of the ascending aorta. One-piece polyester fabric tube which combines a conventional vascular graft part and an endovascular stent graft part, including a delivery system. The E-vita OPEN NEO implant consists of a self-expanding stent graft part, a conventional vascular graft part, and the delivery system.</Description><Size>Stent graft, 20-40mm diameter, 120-180mm length : Vascular graft, 26-30mm diameter, 100mm length : Perfusion branch, 10mm diameter, 100mm length : Collar, 30mm width</Size><SupplierCode>40391</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107662</SubCategoryID><GroupID>108550</GroupID><ARTGs><ARTG>374560</ARTG></ARTGs><MinimumBenefit>19000</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH752</BillingCode><PriorBillingCodes><PriorBillingCode>LM493</PriorBillingCode></PriorBillingCodes><Name>Pedicle Screw</Name><Description>Pedicle Screw</Description><Size>Diameter 4.5 - 9.5 mm  Length 25 - 110 mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>362890</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY097</BillingCode><PriorBillingCodes><PriorBillingCode>JG008</PriorBillingCode></PriorBillingCodes><Name>VENTOTENE Fixed Screw</Name><Description>Standard Solid</Description><Size>4.5/5.5/6.5/7.5mm Diameter  25-110mm Length</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>397231</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB084</BillingCode><Name>REVERE TRANSITION HA Coated Monoaxial Screw</Name><Description>Monoaxial Screw HA Coated</Description><Size>6.5mm - 8.5mm x 35mm - 65mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB089</BillingCode><Name>CREO Stabilization System Preassembled Monoaxial Screw</Name><Description>The CREO Stabilization System implants are non-cervical spinal fixation devices intended for posterior pedicle screw fixation, posterior hook fixation or anterolateral fixation.</Description><Size>4.75 and 5.5  4.0mm diameter to 8.5mm diameter  20mm to 90mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><Note>The Prostheses List (PL) billing code does not cover the use of the device for vertebral body tethering (VBT) for the management of adolescent idiopathic scoliosis (AIS).</Note><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU017</BillingCode><Name>Romeo 2  Posterior Thoraco-lumbar Fixation System - Monoxial Screw</Name><Description>Monomial pedicle screw</Description><Size>Diameter: 4mm, 5mm, 6mm, 7mm, 8mm  Length: 25m, 30mm, 35mm, 40mm, 45mm, 50mm, 55mm, 60mm, 70mm, 80mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>198720</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ296</BillingCode><Name>Invictus Spinal Fixation System</Name><Description>Monoaxial Pedicle Screw, Ti Alloy </Description><Size>(4.5 - 12.5) mm diam x (20 - 130) mm length </Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>398576</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB373</BillingCode><Name>Aesculap Spinal System</Name><Description>Monoaxial Screw - titanium alloy</Description><Size>All Sizes</Size><SupplierCode>40020</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>134538</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY708</BillingCode><Name>Spinal Fixation System</Name><Description>Matrix Preassembled Monoaxial Pedicle Screw, Cannulated</Description><Size>5.00mm - 9.00mm Diameter; 20mm - 65mm Length</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>293276</ARTG><ARTG>293275</ARTG></ARTGs><MinimumBenefit>889</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY096</BillingCode><PriorBillingCodes><PriorBillingCode>JG007</PriorBillingCode></PriorBillingCodes><Name>VENTOTENE Fixed Screw</Name><Description>Standard Cannulated</Description><Size>5.5/6.5/7.5mm Diameter  25-80mm Length</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>397231</ARTG></ARTGs><MinimumBenefit>889</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JA013</BillingCode><PriorBillingCodes><PriorBillingCode>OH354</PriorBillingCode></PriorBillingCodes><Name>Novel/Zenius Reduction Mono screw</Name><Description>Monoaxial Reduction pedicle screw</Description><Size>5.5-8.5</Size><SupplierCode>40213</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><Suffix>With cap/cover plate</Suffix><ARTGs><ARTG>148858</ARTG></ARTGs><MinimumBenefit>835</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC823</BillingCode><Name>CD Horizon</Name><Description>Legacy Fixed Iliac Screw</Description><Size>5.5mm to 8.5mm Diameter</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><Suffix>Closed</Suffix><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC636</BillingCode><Name>CD Horizon</Name><Description>Eclipse Dual Head Screws</Description><Size>20-60mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><Suffix>Complex</Suffix><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>875</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ220</BillingCode><Name>CD HORIZON Spinal System - Uniaxial Screws and Sagittal Adjusting Screws</Name><Description>CD HORIZON SOLERA Uniaxial Screws and Sagittal Adjusting Screws
</Description><Size>Diameter:  4.0mm - 8.5mm  Length: 20mm - 55mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Change to Group benefit</ChangeExplanation><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER445</BillingCode><Name>LnK Spinal Fixation System/OpenLoc-L Spinal Fixation System-Pedicle Screw, monoaxial</Name><Description>LnK Spinal Fixation System/OpenLoc-L Spinal Fixation System-Pedicle Screw, monoaxial;self tapping and non self tapping; standard and reduction; accommodates rods 5.0, 5.5, 6.0 and 6.35 mm dia.</Description><Size>dia (4.0-8.5mm) x length (20-150mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>286123</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM448</BillingCode><PriorBillingCodes><PriorBillingCode>NK064</PriorBillingCode></PriorBillingCodes><Name>Excella Uniplanar Pedicle Screw</Name><Description>Excella Pedicle Screw System Uniplanar Pedicle Screw</Description><Size>4.0 to 6.5mm diameter  25 to 55 long</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>295225</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ218</BillingCode><Name>CD HORIZON Spinal System - Cannulated Sagittal Adjusting Screws</Name><Description>Cannulated Sagittal Adjusting Screws
</Description><Size>Diameter:  4.5mm - 7.5mm   Length: 25mm - 55mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>889</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER331</BillingCode><Name>Ulrich Pedicle Screw System-Pedicle Screw, monoaxial</Name><Description>Ulrich Pedicle Screw System (uCentum,flamenco)-Pedicle Screw, monoaxial, standard or long arm</Description><Size>dia (4.5-10 mm) x length (25-60 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>279706</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH059</BillingCode><Name>Monoaxial Screws</Name><Description>Monoaxial Screws</Description><Size>20-55mm Length</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU126</BillingCode><Name>M.U.S.T Monoaxial Pedicle Screws</Name><Description>Monoaxial Screws</Description><Size>4.5 - 8mm; Length 25-90 mm.</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>196964</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ936</BillingCode><Name>Expedium Spine System</Name><Description>Monoaxial Screw</Description><Size>Diameter 4.35-10mm; Length 25-80mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>128257</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY597</BillingCode><Name>Universal Spinal system – USS &amp; USS II</Name><Description>Pedicle and Vertebral Screws</Description><Size>25mm - 110mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>133401</ARTG><ARTG>293276</ARTG><ARTG>293275</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ103</BillingCode><Name>RESPONSE Spine System – Uniaxial Screw</Name><Description>Pedicle Uniaxial Screw</Description><Size>4-7mm diameter, 20mm-100mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>233454</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE801</BillingCode><Name>Mariner Uniaxial Screw</Name><Description>Uniaxial Screw</Description><Size>4.5-7.5mm Diameter, 20-110mm Lengths    </Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH050</BillingCode><Name>Monoaxial Screws</Name><Description>Dual Head Screws</Description><Size>35-45mm Length</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH580</BillingCode><Name>Venus Spinal Fixation System - Pedicle Screws - Mono</Name><Description>Venus - Monoaxial Pedicle Screws</Description><Size>D 4.0-7.2mm L 25-70mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>316187</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW013</BillingCode><PriorBillingCodes><PriorBillingCode>ZI993</PriorBillingCode></PriorBillingCodes><Name>Vitality Spine System - Monoaxial Pedicle Screws</Name><Description>Monoaxial pedicle Screws Titanium</Description><Size>Diameter = 4.0mm-7.5mm  Length= 20mm-55mm</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>287242</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW581</BillingCode><Name>ES2 Augmentable Monoaxial Screw</Name><Description>Fenestrated Cannulated Monoaxial Screw</Description><Size>Dia 5.5mm to 7.5mm, length 30mm to 90mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>315418</ARTG></ARTGs><MinimumBenefit>889</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW756</BillingCode><PriorBillingCodes><PriorBillingCode>ER202</PriorBillingCode></PriorBillingCodes><Name> Mesa Monoaxial Screw    </Name><Description>Monoaxial screw, rotating head    </Description><Size>Diameter: 4.5mm - 8.5mm, Length: 25mm - 55mm </Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><Suffix>Integrated Locking Mechanism</Suffix><ARTGs><ARTG>154442</ARTG></ARTGs><MinimumBenefit>812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV056</BillingCode><Name>Armada (Fixed Screw)</Name><Description>Fixed screw</Description><Size>4.0/4.5/5.0/5.5/6.5/7.5 x 25-55mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB008</BillingCode><Name>DPS Spine System - Monoaxial Pedicle Screw</Name><Description>Mono-axial pedicle screws</Description><Size>Diameter 4/5/6/7mm; Length 25 - 55mm.</Size><SupplierCode>40026</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>214788</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JA011</BillingCode><PriorBillingCodes><PriorBillingCode>OH357</PriorBillingCode></PriorBillingCodes><Name>Medyssey Spinal Fixation System</Name><Description>Monoaxial Screw</Description><Size>4.0-8.5</Size><SupplierCode>40213</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>148858</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB213</BillingCode><Name>CREO® Side Loading Monoxial Screw</Name><Description>Monoaxial screw</Description><Size>Diameter: 4-10.5mm  Length: 20-120mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY003</BillingCode><Name>Katana Monoaxial Screw</Name><Description>Monoaxial Pedicle Screw</Description><Size>4.5 - 7.5mm diameter   25 - 55mm length</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>396083</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER330</BillingCode><Name>Ulrich Pedicle Screw System-Pedicle Screw, monoaxial, cannulated</Name><Description>Ulrich Pedicle Screw System (cosmicMIA, uCentum)-Pedicle Screw, monoaxial, cannulated, with or without HA coating or fenestrations</Description><Size>dia (4.5-10 mm) x length (25-60 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>289054</ARTG><ARTG>279706</ARTG></ARTGs><MinimumBenefit>889</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV151</BillingCode><Name>Reline (Cannulated Monoaxial Screw)</Name><Description>Cannulated Fixed Pedicle Screw</Description><Size>4.5-12.5mm diameter; 25-120mm length</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>889</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB367</BillingCode><Name>Aesculap Spinal System</Name><Description>Monoaxial Cannulated Screw</Description><Size>All sizes</Size><SupplierCode>40020</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>134538</ARTG></ARTGs><MinimumBenefit>889</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB059</BillingCode><Name>TINA Minimally Invasive Spine System</Name><Description>Monoaxial Cannulated Screw</Description><Size>All sizes</Size><SupplierCode>40026</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>214788</ARTG></ARTGs><MinimumBenefit>889</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC967</BillingCode><Name>CD HORIZON Spinal System - Fixed Angle Screw</Name><Description>CD HORIZON SOLERA Fixed Angle Screw</Description><Size>Diameter: 4.0mm - 10.5mm

Length:  15mm - 110mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ012</BillingCode><Name>Centaur Monoaxial Screw</Name><Description>Monoaxial screw</Description><Size>Diameter 4mm-10mm, lengths 20mm-110mm</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>217033</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY075</BillingCode><PriorBillingCodes><PriorBillingCode>DR005</PriorBillingCode></PriorBillingCodes><Name>Life Spine Pedicle Screw System - Pedicle Screw, Monoaxial</Name><Description>Life Spine Pedicle Screw System - Pedicle Screw, Monoaxial, Standard/Reduction</Description><Size>dia (4.5-8.5)mm x length (30-125)mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>321122</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB083</BillingCode><Name>REVERE Monoaxial Screw</Name><Description>Monoaxial Screw</Description><Size>4.0mm x 20-35mm in 5mm increments
4.5mm x 20-45mm in 5mm increments
5.0mm x 25-55mm in 5mm increments
5.5mm x 20 -50mm in 5mm increments
5.5 x 27mm in 5mm increments and 25mm-6mm increments in 5mm increments
6.5mm x 25-65mm in 5mm increments
6.5mm x 27mm -55mm in 5mm increments and 25mm - 65mm in 5mm increments
8.5mm x 25mm-65mm in 5mm increments
9.0mm x 25- 25mm-120mm in 5mm increments
10.0mm x 25mm-120mm in 5mm increments</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER658</BillingCode><Name>LnK AccelFix Spinal Fixation System-Monoaxial screw</Name><Description> AccelFix S/AccelFix DS/AccelFix SS Monoaxial screws, reduction or non-reduction, Ti, sterile.</Description><Size>Diameter: 4-8.5 mm  Length:    34.5-176.5 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>384815</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW385</BillingCode><Name>Xia Spine System</Name><Description>Monoaxial Screw</Description><Size>Dia 4.5 - 8.5mm Length 25 - 60mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>279160</ARTG><ARTG>279150</ARTG><ARTG>279159</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KB015</BillingCode><Name>AnyPlus II Mono Screw</Name><Description>Monaxial Pedicle Screw and Mono Reduction Screws</Description><Size>Diameter: 4.5-7.5mm  Length: 35-55mm</Size><SupplierCode>40247</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>353891</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU040</BillingCode><Name>Perla TL Posterior thoraco-lumbar fixation system - monoaxial screw</Name><Description>Monoaxial pedicle screws</Description><Size>Diameter: 4.5 - 9.5mm.  Length: 25 - 120mm.</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER615</BillingCode><PriorBillingCodes><PriorBillingCode>OF005</PriorBillingCode></PriorBillingCodes><Name>Firebird mono axial screws</Name><Description>Firebird mono axial pedicle screws in various diameters and lengths. Titanium.</Description><Size>4.0, 4.5, 5.5, 6.5, 7.5. 8.5; 25mm-100mm in 5mm increments</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>195012</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV112</BillingCode><Name>Reline (Monoaxial Screw)</Name><Description>Fixed Screw</Description><Size>4.0mm-12.5mm in diameter; 15-120mm in length</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI039</BillingCode><Name>HPS™ Monoaxial Pedicle Screw</Name><Description>Monaxial pedicle screw</Description><Size>Diameter: 5-8mm  Length: 30-60mm</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>345870</ARTG></ARTGs><MinimumBenefit>889</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH081</BillingCode><Name>ZINA MIS Monoaxial Screw </Name><Description>ZINA MIS Spine System - Cannulated Monoaxial Screw</Description><Size>Diameter x Length ( mm )   4.5×30   4.5×35  4.5×40  4.5×45  4.5×50  4.5×55  4.5×60  4.5×65  5.0×30  5.0×35  5.0×40  5.0×45  5.0×50  5.0×55  5.0×60  5.0×65  5.5×30  5.5×35  5.5×40  5.5×45  5.5×50  5.5×55  5.5×60  5.5×65  6.0×30  6.0×35  6.0×40  6.0×45  6.0×50  6.0×55  6.0×60  6.0×65  6.5×30  6.5×35  6.5×40  6.5×45  6.5×50  6.5×55  6.5×60  6.5×65  7.0×30  7.0×35  7.0×40  7.0×45  7.0×50  7.0×55  7.0×60  7.0×65  7.5×30  7.5×35  7.5×40  7.5×45  7.5×50  7.5×55  7.5×60  7.5×65  </Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>889</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JA008</BillingCode><PriorBillingCodes><PriorBillingCode>OH355</PriorBillingCode></PriorBillingCodes><Name>Medyssey Spinal Fixation System</Name><Description>Cannulated Monoaxial Screw</Description><Size>4.0-8.5</Size><SupplierCode>40213</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>148858</ARTG></ARTGs><MinimumBenefit>889</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU125</BillingCode><Name>M.U.S.T Monoaxial Pedicle Screws Cannulated</Name><Description>Monoaxial screws cannulated</Description><Size>5 - 7 mm: Length 30- 60 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>196964</ARTG></ARTGs><MinimumBenefit>889</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ820</BillingCode><Name>Viper Spinal System - monoaxial screw</Name><Description>Monoaxial screw</Description><Size>30 - 80mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>145290</ARTG></ARTGs><MinimumBenefit>889</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH519</BillingCode><Name>DSS Spinal System</Name><Description>Monoaxial Pedicle Screw - cannulated</Description><Size>5-9mm Diam x 30-60mm length</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>186733</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY091</BillingCode><PriorBillingCodes><PriorBillingCode>DR036</PriorBillingCode></PriorBillingCodes><Name>Z-Medical Pedicle Screw System - Pedicle Screws, Monoaxial</Name><Description>Z-Medical Pedicle Screw System - Pedicle Screws, Monoaxial, Cannulated</Description><Size>Dia (5-8)mm x Length (35-55)mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>343676</ARTG></ARTGs><MinimumBenefit>889</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB215</BillingCode><Name>CREO® Side Loading Monoaxial Screw, Cannulated</Name><Description>Cannulated monoaxial pedicle screw</Description><Size>Diameter: 4.0 - 10.5mm  Length: 20 -120mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>889</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VB006</BillingCode><Name>Lumfix Monoaxial Screw </Name><Description>Self Tapping Screw, single or dual thread , std or reduction castle. </Description><Size>(4.0 - 8.5)mm diameter x (20- 60)mm length </Size><SupplierCode>40229</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>327225</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW020</BillingCode><Name>WEGO Spinal Systems </Name><Description>Monoaxial screws </Description><Size>All sizes</Size><SupplierCode>40252</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>330363</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV121</BillingCode><Name>Precept (Fixed Screw)</Name><Description>Fixed Screw</Description><Size>4.5-12.5mm diameter; 25-120mm length</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI013</BillingCode><Name>Streamline TL- Fixed Pedicle Screws</Name><Description>Fixed Pedicle Screws in various diameters and lengths (Titanium Alloy)</Description><Size>4.5mm diameter x 20mm to 45mm in 5mm increments; 5.5,6.5 &amp; 7.5mm diameters x 30mm to 60mm in 5mm increments</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>233599</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER222</BillingCode><Name>SIGNUS Diplomat Pedicle Screw System - Monoaxial Screw</Name><Description>SIGNUS Diplomat Pedicle Screw System - Monoaxial Screw</Description><Size>dia (5.5-9.5 mm) x length (30-100 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108552</GroupID><ARTGs><ARTG>216751</ARTG></ARTGs><MinimumBenefit>728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY706</BillingCode><Name>Spinal Fixation System</Name><Description>Matrix Preassembled Pedicle Screw, Cannulated</Description><Size>5.00mm - 9.00mm; 20mm - 65mm Length</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>293276</ARTG><ARTG>293275</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY004</BillingCode><Name>Katana Polyaxial Screw</Name><Description>Polyaxial Pedicle Screw</Description><Size>4.5 – 9.5mm diameter, 20 - 100mm length</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>396083</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF177</BillingCode><Name>Freedom Posterior Screw</Name><Description>Polyaxial Screw</Description><Size>Ø3.5, Ø4.0, Ø4.5  8mm to 50mm in length.</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>203838</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR042</BillingCode><Name>MANTIS</Name><Description>Screw, Cannulated, Multiaxial, Ti</Description><Size>4.5mm - 7.5mm x 25mm - 60mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>278581</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW580</BillingCode><Name>ES2 Augmentable Polyaxial Screw</Name><Description>Fenestrated Cannulated Polyaxial Screw</Description><Size>Dia 5.5mm to 8.5mm, length 30mm to 90mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>279143</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW760</BillingCode><PriorBillingCodes><PriorBillingCode>ER214</PriorBillingCode></PriorBillingCodes><Name>Everest Spinal System -Cannulated Screw</Name><Description>Polyaxial Screw, Cannulated</Description><Size>(4.5 -10.5)mm diam x (20-110)mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>154442</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW632</BillingCode><Name>Xia Serrato Cannulated Polyaxial Screw</Name><Description>Cannulated Polyaxial Screw</Description><Size>Dia 4.5mm-7.5mm; Length 20mm-60mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>279159</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB090</BillingCode><Name>CREO Stabilization System Preassembled Polyaxial Screw</Name><Description>The CREO Stabilization System implants are non-cervical spinal fixation devices intended for posterior pedicle screw fixation, posterior hook fixation or anterolateral fixation.</Description><Size>4.0mm diameter to 10.5mm diameter
20mm to 120mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW027</BillingCode><Name>WEGO Spinal Systems </Name><Description>Polyaxial screws </Description><Size>All sizes</Size><SupplierCode>40252</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>330363</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY289</BillingCode><Name>USS llio-Sacral Fixation system</Name><Description>Polyaxial screw</Description><Size>20mm to 140mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>133401</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB130</BillingCode><Name>CREO MCS - Polyaxial Screw</Name><Description>Pre-assembled dual outer diameter polyaxial screw</Description><Size>Diameter: 5.0- 6.5 mm, Length 20-45mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY556</BillingCode><Name>Expedium Spine System</Name><Description>Polyaxial Screws</Description><Size>4.35 - 8mm diameter</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>178040</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH076</BillingCode><Name>Adena™ CBT Polyaxial Screw</Name><Description>Cortical Thread Polyaxial Screw</Description><Size>4.0 mm - 6.5 mm Diameter  20 mm - 45 mm Length</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH045</BillingCode><Name>Polyaxial Screws</Name><Description>Polyaxial &amp; Reduction Polyaxial Screws</Description><Size>20-55mm Length</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU109</BillingCode><Name>M.U.S.T. Polyaxial Pedicle Screws</Name><Description>Polyaxial Screws</Description><Size>4.0 -10mm; length 20 -100mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>196964</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU153</BillingCode><Name>MUST MINI Polyaxial Screws</Name><Description>Polyaxial Screw</Description><Size>Diameter from 3.5 to 6  Length  from 10 to 50 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>291175</ARTG><ARTG>404164</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB079</BillingCode><Name>REVERE Polyaxial Screw</Name><Description>Polyaxial screw</Description><Size>5.5 Titanium, Alloy and Stainless Steel- 4.0-8.5mm x 20mm to 90mm in 5mm increments
5.5 Reduction screws - 5.5mm-7.5mm x 30mm-90mm in 5mm increments
6.35 Titanium Alloy and Stainless Steel - 5.5mm - 90mm x 25mm to 120mm in 5mm increments
5.5 Dual Diameter Screw Titanium Alloy and Stainless Steel - 5.5mm, 6.0mm 7.0mm, 7.5mm x 30mm to 100mm in 5mm increments
6.35 Dual Diameter Screws Titanium Alloy and Stainless Steel - 5.5mm, 6.0mm, 7.0mm, 7.5mm x 30mm to 65mm in 5mm increments
4.0-8.0mm diameter 20-90mm length
4.5 - 6.5mm diameter uniplanar fracture reduction screws, 25-55mm in 5mm increments</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB153</BillingCode><Name>QUARTEX Polyaxial Screws</Name><Description>Polyaxial screws</Description><Size>3.5-5.5mm diameter
8-50mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI466</BillingCode><PriorBillingCodes><PriorBillingCode>NK081</PriorBillingCode></PriorBillingCodes><Name>Non-Cannulated Polyaxial Pedicle Screws</Name><Description>Non-Cannulated Polyaxial Pedicle Screws</Description><Size>4.5mm to 9.5mm diameter</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>295277</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH089</BillingCode><Name>Polyaxial Pedicle Screw   </Name><Description>Polyaxial Pedicle Screw </Description><Size>Diameter : 4.5 mm - 9.5 mm   Length : 35 mm - 120 mm </Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>380418</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH048</BillingCode><Name>Polyaxial Screws</Name><Description>Dual Head Screws</Description><Size>35-45mm Length</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Complex</Suffix><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KB002</BillingCode><PriorBillingCodes><PriorBillingCode>SV068</PriorBillingCode></PriorBillingCodes><Name>STERISPINE™ sterile Multiaxial non cannulated Pedicle Screw</Name><Description>Non Cannulated pedicle screws</Description><Size>Multiaxial screws  Diameter: 5.5-7.5 mm   Length: 25-60 mm</Size><SupplierCode>40247</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Complex</Suffix><ARTGs><ARTG>273286</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI272</BillingCode><Name>CD Horizon</Name><Description>Dual Rod Multi-Axial Screw</Description><Size>Diameter: 5.5-8.5mm  Length: 30-55mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Complex</Suffix><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW761</BillingCode><PriorBillingCodes><PriorBillingCode>ER215</PriorBillingCode></PriorBillingCodes><Name>Everest Spinal System-Fenestrated Screw</Name><Description>Polyaxial Screw, Fenestrated</Description><Size>(4.5 -9.5)mm diam x (20-110)mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>154442</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW521</BillingCode><Name>Mantis Augmentable Screw</Name><Description>Augmentable Pedicle Screw</Description><Size>5.5-8.5mm diameter, 40-65mm Length</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>279142</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM436</BillingCode><PriorBillingCodes><PriorBillingCode>NK116</PriorBillingCode></PriorBillingCodes><Name>Amendia Savannah-T Pedicle Screw System-Polyaxial Pedicle Screw-Cannulated</Name><Description>Pedicle Screw System-Polyaxial Pedicle Screw-Cannulated, Low, Mid, High Top standard and Grip Quick Threads</Description><Size>dia (5.5-7.5 mm) x length (30-65 mm)</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>281992</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW734</BillingCode><PriorBillingCodes><PriorBillingCode>ER025</PriorBillingCode></PriorBillingCodes><Name>Denali cannulated polyaxial screw</Name><Description>Cannulated polyaxial pedicle screw</Description><Size>Diameter:  5.5mm, 6.5mm and 7.5mm  Length:  35 to 55mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>154442</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER144</BillingCode><Name>Signus Pedicle Screw System-Pedicle Screw Polyaxial Cannulated</Name><Description>Signus Pedicle Screw System-Pedicle Screw Polyaxial Cannulated</Description><Size>4.5 - 7.5mm x 30 - 70mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>216751</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KB014</BillingCode><Name>AnyPlus Long Arm Screw</Name><Description>Polyaxial cannulated pedicle screws</Description><Size>Diameter: 5.0 - 7.5mm  Length 25 -100mm</Size><SupplierCode>40247</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>353891</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ049</BillingCode><Name>Centaur Screw System</Name><Description>Cannulated Polyaxial Screw</Description><Size>4mm - 10mm</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>217033</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KB001</BillingCode><PriorBillingCodes><PriorBillingCode>SV070</PriorBillingCode></PriorBillingCodes><Name>STERISPINE™ sterile Multiaxial Pedicle Screws</Name><Description>Cannulated: Fenestrated/ Multi Axial Cannulated Extended Head/ Extended Head Max and Auto Adjust screw</Description><Size>Cannulated, Multi Axial Cannulated Extended Head, Extended Head Max and Auto Adjust  4.5mm x 25; 30; 35 mm  5.5mm x 25; 30; 35; 40; 45; 50; 55; 60 mm  6.5mm x 25; 30; 35; 40; 45; 50; 55; 60 mm  7.5mm x 25; 30; 35; 40; 45; 50; 55; 60 mm  Fenestrated  4.5mm x 30;35;40 mm  5.5mm x 30; 35; 40; 45; 50; 55; 60 mm  6.5mm x 30; 35; 40; 45; 50; 55; 60 mm  7.5mm x 30; 35; 40; 45; 50; 55; 60 mm  Fenestrated Extended Head Max  4.5mm x30; 35; 40 mm  5.5mm x 30; 35; 40; 45; 50; 55; 60 mm  6.5mm x 25; 30; 35; 40; 45; 50; 55; 60 mm  7.5mm x 25; 30; 35; 40; 45; 50; 55; 60 mm</Size><SupplierCode>40247</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>273286</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV122</BillingCode><Name>Precept (Reduction Screw)</Name><Description>Reduction Screw</Description><Size>4.5-7.5mm diameter; 25-60mm length</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW484</BillingCode><Name>ES2 Spinal System, Screw</Name><Description>Polyaxial cannulated screw with integrated blades</Description><Size>Diam 4.5mm to 8.5mm, Length 25mm to 90mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>278581</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER332</BillingCode><Name>Ulrich Pedicle Screw System-Pedicle Screw, polyaxial, cannulated</Name><Description>Ulrich Pedicle Screw System (uCentum)-Pedicle Screw, polyaxial, cannulated, with or without fenestrations</Description><Size>dia (4.5-10 mm) x length (25-60 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>279706</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER659</BillingCode><Name>LnK AccelFix Spinal Fixation System-MIS Polyaxial screw</Name><Description>AccelFix MIS Polyaxial screw, open or closed, cannulated, sterile, Ti</Description><Size>Diameter: 5.5-9.5 mm  Length:    30-150 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>384815</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB043</BillingCode><Name>ELLIPSE Stabilization System, Polyaxial Screw</Name><Description>Polyaxial Bone Screw</Description><Size>3.5mm - 4.5mm diameter 8mm x 50mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU052</BillingCode><Name>Perla TL Posterior thoraco-lumbar fixation system - polyaxial screw</Name><Description>Polyaxial lateral mass screws: polyaxial screws, reduction screws, 25D screws</Description><Size>Diameter (polyaxial screws, reduction screws): 4.5 - 10.5mm. Diameter (25D screws): 4.5 - 6.5mm  Length (polyaxial screws, reduction screws): 25 - 120mm. Length: 25 - 90mm.</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC822</BillingCode><Name>CD Horizon</Name><Description>Legacy Multiaxial Iliac Screw</Description><Size>Dia 5.5 to 10.5mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY705</BillingCode><Name>Spinal Fixation System</Name><Description>Matrix Preassembled Polyaxial Pedicle Screw</Description><Size>4.00mm - 9.00mm; 20mm  - 100mm Length</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>293276</ARTG><ARTG>293275</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC458</BillingCode><Name>TSRH 3D </Name><Description>Screw</Description><Size>4.5 -8.5mm diameter</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ219</BillingCode><Name>CD HORIZON Spinal System - Multi-Axial Screw</Name><Description>CD HORIZON SOLERA Multi-Axial Screw, HA coated Multi-Axial Screw
</Description><Size>Diameter:  4.0mm - 10.5mm Length: 15mm - 110mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF112</BillingCode><Name>Freedom Polyaxial Screws</Name><Description>Polyaxial reduction screws with standard and extended tabs</Description><Size>Diameter 4.5 to 9.5mm, lengths from 25 to 60mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>203838</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV148</BillingCode><Name>Reline (Cannulated Fenestrated screw)</Name><Description>Pedicle Screw</Description><Size>4.5-12.5mm diameter; 25-120mm length</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV087</BillingCode><Name>Precept (Polyaxial Screw)</Name><Description>Polyaxial Screw</Description><Size>4.5 x 25-45mm, 5.5-8.5 x 30-100mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU148</BillingCode><Name>M.U.S.T. Fenestrated Polyaxial Pedicle Screw</Name><Description>Fenestrated Polyaxial Pedicle Screw</Description><Size>Diameter 5-10mm, Length 30-90mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>196964</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH704</BillingCode><Name>HPS 2.0 Pedicle Screw</Name><Description>Pedicle Screw with Reduction and Extended tabs - Cannulated &amp; Fenestrated</Description><Size>4.5-9.5mm diameters</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>186733</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB364</BillingCode><Name>Aesculap Spinal System</Name><Description>Polyaxial Cannulated Screw</Description><Size>All Sizes</Size><SupplierCode>40020</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>134538</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB080</BillingCode><Name>REVERE TRANSITION HA coated Pedicle Screw</Name><Description>Polyaxial Screw HA Coated, Dual Outer Diameter, Prefered Angle</Description><Size>5.5mm-8.5mm x 35mm - 100mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>196585</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI260</BillingCode><Name>Infinity Spinal System</Name><Description>Multi-Axial Screws</Description><Size>Diameter 3.0 - 5.5mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER435</BillingCode><Name>LnK Posterior Cervical Fixation System/CastleLoc-S Posterior Cervical Fixation System-Polyax. Screw</Name><Description>LnK Posterior Cervical Fixation System/CastleLoc-S Posterior Cervical Fixation System-Polyaxial Screw, standard, semi-reduction and reduction</Description><Size>Dia (3.5-4.0 mm) x length (10-50 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>384816</ARTG><ARTG>286122</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VB007</BillingCode><Name>Lumfix Polyaxial Screw</Name><Description>Std or double threaded, std or extended castle  self tapping </Description><Size>(4.0 -8.5)mm diameter x (20-90)mm length </Size><SupplierCode>40229</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>327225</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER446</BillingCode><Name>LnK Spinal Fixation System/OpenLoc-L Spinal Fixation System-Pedicle Screw, polyaxial</Name><Description>LnK Spinal Fixation System/OpenLoc-L Spinal Fixation System-Pedicle Screw; polyaxial; self tapping or non self tapping; standard or reduction; accommodates rods of 5.0, 5.5, 6.0 and 6.35mm in diameter</Description><Size>dia (4.0-8.5mm) x length (20-150mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>286123</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM460</BillingCode><PriorBillingCodes><PriorBillingCode>NK016</PriorBillingCode></PriorBillingCodes><Name>X90 Pedicle Screw</Name><Description>Capless, Polyaxial pedicle screw</Description><Size>Diameter 4.75 - 8.25mm  Length 30 -55mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>159605</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM401</BillingCode><PriorBillingCodes><PriorBillingCode>NK006</PriorBillingCode></PriorBillingCodes><Name>Fortex Pedicle Screw system - Pedicle Screw</Name><Description>Polyaxial pedicle screw</Description><Size>4.75, 5.5, 6.5, 7.5, 8.25mm diameter. 30, 35, 40, 45, 50, 55mm lengths</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>159605</ARTG><ARTG>160750</ARTG><ARTG>170220</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM413</BillingCode><PriorBillingCodes><PriorBillingCode>NK034</PriorBillingCode></PriorBillingCodes><Name>Certex Spinal Implant System Screw</Name><Description>Screws</Description><Size>Diameter 3.5mm - 4.5mm  Length 10mm – 42mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>160750</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER310</BillingCode><Name>Ulrich posterior OCT System (neon3)-Pedicle Screws</Name><Description>Ulrich posterior OCT System (neon3)-Pedicle Screws, non-cannulated, lateral mass screws</Description><Size>dia (3.5-4 mm) x length (10-28 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>279706</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER143</BillingCode><Name>Signus Pedicle Screw System-Pedicle Screw Polyaxial</Name><Description>Signus Pedicle Screw</Description><Size>4.5 - 7.5mm x 30 - 70mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>216751</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER620</BillingCode><PriorBillingCodes><PriorBillingCode>OF059</PriorBillingCode></PriorBillingCodes><Name>Centurion Multi-Axial Screws</Name><Description>Multi-Axial and Smooth Shank Multi-Axial Screws</Description><Size>3.5mm Diameter – 10mm - 52mm in 2mm increments  4.0mm Diameter – 10mm - 52mm in 2mm increments  4.5mm Diameter – 10mm – 50mm in 5mm increments  5.0mm Diameter – 10mm – 50mm in 5mm increments</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>195012</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ013</BillingCode><Name>Centaur Screw System</Name><Description>Polyaxial Screw</Description><Size>4mm-13mm</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>217033</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK225</BillingCode><Name>Oasys-Occipito Cervico Thoracic System</Name><Description>Polyaxial Screw</Description><Size>Dia: 3.5mm x Length: 10mm - 40mm  Dia: 4.0mm x Length: 10mm - 50mm  Dia: 4.5mm x Length: 20mm - 52mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>279144</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW724</BillingCode><PriorBillingCodes><PriorBillingCode>ER014</PriorBillingCode></PriorBillingCodes><Name>Denali Spinal System / Polyaxial Pedicle Screw</Name><Description>Polyaxial Pedicle Screw</Description><Size>Diameter: 3.5 - 8.5mm, Length: 10 - 100mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>154442</ARTG><ARTG>159828</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV024</BillingCode><Name>VuePoint screw (multi axial)</Name><Description>Screw (mulit-axial)</Description><Size>3.5 - 5.5mm diameter, 10-40mm length</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>209198</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB009</BillingCode><Name>DPS Spine System - Polyaxial Pedicle Screw</Name><Description>Polyaxial pedicle screws</Description><Size>Diameter 4/5/6/7mm; Length 25 - 55mm  Wide Angle 5.5/6.0/6.5/7.0/7.5/8.0 mm; Length 25 - 135 mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>214788</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV117</BillingCode><Name>Reline (Reduction Screw)</Name><Description>Reduction Screw</Description><Size>4.0-12.5mm in diameter; 15-120mm in length</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV115</BillingCode><Name>Reline (Polyaxial Screw)</Name><Description>Polyaxial Screw</Description><Size>4.0-12.5mm diameter, 15-120mm length</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB224</BillingCode><Name>Aesculap Spinal System</Name><Description>Polyaxial Screw - titanium alloy</Description><Size>All sizes</Size><SupplierCode>40020</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>134538</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV067</BillingCode><Name>Armada (Polyaxial Screws)</Name><Description>Polyaxial screw</Description><Size>Polyaxial Screw 
4.5-10.0mm x 25-120mm
lliac Screw
6.5/7.5/8.5/9.5mm
(60/70/80/90/100mm)
Provisional locking screw size ranges from 
4.0mmx25-45mm,
4.5mmx25-45mm,
5.0mmx25-50mm,
5.5mmx25-55mm,
6.5mmx30-55mm
Uniplanar Screw 5.0/5.5/6.5mm x 25/30/35/40/45/5</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV057</BillingCode><Name>Armada (Reduction Screw)</Name><Description>Reduction Screw</Description><Size>4.5-8.5mm x 20-120mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BF006</BillingCode><Name>Smartloc Spinal Fixation System/ Polyaxial Pedicle Screw &amp; Reduction Screw</Name><Description>Polyaxial Pedicle Screw and Reduction Screw</Description><Size>Length 30mm – 55mm; Diameter 4.5mm, 5.5mm, 6.0mm, 6.5mm, 7.0mm, 7.5mm, 8.0mm</Size><SupplierCode>40171</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>150778</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV089</BillingCode><Name>Armada (Fenestrated Screw)</Name><Description>Fenestrated Screw</Description><Size>5.5 - 8.5 x 30-65mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH484</BillingCode><Name>DSS HP Spinal System - Pedicle Screw</Name><Description>Cannulated Pedicle Screw, Titanium</Description><Size>(5 - 10)mm diam x (30 - 110(mm length</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>186733</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER288</BillingCode><Name>Premia Spine Versalink Fixation System-Polyaxial Pedicle Screw</Name><Description>Premia Spine Versalink Fixation System-Cannulated Polyaxial Pedicle Screw</Description><Size>dia (5.5-8.5)mm x length (25-60)mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>267145</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER406</BillingCode><Name>LnK MIS Spinal System/PathLoc-L MIS Spinal System-Pedicle Screw</Name><Description>LnK MIS Spinal System /PathLoc-L MIS Pedicle screw, polyaxial,cannulated,self-tapping, double Thread, with sleeve</Description><Size>dia (5.5-7.5mm) x length (30-60 mm); sleeve length (47-127 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>286124</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM444</BillingCode><PriorBillingCodes><PriorBillingCode>NK059</PriorBillingCode></PriorBillingCodes><Name>Excella Cannulated Pedicle Screw</Name><Description>Cannulated Pedicle Screw</Description><Size>4.75 to 8.5mm diameter  25 to 60 mm length</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>295225</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ146</BillingCode><Name>Evolution Spine Whistler Modular Pedicle Screw System-Pedicle Screw</Name><Description>Evolution Spine Whistler Modular Pedicle Screw System-Pedicle Screw Shank, solid or cannulated, sterile or non-sterile, HA coated or uncoated.</Description><Size>Diameter: 4.75-10.50 mm Length: 25-120 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>445292</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Change to Group benefit</ChangeExplanation><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER311</BillingCode><Name>Ulrich posterior OCT System (neon3)-Pedicle Screws, cannulated</Name><Description>Ulrich posterior OCT System (neon3)-Pedicle Screws, cannulated</Description><Size>dia (4-5.5 mm) x length (20-55 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>279706</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB018</BillingCode><Name>REVOLVE Stabilization System Poliaxial Screw</Name><Description>Polyaxial, cannulated pedicale screw</Description><Size>5.5mm - 8.5mm diameter 30mm - 90mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>190043</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB199</BillingCode><Name>CREO S2AI Preferred Angle</Name><Description>Cannulated CoCr polyaxial screw</Description><Size>Diameter 6.0 -10.5mm  Length 60-120mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB060</BillingCode><Name>REVLOK Fenestrated Screw System Screw</Name><Description>Fenestrated Screw</Description><Size>5.5mm -10.5mm x 30mm -120mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>196054</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI467</BillingCode><PriorBillingCodes><PriorBillingCode>NK082</PriorBillingCode></PriorBillingCodes><Name>Cannulated Polyaxial Pedicle Screw</Name><Description>Cannulated Polyaxial Pedicle Screw</Description><Size>All sizes</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>295277</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB081</BillingCode><Name>REVERE Cannulated Polyaxial Screw</Name><Description>Cannulated Polyaxial Screw</Description><Size>5.5mm x 25 - 8.5 x 65mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HC026</BillingCode><Name>G2S Cannulated Polyaxial Screw</Name><Description>Cannulated Polyaxial screw</Description><Size>W:5.5-7.5mm</Size><SupplierCode>40349</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>274075</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU147</BillingCode><Name>M.U.S.T. Fenestrated Polyaxial Cannulated Pedicle Screw</Name><Description>Fenestrated Polyaxial Cannulated Pedicle Screw</Description><Size>Diameter 4.5-10mm, Length 25-100mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>196964</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU106</BillingCode><Name>M.U.S.T Polyaxial Pedicle Screws Cannulated</Name><Description>Polyaxial Cannulated Screws</Description><Size>4.5-10mm; Length 25 -100mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>196964</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW726</BillingCode><PriorBillingCodes><PriorBillingCode>ER017</PriorBillingCode></PriorBillingCodes><Name>Mesa Spinal System / Polyaxial Pedicle Screw</Name><Description>Polyaxial Pedicle Screw, Titanium</Description><Size>(3.5 - 12.5)mm diam, lengths (10-110)mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Integrated Locking Mechanism</Suffix><ARTGs><ARTG>159828</ARTG><ARTG>154442</ARTG></ARTGs><MinimumBenefit>1257</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM508</BillingCode><Name>Polyaxial Pedicle Screws</Name><Description>Polyaxial Pedicle Screws</Description><Size>Diameter 5.5 - 7.5mm  Length 35 - 55mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Integrated Locking Mechanism</Suffix><ARTGs><ARTG>366793</ARTG></ARTGs><MinimumBenefit>1257</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER512</BillingCode><PriorBillingCodes><PriorBillingCode>EU001</PriorBillingCode></PriorBillingCodes><Name>e.Spine PEDICULAR SCREW</Name><Description>spine Pedicular Screw for sacral-thoraco-lumbar osteosynthesis</Description><Size>Pedicle or Reduction pedicle;
Diameter 4.35 Length 25 to 55 mm,
Diameter 5 Length 25 to 60 mm,
Diameter 6 Length 25 to 65 mm,
Diameter 6.5 Length 25 to 70 mm,
Diameter 7 Length 30 to 80 mm.</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>171952</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KB012</BillingCode><Name>AnyPlus II Poly Screw</Name><Description>Polyaxial pedicle screws and reduction screws</Description><Size>Diameter:4.5-7.5mm  Length: 35-55mm</Size><SupplierCode>40247</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>353891</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ064</BillingCode><Name>Centaur Spinal System</Name><Description>Polyaxial Screw</Description><Size>Diameter 5mm -10mm  Length 20mm -100mm</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>407189</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HC016</BillingCode><Name>KM POLYAXIAL</Name><Description>Polyaxial Screw</Description><Size>W:3.5-7.5mm L:10-55mm</Size><SupplierCode>40349</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>201492</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH052</BillingCode><Name>Polyaxial Screws</Name><Description>Polyaxial Screws</Description><Size>10-52mm Length</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY008</BillingCode><Name>Reform Modular Polyaxial Screws</Name><Description>Module Polyaxial Screws</Description><Size>Diameter 4.5mm to 10.5mm  Length 25mm to 120mm  Cannulated and Non-Cannulated</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>287905</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER571</BillingCode><PriorBillingCodes><PriorBillingCode>OF076</PriorBillingCode></PriorBillingCodes><Name>Firebird Modular Screws</Name><Description>Modular pedicle screws - shank</Description><Size>Diameter - 4mm -11.5mm   Length - 25mm - 110mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>195012</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER544</BillingCode><Name>Biedermann Motech MOSS Spinal Fixation System-Ti Pedicle Screw</Name><Description>Polyaxial Screw shank-solid and cannulated/fenestrated</Description><Size>Ø4.3mm - Ø10.0 mm diameter, 20-120mm length</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>337238</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER333</BillingCode><Name>Ulrich Pedicle Screw System-Pedicle Screw, Polyaxial</Name><Description>Ulrich Pedicle Screw System (uCentum, flamenco)-Pedicle Screw, Polyaxial, standard or long arm</Description><Size>dia (4.5-10 mm) x length (25-60 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>279706</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV142</BillingCode><Name>Reline (Mod Shank)</Name><Description>Screw Shank</Description><Size>4.0-10.5mm x 25-90mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM441</BillingCode><PriorBillingCodes><PriorBillingCode>NK056</PriorBillingCode></PriorBillingCodes><Name>Excella Polyaxial Pedicle Screw</Name><Description>Polyaxial Pedicle Screw</Description><Size>5.5 to 7.5 mm diameter  35 to 60 mm length</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>295225</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW384</BillingCode><Name>Xia Spine System</Name><Description>Polyaxial Screw</Description><Size>Dia: 4mm - 10.5mm Length: 20mm - 100mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>139620</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV139</BillingCode><Name>Reline (Mod Shank) Cannulated</Name><Description>Screw Shank</Description><Size>4.5-12.5mm x 25-120mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB011</BillingCode><Name>Spine System Evolution</Name><Description>Screw</Description><Size>Dia 5 - 8mm, length 30 - 55mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>134538</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV120</BillingCode><Name>Precept (MP Screw Shank)</Name><Description>Screw Shank</Description><Size>4.5-7.5mm diameter; 25-60mm length</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH708</BillingCode><Name>Athena Polyaxial screw shank</Name><Description>Polyaxial screw shank intended for pedicle or cortical bone trajectory screw insertion. The shanks have a quad to dual lead thread for increased cortical bone purchase. The screw shanks are also fenestrated to enable screw augmentation with bone cement</Description><Size>5mm -8.5mm diameter   30mm to 100mm screw lengths   </Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>337150</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV084</BillingCode><Name>Precept (Screw Shank)</Name><Description>Screw shank</Description><Size>4.8-8.5mm x (25-50mm)</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY098</BillingCode><PriorBillingCodes><PriorBillingCode>JG009</PriorBillingCode></PriorBillingCodes><Name>VENTOTENE Modular Screw</Name><Description>Standard Solid</Description><Size>4.5/5.5/6.5/7.5mm diameter  25-100mm length</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>397231</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB129</BillingCode><Name>CREO MCS - Screw Post</Name><Description>Double threaded, dual outer diameter screw post</Description><Size>Diameter 5.0-7.5mm, Length 20-45mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE769</BillingCode><Name>NorthStar OCT  </Name><Description>NorthStar OCT Polyaxial Screw  </Description><Size>3.5, 4.0, 4.5, 5.5mm Diameter  8-40mm Lengths  </Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB100</BillingCode><Name>CREO AMP™ Modular Screw Shaft</Name><Description>Modular screw shaft</Description><Size>4.0mm - 10.5mm x 20mm - 120mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU041</BillingCode><Name>Perla TL Posterior thoraco-lumbar fixation system - polyaxial screw-shank</Name><Description>Polyaxial screw shanks: cortical bone screw shanks, degenerative bone screw shanks</Description><Size>Diameter (cortical bone screw shank): 4.5 - 7.5mm, Diameter (degenerative bone screw shank): 4.5 - 9.5mm.  Length (cortical bone screw shank): 25 - 50mm. Length (degenerative bone screw shank): 25 - 120mm.</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC459</BillingCode><Name>TSRH 3D </Name><Description>Extended Post Screw</Description><Size>30 - 60mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ064</BillingCode><Name>Invictus SI Core </Name><Description>Polyaxial Pedicle Screw, Cannulated, Dual Lead,  Radial Fenestration.  open or closed tulip. Ti Alloy</Description><Size>( 9.0-11.5)mm Dia x (60-100)mm length </Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>398576</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU154</BillingCode><Name>MUST MINI Cannulated Polyaxial Screw</Name><Description>Cannulated Polyaxial Screw</Description><Size>Diameter: 4 - 6  Length: 10 - 50 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>404164</ARTG><ARTG>291175</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE669</BillingCode><Name>icotec Pedicle System Polyaxial Screw</Name><Description>Polyaxial Pedicle Screw</Description><Size>Size(s):4.5, 5.5, 6.5 and 7.5mm diameter   25-60mm length</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>283853</ARTG></ARTGs><Note>Only to be reimbursed when used in patients with spinal tumours requiring regular magnetic resonance imaging (MRI) and/or computerised tomography (CT) imaging and or adjuvant radiotherapy and/or proton therapy.</Note><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER662</BillingCode><Name>LnK AccelFix Spinal Fixation System-polyaxial screw  </Name><Description>AccelFix S/AccelFix DS/AccelFix SS polyaxial screws, sterile, single or double lead, standard or variable pitch, closed or open, Ti, sterile</Description><Size>Diameter: 4-8,5 mm  Length: 34.2-176.5 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>384815</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW745</BillingCode><PriorBillingCodes><PriorBillingCode>ER049</PriorBillingCode></PriorBillingCodes><Name>Everest Spinal System -Pedicle Screw</Name><Description>Polyaxial Pedicle Screw, Ti</Description><Size>Diameter: 4.5mm-10.5mm,  Length: 25mm - 110mm (open or closed)</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>154442</ARTG><ARTG>293862</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HC033</BillingCode><Name>SAXXO SCREW</Name><Description>POLYAXIAL SCREW</Description><Size>W:4.5-8mm L:30-55mm</Size><SupplierCode>40349</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>331780</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HC034</BillingCode><Name>G2S-KM SCREW</Name><Description>POLYAXIAL SCREW</Description><Size>W;4.5-7.5mm , L:25-60mm</Size><SupplierCode>40349</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>274075</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JA014</BillingCode><PriorBillingCodes><PriorBillingCode>OH353</PriorBillingCode></PriorBillingCodes><Name>Novel/Zenius Reduction Poly Screw</Name><Description>Polyaxial Reduction pedicle screw</Description><Size>5.5-8.5</Size><SupplierCode>40213</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>148858</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH579</BillingCode><Name>Venus Spinal Fixation Systems - Pedicle Screws - Poly Non Cannulated</Name><Description>Venus - Pedicle Screws - Polyaxial Non Cannulated</Description><Size>D 4.0-8.5mm L20-120mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>316187</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW014</BillingCode><PriorBillingCodes><PriorBillingCode>ZI905</PriorBillingCode></PriorBillingCodes><Name>Virage Pedicle Polyaxial Screws</Name><Description>Pedicle polyaxial screws</Description><Size>3.5mm-5.0mm x 10-45mm</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>111775</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ041</BillingCode><Name>Invictus Polyaxial  Pedicle Screw</Name><Description>Polyaxial or Favoured Angle (Medial /Lateral or Cranial/Caudal) Pedicle Screw , Full or Partial Thread.   Ti Alloy</Description><Size>(3.5 - 12.5)mm x (8-130)mm</Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>398576</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ062</BillingCode><Name>Invictus Osseoscrew</Name><Description>Pedicle Screw, Cannulated, Std, Extended, Reduction Tab. Ti Alloy</Description><Size>(6,.5 - 7.5)mm dia x (40-55)mm length </Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>398576</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE704</BillingCode><Name>Mariner Cannulated Pedicle Screw Shanks</Name><Description>Posterior Fixation System</Description><Size>4.5-10.5mm Diameters.  20-110mm Lengths.</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH077</BillingCode><Name>Kumafix Pedicle Shank Screw </Name><Description>Shank Screw </Description><Size>Diameter : 5.5 mm - 6.6 mm   Length :     40 mm - 55 mm</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ038</BillingCode><Name>Invictus  Shank </Name><Description>Polyaxial , solid or cannulated Ti Alloy </Description><Size>(4-12.5)mm dia x (20-130)mm length </Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>398576</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ100</BillingCode><Name>RESPONSE Spine System – Polyaxial Screw</Name><Description>Pedicle Polyaxial Screw</Description><Size>4-9mm diameter, 20mm-110mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>233454</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN263</BillingCode><Name>SYMPHONY OCT System</Name><Description>Polyaxial screws</Description><Size>3.0-5.5mm diameter</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>178040</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI503</BillingCode><Name>PASS Polyaxial Spinal System - Pedicle Screws</Name><Description>Polyaxial Pedicle Screws</Description><Size>4.5 to 7.5mm diameter</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>295277</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY598</BillingCode><Name>Spinal Fixation System</Name><Description>Pedicle: Screw, Head</Description><Size>4mm - 9mm D</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>293276</ARTG><ARTG>133401</ARTG><ARTG>293275</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IB005</BillingCode><Name>Vertefix II Poly-Axial Screw</Name><Description>Multi/ Poly-Axial Pedicle Screw</Description><Size>Diameters: 5.5, 6.5, 7.5mm length: 35, 40, 45, 50mm</Size><SupplierCode>40009</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>188902</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JA012</BillingCode><PriorBillingCodes><PriorBillingCode>OH358</PriorBillingCode></PriorBillingCodes><Name>Medyssey Spinal Fixation System</Name><Description>Polyaxial Screw</Description><Size>4.0-8.5</Size><SupplierCode>40213</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>148858</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW015</BillingCode><PriorBillingCodes><PriorBillingCode>ZI994</PriorBillingCode></PriorBillingCodes><Name>Vitality Spine System - Polyaxial Pedicle Screws</Name><Description>Polyaxial Pedicle Screws Titanium</Description><Size>Diameter = 4.0mm-10.5mm  Length= 20mm-120mm</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>287242</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE788</BillingCode><Name>Mariner Screw</Name><Description>Polyaxial and Extended Tab Uni-Planar Screws  </Description><Size>4.5mm. 5.5mm, 6.5mm &amp; 7.5mm Diameters, 20mm to 110mm Lengths  </Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE664</BillingCode><Name>Mariner Pedicle Screw Shank</Name><Description>Posterior Fixation System</Description><Size>4.5, 5.5, 6.5, 7.5, 8.5, 9.5 and 10.5mm Diameters  25-110mm Length</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY099</BillingCode><PriorBillingCodes><PriorBillingCode>JG010</PriorBillingCode></PriorBillingCodes><Name>VENTOTENE Modular Screw</Name><Description>Standard Cannulated</Description><Size>5.5/6.5/7.5mm diameter  30-70mm length</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>397231</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU058</BillingCode><Name>Perla TL Posterior thoraco-lumbar fixation system - cannulated polyaxial screw-shank</Name><Description>Modular cannulated polyaxial bone screw shanks, modular cannulated fenestrated polyaxial bone screw shanks</Description><Size>Diameter: 4.5 - 8.5mm  Length: 25 - 60mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI523</BillingCode><Name>CD Horizon™ ModuLeX™ 5.5 Spinal System - Screw Shank </Name><Description>Screw Shank</Description><Size>Diameter: 4.5-7.5mm; Length 30-55mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>422153</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI472</BillingCode><PriorBillingCodes><PriorBillingCode>NK087</PriorBillingCode></PriorBillingCodes><Name>Polyaxial Pedicle Screws</Name><Description>Polyaxial Pedicle Screws</Description><Size>All sizes</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>295277</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB122</BillingCode><Name>CREO MIS Posterior Stabilization System - Bone Screws</Name><Description>Cannulated self-tapping polyaxial screws - Shank</Description><Size>Diameter 4.5-10.5mm, Length 25-120mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW775</BillingCode><PriorBillingCodes><PriorBillingCode>ER476</PriorBillingCode></PriorBillingCodes><Name>Yukon OCT System</Name><Description>Polyaxial Posterior Cervical Screws</Description><Size>3.5-5.0 diameter, length 10-50mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>159828</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB210</BillingCode><Name>CREO One</Name><Description>Monaxial pedicle screw  </Description><Size>Diameter: 5.5 -7.5mm  Length: 35-55mm  </Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB069</BillingCode><Name>BEACON™ Stabilization System Posted Screw</Name><Description>Posted Screw and Reduction Screw</Description><Size>4.5mm - 9.5mm diameter 25mm - 90mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>219169</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY001</BillingCode><Name>Reform Polyaxial Screw</Name><Description>Polyaxial Screw</Description><Size>Diameter 4.5mm to 10.5mm  Length 25mm to 120mm  Cannulated and Non-Cannulated</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>287905</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ054</BillingCode><Name>Centaur Screw System</Name><Description>Polyaxial Screw HA Coated</Description><Size>4mm - 10mm</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>217033</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW631</BillingCode><Name>Xia Serrato Polyaxial Screw</Name><Description>Polyaxial Screw, Reduction Polyaxial Screw, Medial Biased Angle Screw</Description><Size>Dia 4mm-10.5mm, Length 20mm-130mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>279159</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW593</BillingCode><Name>Xia 4.5 CT Polyaxial  Screw</Name><Description>Cortical Thread Polyaxial Screw</Description><Size>Dia 4mm to 6.5mm, length 20mm to 45mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>279160</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY009</BillingCode><Name>Reform POCT Polyaxial Screw</Name><Description>Polyaxial Screw</Description><Size>Length 8mm to 50mm</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>287906</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI465</BillingCode><PriorBillingCodes><PriorBillingCode>NK080</PriorBillingCode></PriorBillingCodes><Name>Cannulated Polyaxial Pedicle Screws</Name><Description>Cannulated Polyaxial Pedicle Screws</Description><Size>4.5 to 9.5mm diameter  all lengths</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>295277</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC736</BillingCode><Name>Vertex Max Cannulated Screw</Name><Description>Posterior cannulated cervical screw</Description><Size>Diameter 3.5 - 4.5mm
Length 20 - 60mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI395</BillingCode><Name>CD HORIZON Voyager Fenestrated Screws</Name><Description>Fenestrated multi-axial screw</Description><Size>Diameter:4.5mm-10.5mm, Length: 30mm-80mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>187126</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY076</BillingCode><PriorBillingCodes><PriorBillingCode>DR006</PriorBillingCode></PriorBillingCodes><Name>Life Spine Pedicle Screw System - Pedicle Screw, Polyaxial, Cannulated</Name><Description>Life Spine Pedicle Screw System (Nautilus, Avatar)-Pedicle Screw, Polyaxial, Cannulated,</Description><Size>dia (4.5-10 mm) x length (25-125 mm)</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>321122</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB082</BillingCode><Name>REVERE TRANSITION HA Coated Cannulated Polyaxial Screw</Name><Description>Polyaxial Screw HA Coated, Cannulated</Description><Size>6.5mm - 8.5mm x 35mm - 6mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>196585</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY089</BillingCode><PriorBillingCodes><PriorBillingCode>DR034</PriorBillingCode></PriorBillingCodes><Name>Z-Medical Pedicle Screw System - Pedicle Screws, Cannulated</Name><Description>Z-Medical Pedicle Screw - Cannulated (polyaxial and uniplanar)</Description><Size>Dia. (5-8)mm x Length (35-55)mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>343676</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU057</BillingCode><Name>Perla TL Posterior thoraco-lumbar fixation system - cannulated polyaxial screw</Name><Description>Cannulated polyaxial screws, cannulated sagittal screws: cannulated /cannulated &amp; fenestrated</Description><Size>Diameter: 4.5-10.5mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI036</BillingCode><Name>CD HORIZON Fenestrated Screw</Name><Description>Fenestrated multi-axial screw</Description><Size>Diameter:4.5 - 10.5mm, Length: 30 - 80mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>187126</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC968</BillingCode><Name>CD HORIZON Spinal System - Cannulated Multi-Axial Screw</Name><Description>CD HORIZON Cannulated Multi-Axial Screw</Description><Size>Diameter: 4.0mm - 10mm    Length:  20mm - 110mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>169514</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN198</BillingCode><Name>Viper Spine System</Name><Description>Polyaxial, uniplanar cannulated screws</Description><Size>4.35 to 10mm diameter</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>178040</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU026</BillingCode><Name>Romeo 2 MIS Posterior Thoraco-lumbar Fixation System - Cannulated Polyaxial Screw</Name><Description>Cannulated polyaxial pedicle screw, perforated cannulated polyaxial pedicle screw</Description><Size>Cannulated Screw -  Diameter: 5mm, 6mm, 7mm  Length: 30mm, 35mm, 40mm, 45mm, 50mm, 55mm, 60mm  Perforated Cannulated Screw -  Diameter: 5mm,  6mm, 7mm, 8mm  Length: 35mm, 40mm, 45mm, 50mm, 55mm, 60mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>198720</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN324</BillingCode><Name>SYMPHONY OCT System</Name><Description>Polyaxial cannulated screws</Description><Size>3.5-5.5mm diameter</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>178040</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW594</BillingCode><Name>Xia 4.5 CT Cannulated Polyaxial Screw</Name><Description>Cannulated Cortical Thread Polyaxial Screw</Description><Size>Dia 4.5mm to 6.5mm, length 20mm to 45mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>279160</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT016</BillingCode><Name>SOLFIX2 Pedicle Screws</Name><Description>Cannulated and fenestrated screws</Description><Size>Diameter: 5.4mm - 9.4mm  Length: 30mm - 110mm</Size><SupplierCode>40227</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>320880</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV133</BillingCode><Name>Reline System (cannulated polyaxial screw)</Name><Description>Cannulated Polyaxial Screw</Description><Size>4.5-12.5 mm diameter, 25-120mm length</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV123</BillingCode><Name>Precept (Fenestrated Screw)</Name><Description>Fenestrated Screw</Description><Size>4.5-12.5mm diameter; 25-120mm length</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV146</BillingCode><Name>Reline (Fenestrated screw)</Name><Description>Pedicle Screw</Description><Size>4.5-12.5mm diameter; 25-120mm length</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI043</BillingCode><Name>HPS™ 2.0 Polyaxial Pedicle Screw</Name><Description>Cannulated polyaxial screws with MIS option</Description><Size>Diameter: 4.5- 9.5mm  Length: 20mm-60mm</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>345870</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI034</BillingCode><Name>HPS™ Polyaxial Screws</Name><Description>Polyaxial cannulated pedicle screws.</Description><Size>Diameter: 5-9mm  Length: 30-60mm</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>345870</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI009</BillingCode><Name>Streamline Cannulated Polyaxial Pedicle Screws, including MIS.</Name><Description>Cannulated Polyaxial Pedicle Screws in various diameters and lengths (Titanium Alloy)</Description><Size>4.5 x 20mm to 45mm in 5mm increments;  5.5 x 30mm to 60mm in 5mm increments;  6.5 x 30mm to 100mm in 5mm increments;  7.5 x 30mm to 100mm in 5mm increments;  8.5 x 30mm to 100mm in 5mm increments;  9.5 x 40 to 60mm in 5mm increments and 9.5 x 70mm to 100mm in 10mm increments;</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>233599</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BF026</BillingCode><Name>Pedicle Screw</Name><Description>Cannulated Screw,  Carbon Fiber Reinforced Polymer</Description><Size>(6.5-7.5)mm x (35-55) mm length</Size><SupplierCode>40171</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>288089</ARTG></ARTGs><Note>Only to be reimbursed when used in patients with spinal tumours requiring regular magnetic resonance imaging (MRI) and/or computerised tomography (CT) imaging and or adjuvant radiotherapy and/or proton therapy.</Note><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI045</BillingCode><Name>Streamline Polyaxial Screws</Name><Description>Polyaxial cannulated pedicle screws including MIS, reduction and fenestrated screws</Description><Size>Diameter: 4.5 - 9.5mm  Length: 20-60mm</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>345870</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV134</BillingCode><Name>Reline System (cannulated polyaxial reduction screw)</Name><Description>Cannulated Polyaxial Reduction Screw</Description><Size>4.5-12.5mm diameter, 25-120mm length</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC586</BillingCode><Name>CD Horizon Sextant Percutaneous Cannulated Multi Axial Screw</Name><Description>Cannulated titanium percutaneous multi axial screw</Description><Size>Dia 3.5 to 9.5mm, Length 15 to 65mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB060</BillingCode><Name>TINA Minimally Invasive Spine System</Name><Description>Polyaxial Cannulated Screw</Description><Size>All sizes</Size><SupplierCode>40026</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>214788</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY066</BillingCode><PriorBillingCodes><PriorBillingCode>DR048</PriorBillingCode></PriorBillingCodes><Name>Ulrich Medical Pedicle Screw System - Pedicle Screws, polyaxial, cannulated</Name><Description>Ulrich Medical Pedicle Screw System - Pedicle Screws, polyaxial, cannulated</Description><Size>4.5-10.0mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>365230</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU018</BillingCode><Name>Romeo 2 Posterior Thoraco-lumbar Fixation System - Polyaxial Screw, Reduction Screw, 25D Screw</Name><Description>Polyaxial screw, polyaxial reduction screw</Description><Size>Diameter: 4mm, 5mm, 6mm, 7mm, 8mm  Length: 25mm, 30mm, 35mm, 40mm, 45mm, 50mm, 55mm, 60mm, 70mm, 80mm, 90mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>198720</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ944</BillingCode><Name>Expedium Spine System</Name><Description>Polyaxial screws</Description><Size>4.35 - 12mm diameter</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>178040</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY083</BillingCode><PriorBillingCodes><PriorBillingCode>DR013</PriorBillingCode></PriorBillingCodes><Name>Life Spine Pedicle Screw System - Pedicle Screw, Polyaxial</Name><Description>Life Spine Pedicle Screw System (Nautilus) - Pedicle Screw, Polyaxial Standard or Reduction</Description><Size>dia (4.5-8.5mm) x length (25-125mm)</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>321122</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ940</BillingCode><Name>Moss Miami Spinal System</Name><Description>Polyaxial Screw</Description><Size>4.35 to 8mm diameter</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>128257</ARTG><ARTG>97391</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC675</BillingCode><Name>CD Horizon</Name><Description>Legacy Screw</Description><Size>Diameter 3.5 - 10.5mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW045</BillingCode><Name>WEGO Spinal Systems </Name><Description>Cannulated polyaxial screws </Description><Size>All sizes</Size><SupplierCode>40252</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>330363</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC545</BillingCode><Name>Vertex Spinal System</Name><Description>Screws</Description><Size>Diameter 3.5 - 4.5mm Length 6 - 52mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB146</BillingCode><Name>CAPITOL Polyaxial Screw</Name><Description>Self-tapping polyaxial screw</Description><Size>3.5 - 4.0mm diameter, 8-26mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER221</BillingCode><Name>SIGNUS Diplomat Pedicle Screw System-Polyaxial Screw-Shank</Name><Description>SIGNUS Diplomat Pedicle Screw System-Polyaxial Screw-Shank</Description><Size>dia (4.5-9.5 mm) x length (25-100 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Shank</Suffix><ARTGs><ARTG>216751</ARTG></ARTGs><MinimumBenefit>524</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY566</BillingCode><Name>Spinal Fixation System</Name><Description>Matrix Reduction Screw</Description><Size>4.0mm - 8.00mm; 20mm - 65mm Length</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>133401</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY005</BillingCode><PriorBillingCodes><PriorBillingCode>EV042</PriorBillingCode></PriorBillingCodes><Name>BA Posterior Screw</Name><Description>Polyaxial Screw</Description><Size>Ø3.5, Ø4.0, Ø4.5  8mm to 50mm in length.</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>329318</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU001</BillingCode><Name>Perla Posterior Cervico-Thoracic Fixation System - Polyaxial Screw</Name><Description>Polyaxial lateral mass screws: polyaxial screws, smooth shank screws, preferred angle screws</Description><Size>Diameter: 3.5mm, 4.0mm, 4.5 mm Length (polyaxial and preferred angle): 8mm, 10mm, 12mm, 14mm, 16mm, 18mm, 20mm, 24mm, 28mm, 32mm, 36mm, 40mm, 44mm, 48mm, 52mm Length (smooth shank): 18mm, 20mm, 22mm, 24mm, 26mm, 28mm, 30mm, 32mm, 34mm, 36mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH046</BillingCode><Name>Polyaxial Screws</Name><Description>Cannulated</Description><Size>50-110mm Length</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB211</BillingCode><Name>CREO® Side Loading Polyaxial Screw</Name><Description>Side Loading Polyaxial screw with CoCr head and Ti shank</Description><Size>Diameter: 4.0 - 10.5mm  Length: 20 -120mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB191</BillingCode><Name>CREO DLX Polyaxial Screw</Name><Description>Polyaxial screws</Description><Size>Diameter: 4.0mm to 10.5mm  Length: 20mm to 120mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI016</BillingCode><Name>Streamline TL- Polyaxial Pedicle Screws</Name><Description>Polyaxial Pedicle Screws and Reduction Screws in various diameters and lengths (Titanium Alloy)</Description><Size>4.5 x 20mm to 45mm in 5mm increments;
5.5 x 20mm to 60mm in 5mm increments;
6.5 x 20mm to 100mm in 5mm increments;
7.5 x 30mm to 100mm in 5mm increments;
8.5 x 35mm to 100mm in 5mm increments;
9.5 x 35 to 60mm in 5mm increments and 9.5 x 70mm to 100mm in 10mm increments;
10.5 &amp; 11.5 x 35mm to 55mm in 5mm increments.
Reduction: 5.5 &amp; 6.5 &amp; 7.5 x 30mm to 60mm in 5mm increments</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>233599</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV119</BillingCode><Name>Precept (MP Polyaxial Screw)</Name><Description>Polyaxial Screw</Description><Size>4.5-7.5mm diameter; 25-60mm length</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BF025</BillingCode><Name>Pedicle Screw</Name><Description>Polyaxial Screw</Description><Size>(5.5 - 7.5)mm x (35-55) mm</Size><SupplierCode>40171</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><ARTGs><ARTG>288089</ARTG></ARTGs><Note>Only to be reimbursed when used in patients with spinal tumours requiring regular magnetic resonance imaging (MRI) and/or computerised tomography (CT) imaging and or adjuvant radiotherapy and/or proton therapy.</Note><MinimumBenefit>996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF113</BillingCode><Name>Freedom Cannulated Pedicle Screws</Name><Description>Polyaxial Cannulated Pedicle Screws</Description><Size>Diameter 5.5 to 7.5mm, lengths from 35 to 55mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>203838</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ103</BillingCode><PriorBillingCodes><PriorBillingCode>SQ125</PriorBillingCode><PriorBillingCode>SQ125</PriorBillingCode></PriorBillingCodes><Name>NEO Pedicle Screw System - Polyaxial Screw</Name><Description>Pedicle Screw, Iliac Screw, Titanium Alloy</Description><Size>Diameter: 4.5mm - 8.0mm  Length: 25mm - 100mm</Size><SupplierCode>40483</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>289017</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH096</BillingCode><Name>RS8 Long Cannulated Polyaxial Reduction Screw </Name><Description>Cannulated Polyaxial Reduction Screw </Description><Size>Diameter : 5.0 - 7.5 mm   Length : 25 - 120 mm </Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>380418</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE593</BillingCode><Name>Newport MIS Extended Tab Polyaxial Screw</Name><Description>Cannulated Polaxial Pedicle Screw</Description><Size>4.75, 5.5, 6.5, 7.5, 8.5 and 9.5mm diameter
Lengths 30 - 60mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ063</BillingCode><Name>Invictus Favored Angle</Name><Description>Polyaxial Pedicle Screw, Cannulated , Open or Closed Tulip.  Ti Alloy</Description><Size>(6.5- 10.5)mm dia x (60-110)mm length</Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>398576</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ037</BillingCode><Name>Invictus Polyaxial Pedicle Screw</Name><Description>Cannulated, complete polyaxial screw, Ti Alloy</Description><Size>( 4.5 -10.5 )mm diameter  x  (20-130)mm length </Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>398576</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JA009</BillingCode><PriorBillingCodes><PriorBillingCode>OH356</PriorBillingCode></PriorBillingCodes><Name>Medyssey Spinal Fixation System</Name><Description>Cannulated Polyaxial Screw</Description><Size>4.0-8.5</Size><SupplierCode>40213</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>148858</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH080</BillingCode><Name>ZINA MIS Polyaxial Screw</Name><Description>ZINA MIS Spine System - Cannulated Polyaxial Screw</Description><Size> Diameter x Length ( mm )    4.5×25      4.5×30      4.5×35      4.5×40      4.5×45      4.5×50      4.5×55      4.5×60      4.5×65      5.0×30      5.0×35      5.0×40      5.0×45      5.0×50      5.0×55      5.0×60      5.0×65      5.5×30      5.5×35      5.5×40      5.5×45      5.5×50      5.5×55      5.5×60      5.5×65      6.0×30      6.0×35      6.0×40      6.0×45      6.0×50      6.0×55      6.0×60      6.0×65      6.5×30      6.5×35      6.5×40      6.5×45      6.5×50      6.5×55      6.5×60      6.5×65      7.0×30      7.0×35      7.0×40      7.0×45      7.0×50      7.0×55      7.0×60      7.0×65      7.5×30      7.5×35      7.5×40      7.5×45      7.5×50      7.5×55      7.5×60      7.5×65      8.0×30      8.0×35      8.0×40      8.0×45      8.0×50      8.0×55      8.0×60      8.0×65      8.5×30      8.5×35      8.5×40      8.5×45      8.5×50      8.5×55      8.5×60      8.5×65    </Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH578</BillingCode><Name>Venus Spinal Fixation Systems - Pedicle Screws - Poly Cannulated</Name><Description>Polyaxial Pedicle Screws - Cannulated</Description><Size>D 4.0-8.5mm L 25-100mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>316187</ARTG></ARTGs><MinimumBenefit>1085</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW759</BillingCode><PriorBillingCodes><PriorBillingCode>ER212</PriorBillingCode></PriorBillingCodes><Name>Mesa Polyaxial Cannulated Screw</Name><Description>Cannulated Pedicle Screw, polyaxial </Description><Size>Diameter: 5.5-6.5mm Length: 30-45mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108553</GroupID><Suffix>Integrated Locking Mechanism, Cannulated</Suffix><ARTGs><ARTG>154442</ARTG></ARTGs><MinimumBenefit>1105</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC014</BillingCode><PriorBillingCodes><PriorBillingCode>BF023</PriorBillingCode></PriorBillingCodes><Name>Redmond Screw</Name><Description>Variable or constrained self-drilling/self-tapping/oversized screw</Description><Size>Length: 12mm, 13mm, 14mm, 15mm, 16mm, 17mm, 18mm, 20mm   Diameter: 4.0m (self-drilling and self-tapping); 4.5mm (oversized)</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>211536</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HC025</BillingCode><Name>Screw</Name><Description>The Screw is used with the Perfect-C implant to obtain cortical fixation.</Description><Size>Length 14 - 18mm</Size><SupplierCode>40349</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>262490</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER576</BillingCode><PriorBillingCodes><PriorBillingCode>OF079</PriorBillingCode></PriorBillingCodes><Name>Cetra Bone Scews</Name><Description>Self tapping and self drilling bone screws</Description><Size>Diameter: 4mm-4.5mm  Length:10mm-20mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>195018</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER187</BillingCode><Name>SIGNUS Contact Thoracolumbar Plating System-Solid Screw</Name><Description>SIGNUS Contact Thoracolumbar Plating System-Solid Screw</Description><Size>Dia 6 mm, length 25-45 mm in 5 mm increments</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>216749</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW571</BillingCode><Name>LITe Plate System - Screw</Name><Description>Bone Screw</Description><Size>Dia 5mm-5.5mm, Length 22mm-60mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>277947</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV031</BillingCode><Name>Traverse Bolt</Name><Description>The Traverse system, of which the Traverse bolt is a component, is indicated for use as an adjunct to fusion via a lateral or anterolateral surgical approach, above the bifurcation of the great vessels, in the treatment of thoracic and thoracolumbar (T1-L</Description><Size>6.5mm x (25/30/35/40/45/50/55/60/65mm)
7.5mm x (25/30/35/40/45/50/55/60/65mm)</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>132467</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BF023</BillingCode><Name>Redmond Screw</Name><Description>Variable or constrained self-drilling/self-tapping/oversized screw</Description><Size>Length: 12mm, 13mm, 14mm, 15mm, 16mm, 17mm, 18mm, 20mm 
Diameter: 4.0m (self-drilling and self-tapping); 4.5mm (oversized)</Size><SupplierCode>40171</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>211536</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB042</BillingCode><Name>XTEND Fixed Angled Screws</Name><Description>Fixed Angled Bone Screws</Description><Size>4.2, 4.6 and 5.1mm diameter x 10mm - 20mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>190070</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY007</BillingCode><PriorBillingCodes><PriorBillingCode>EV008</PriorBillingCode></PriorBillingCodes><Name>Evolution ACDF Plate Bone Screw</Name><Description>Bone screw</Description><Size>4.0mm diameter 10-20mm, 4.5mm diameter 10-20mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>248233</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC611</BillingCode><Name>Vantage</Name><Description>Vantage Plates and Screws; Thoracic Screw</Description><Size>5.5-10.5 x 15-100mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU012</BillingCode><Name>Scarlet AC-T Screw, Reduction Screw</Name><Description>Screw, reduction screw</Description><Size>Diameter: 3mm, 3.5mm  Length: 12mm, 14mm, 16mm, 18mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>166154</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ512</BillingCode><Name>Skyline Cervical Plate System</Name><Description>Skyline anterior cervical screw, titanium</Description><Size>Self drilling 4.0 mm, 12-18mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>178040</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV163</BillingCode><Name>ACP Screw Fixed Angle</Name><Description>Fixed Angle, self drilling and self tapping</Description><Size>Diameter - 3.5mm to 4.0mm  Length - 11mm to 19mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>209198</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB069</BillingCode><Name>Aesculap Bone Screws</Name><Description>Titanium alloy</Description><Size>All sizes</Size><SupplierCode>40020</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>134538</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV169</BillingCode><Name>Modulus ALIF Bolt</Name><Description>Fixation bolt</Description><Size>Diameter: 5-6mm  Length: 15-30mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>132498</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV052</BillingCode><Name>Leverage LFS (Bone Screw)</Name><Description>The Leverage LFS, of which the bone screw is a component, is intended for use in the lower cervical and upper thoracic spine (C3 to T3) in laminoplasty procedures. Leverage LFS is used to hold allograft material in place in order to prevent the allograft </Description><Size>2.6/3mm x 5-8mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV039</BillingCode><Name>Halo Bone Screw</Name><Description>The Halo System, of which the Halo bone screw  is a component, is indicated for use via a lateral or anterolateral surgical approach above the bifurcation of the great vessels in the treatment of thoracic and thoracolumbar (T1-L5) spine instability or via</Description><Size>5.5mm x (20/22/24/26/28/30/32/34mm)
6.5mm x (20/22/24/26/28/30/32/34mm)</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>133401</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV034</BillingCode><Name>Traverse Bone Screw</Name><Description>The Traverse system, of which the Traverse bone screw is a component, is indicated for use as an adjunct to fusion via a lateral or anterolateral surgical approach, above the bifurcation of the great vessels, in the treatment of thoracic and thoracolumbar</Description><Size>5.5mm x (25/30/35/40/45/50/55/60/65mm)
6.5mm x (25/30/35/40/45/50/55/60/65mm)</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>132467</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI038</BillingCode><Name>Shark CP Locking Plate Screws</Name><Description>Self drilling screws, variable or fixed angle, titanium alloy. </Description><Size>4 - 4.5mm diameter, 12-22mm length </Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>345367</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV041</BillingCode><Name>Helix Mini bone screw</Name><Description>The Helix Mini system, of which the Helix Mini bone screw is a component, is intended for anterior screw fixation of the cervical spine. These implants have been designed to provide stabilisation as an adjunct to cervical fusion. Indications for the use o</Description><Size>4.0mm x (11/13/15mm)
4.5mm x (11/13/15mm)</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC018</BillingCode><PriorBillingCodes><PriorBillingCode>JA025</PriorBillingCode></PriorBillingCodes><Name>Centinel Spine</Name><Description>Stalif Bone Screws</Description><Size>D: 4.5 - 6.0mm  L: 25 - 40mm</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>196068</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU123</BillingCode><Name>MectaLIF Anterior Stand-Alone Screws</Name><Description>Bone Screws</Description><Size>Diameter: 5 &amp; 5.5mm  Length: 25, 30, 35 &amp; 40mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>222456</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ022</BillingCode><Name>Insignia Anterior Cervical Plating System </Name><Description>Screw,  fixed/variable angle,  Self-drilling/Self Tapping. Dual lead Ti Alloy</Description><Size>(4 - 4.5)mm diameter x (10- 18)mm length </Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>398575</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV070</BillingCode><Name>Helix-Revolution (screw)</Name><Description>Bone Screw</Description><Size>4 x 11-19mm; 4.5 x 11-19mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>133466</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU167</BillingCode><Name>MUST Mini Occipital Screws</Name><Description>Occipital Bone Screws</Description><Size>Ø 4 and 5 mm. L 6÷16 mm.</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>222456</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH618</BillingCode><Name>HumanTech - Hero Cervical Plate System - Screws</Name><Description>Cervical Plate Screws</Description><Size>D: 4.0mm L: 12 - 18mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>316053</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV107</BillingCode><Name>CoRoent (Screw)</Name><Description>Bone Screw</Description><Size>10-70mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>132498</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV023</BillingCode><Name>VuePoint Screw (occipital bone)</Name><Description>Bone Screw</Description><Size>4.5-5.0mm diameter, 6-14mm length</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>209198</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE660</BillingCode><Name>Shoreline ACS Bone Screws</Name><Description>Self drilling and self tapping bone screws</Description><Size>3.5 and 4.0mm diameters
10-18mm length</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>298002</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE793</BillingCode><Name>Admiral Cervical Plate</Name><Description>Admiral Cervical Plate Screws</Description><Size>4.0 &amp; 4.3mm Diameter, 10-18mm Lengths</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>275780</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ049</BillingCode><Name>Invictus Occipital Screw </Name><Description>Occipital Screw  Ti Alloy</Description><Size>(4.5 - 5.0)mm diameter x (6-16)mm length </Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>398576</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH083</BillingCode><Name>Katia Bone Screw</Name><Description>Cancellous Screw   Fixed or Variable Angle</Description><Size>4.0 mm &amp; 4.5 mm   10 mm - 17 mm</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH053</BillingCode><Name>Screw</Name><Description>Occipital Screw</Description><Size>6-12mm Length</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FC011</BillingCode><Name>Ally Bone Screw</Name><Description>For use with DTRAX Cages</Description><Size>One size</Size><SupplierCode>40377</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>290978</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JA019</BillingCode><PriorBillingCodes><PriorBillingCode>OH539</PriorBillingCode></PriorBillingCodes><Name>Spinal Plate Screws</Name><Description>Self-Drilling and Self-Tapping Plate Screws</Description><Size>Diam - 4.0 - 4.5mm
Length - 10 - 16mm</Size><SupplierCode>40213</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>289731</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW042</BillingCode><PriorBillingCodes><PriorBillingCode>BH108</PriorBillingCode></PriorBillingCodes><Name>Anterior Cervical Plate System</Name><Description>Titanium Cancellous Bone Screw</Description><Size>4 - 20mm</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>287242</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV162</BillingCode><Name>ACP Screw - Variable Angle</Name><Description>Variable Angle Bone Screw, self tapping and self drilling</Description><Size>Diameter - 3.5mm - 4.0mm  Length - 11mm to 19mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>209198</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER548</BillingCode><Name>Biedermann Motech MOSS Spinal Fixation System-Ti hook bone screw</Name><Description>Bone screw for hook</Description><Size>10.5mm - 13.5mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>337238</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER624</BillingCode><PriorBillingCodes><PriorBillingCode>OF070</PriorBillingCode></PriorBillingCodes><Name>SKYHAWK Bone Screws</Name><Description>Primary and Rescue Screws</Description><Size>Primary Screw: 5.5 mm diameter,  30mm- 60mm length (in 5mm increments)  Rescue Screw: 6.5 mm diameter, 30mm - 60mm length (in 5mm increments)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>206571</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER573</BillingCode><PriorBillingCodes><PriorBillingCode>OF013</PriorBillingCode></PriorBillingCodes><Name>Unity Lumbar Plate</Name><Description>Unity Bone Screw</Description><Size>6-7mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>195018</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM528</BillingCode><Name>Cervical Plate screws</Name><Description>Cervical Plate screws</Description><Size>4/4.5 mm diameter  12-20mm long</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>375813</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER351</BillingCode><Name>Ulrich Anterior Distraction Device (ADDplus)-Screws, Osmium, cancellous</Name><Description>Ulrich Anterior Distraction Device (ADDplus)-Screws, Osmium,cancellous</Description><Size>dia (4-4.5mm) x length (12-26mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>279702</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ052</BillingCode><Name>Aurora Screw</Name><Description>Bone Screw</Description><Size>24mm - 32mm</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>217032</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ014</BillingCode><Name>Aquila Plate System</Name><Description>Bone Screw</Description><Size>10-20mm</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>217032</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW781</BillingCode><PriorBillingCodes><PriorBillingCode>ER495</PriorBillingCode></PriorBillingCodes><Name>Ozark Cervical Plate System Screw</Name><Description>Screw, fixed or variable angle</Description><Size>(4-4.5)mm diameter x (10-26)mm length</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>290395</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER623</BillingCode><PriorBillingCodes><PriorBillingCode>OF060</PriorBillingCode></PriorBillingCodes><Name>Centurion Occipital Bone Screws and Rescue Screws</Name><Description>Occipital Bone screws with non-anodized heads</Description><Size>6mm – 14mm in 2mm increments</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>195012</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW393</BillingCode><Name>Xia Spine System</Name><Description>Bone Screw</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>279150</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER209</BillingCode><Name>SIGNUS  Cervical Plating Implant System-Bone Screw</Name><Description>SIGNUS  Cervical Plating Implant System-Cervical Bone Screw, fixed or variable angle; self drilling or self tapping</Description><Size>dia (2.7-4.3 mm)x length (12-22 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>216749</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER531</BillingCode><Name>E.SPINE System</Name><Description>TANIT SI Screw, non-sterile or sterile</Description><Size>Diameter: 7mm  Length: 40mm - 120mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>171952</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IB006</BillingCode><Name>STACC Cervical Screw</Name><Description>Cervical  Screw</Description><Size>4mm x 14,16 and 18mm</Size><SupplierCode>40009</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>188902</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW016</BillingCode><PriorBillingCodes><PriorBillingCode>ZI904</PriorBillingCode></PriorBillingCodes><Name>Virage Occipital Screws</Name><Description>Occipital Screws</Description><Size>4.5mm x 6-16mm, 5.25mm x 6-16mm</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>111775</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW409</BillingCode><Name>Aviator Anterior Cervical Plating System - Screw</Name><Description>Anterior Cervical Plate System - Screw</Description><Size>4 - 4.35mm diameter, 10 - 18mm length</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>278368</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY032</BillingCode><Name>Osimplant Bone Screw</Name><Description>Bone Screws</Description><Size>Lengths: 12 - 20 mm</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>287906</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW778</BillingCode><PriorBillingCodes><PriorBillingCode>ER491</PriorBillingCode></PriorBillingCodes><Name>Yukon OCT Spinal System</Name><Description>Occipital Screw</Description><Size>(4.5-5.75)mm dia  x (6-16)mm length</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>159828</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT020</BillingCode><Name>Unity+ Screws</Name><Description>Titanium bone screw</Description><Size>Diameter: 5mm, 6mm; Length: 30mm - 50mm.</Size><SupplierCode>40227</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>320878</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST914</BillingCode><Name>REFLEX  Anterior Cervical Plating System</Name><Description>Screw</Description><Size>Diameter 4 - 4.5mm lengths 10mm - 20mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>278368</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER622</BillingCode><PriorBillingCodes><PriorBillingCode>OF015</PriorBillingCode></PriorBillingCodes><Name>Blackstone Medical ACP Bone Screw</Name><Description>Titanium Alloy Bone Screw</Description><Size>4.1mm x 10mm - 18mm. 4.5mm x 10mm - 18mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>195012</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB016</BillingCode><Name>VIP Anterior Cervical Fixed Angle Screws</Name><Description>Anterior Cervical Fixed Angle Bone Screws</Description><Size>4.6mm - 5.1mm Diameter, 12mm - 20mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>190972</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI321</BillingCode><Name>Titan Spine Bone Screws</Name><Description>Titan Spine Bone Screws-Endoskeleton TCS/TAS, standard</Description><Size>dia (3.5-6.5mm) x length (13-35mm)</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>334300</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB014</BillingCode><Name>CITADEL® Anterior Fixed Angles Bone Screws</Name><Description>Fixed Angle screw</Description><Size>22mm - 57mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>190969</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC011</BillingCode><PriorBillingCodes><PriorBillingCode>SF150</PriorBillingCode></PriorBillingCodes><Name>XM Plate Screws</Name><Description>Dual thread screws for XM Plate</Description><Size>Diameter 5.5 &amp; 6.0mm, 20-32mm</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>203838</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE678</BillingCode><Name>icotec Anterior Cervical Plate System - Screw</Name><Description>Self-tapping bone screws</Description><Size>Diameter: 4mm and 4.25mm  Length: 13mm and 15mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>283853</ARTG></ARTGs><Note>Only to be reimbursed when used in patients with spinal tumours requiring regular magnetic resonance imaging (MRI) and/or computerised tomography (CT) imaging and or adjuvant radiotherapy and/or proton therapy.</Note><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GK004</BillingCode><Name>3D fusion cervical screw</Name><Description>The 3D Fusion cervical screw is part of the integral fixation mechanism for the 3D Fusion cervical System (also consisting of the 3D Fusion ACDF Cage and Locking Cap). These components are part of separate applications.    The 3D Fusion ACDF Bone Screws intend to immobilize and stabilize the 3D Fusion ACDF Cage and facilitate spinal fusion between two adjacent lumbar vertebral bodies. The 3D Fusion ACDF Bone Screws are self-drilling, dual thread bone screws designed to fit with integral fixation features of the 3D Fusion cervical system. The threaded locking cap system establishes an intrinsic link between the cage and the fixation screws, creating a rigid locked system, without distortion of the screw head     </Description><Size>Length = 12mm – 20mm  Diameter = 4.0mm &amp; 4.5mm   </Size><SupplierCode>40226</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>406173</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ053</BillingCode><Name>Aquila Plate System</Name><Description>Bone Screw</Description><Size>10mm-20mm</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>217032</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KB003</BillingCode><PriorBillingCodes><PriorBillingCode>SV063</PriorBillingCode></PriorBillingCodes><Name>STERISPINE™ Bone Screws with dual thread</Name><Description>Standard with dual thread</Description><Size>12mm x 3.5mm; 4.0 mm  13mm x 3.5mm; 4.0 mm  15mm x 3.5mm; 4.0 mm</Size><SupplierCode>40247</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>273286</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW741</BillingCode><PriorBillingCodes><PriorBillingCode>ER035</PriorBillingCode></PriorBillingCodes><Name>Caspian OC screw</Name><Description>The Caspian OC screw is used to fixate the Caspian OC plate to the occiput</Description><Size>4.5mm diameter. 6-16mm length in 1mm increments 5.25mm diameter. 6-16mm length in 1mm increments</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>159828</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GK003</BillingCode><Name>3D Fusion Lumbar Bone Screw</Name><Description>Stand-alone anterior lumbar interbody fusion (ALIF) fixation system: cage, screws and locking caps. The 3D Fusion lumbar bone screw is intended to be used as part of the integral screw fixation system and immobilize and stabilize the 3D fusion lumbar cage to facilitate spinal fusion between two adjacent vertebral bodies. The 3D fusion lumbar bone screws are self-drilling, self-tapping, dual thread bone screws designed to fit with threaded features of the 3D Fusion lumbar Cage to secure and stabilise the fusion cage in place with patient’s endplate anatomy.  </Description><Size>Length – 20mm, 25mm, 30mm, 35mm, 40mm, 45mm    Diameter – 5.5mm, 6mm   </Size><SupplierCode>40226</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>406173</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ061</BillingCode><Name>Aquila Spinal System</Name><Description>Bone Screw</Description><Size>10mm-20mm</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>398970</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ016</BillingCode><Name>Aurora Spine System</Name><Description>Bone screw</Description><Size>20mm - 36mm</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>217032</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM461</BillingCode><PriorBillingCodes><PriorBillingCode>NK017</PriorBillingCode></PriorBillingCodes><Name>Fixcet Spinal Facet Screw</Name><Description>Spinal facet screw</Description><Size>30mm - 45mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>160750</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW777</BillingCode><PriorBillingCodes><PriorBillingCode>ER490</PriorBillingCode></PriorBillingCodes><Name>Cayman United Bone Screw</Name><Description>Bone Screw</Description><Size>Length 20-60mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>290395</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW725</BillingCode><PriorBillingCodes><PriorBillingCode>ER016</PriorBillingCode></PriorBillingCodes><Name>Pyrenees Cervical Plate System - Screw</Name><Description>Self-drilling, self-tapping and bone reduction screws</Description><Size>(3.5 - 4.7)mm diam x (10-20)mm length</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>290395</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB160</BillingCode><Name>QUARTEX Occiptal Screws</Name><Description>Occipital Screws</Description><Size>Diameter 4.2mm-4.6mm and Length 6mm-16mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB017</BillingCode><Name>VIP Anterior Cervical Variable Angle Screws</Name><Description>Anterior Cervical Variable Bone Screws</Description><Size>4.6mm - 5.1mm Diameter, 12mm - 20mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>190972</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC006</BillingCode><Name>Alias Cage Screw</Name><Description>Alias Cage - Screw</Description><Size>12-17mm</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>268797</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU029</BillingCode><Name>Tryptik cervical screws</Name><Description>Tryptik cervical screws</Description><Size>Diameter: 4.0 and 4.5 mm;  Length: 12 to 18 mm  </Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>166154</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ514</BillingCode><Name>Skyline Cervical Plate System</Name><Description>Skyline anterior cervical screw.  Titanium</Description><Size>Self Tapping 4.3mm, 10-18mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>145290</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF162</BillingCode><Name>Nik-Alias Screw</Name><Description>Spine cage screw</Description><Size>20-40mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>246581</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB054</BillingCode><Name>CORRIDOR Fixation System Screw Non Cannulated Screws</Name><Description>Bone Screws</Description><Size>3.5mm - 4.5mm diameter, 30mm - 60mm Length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>190041</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC296</BillingCode><Name>Vertex Spinal System</Name><Description>Occipital Screws</Description><Size> 3.0 - 5.0 mm diameter, 4 - 30 mm length</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI477</BillingCode><PriorBillingCodes><PriorBillingCode>NK092</PriorBillingCode></PriorBillingCodes><Name>Occipital Plate Screws</Name><Description>Occipital Plate Screws</Description><Size>All sizes</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>295277</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU047</BillingCode><Name>Juliet Ti LL screw</Name><Description>Bone screw</Description><Size>Diameter: 5mm, 5.5mm  Length: 45mm, 50mm, 55mm, 60mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>338461</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB112</BillingCode><Name>ASSURE® Anterior Plate System – Screws</Name><Description>Standard - Self-drilling or Self Tapping 
Rigid – Self Drilling or Self Tapping</Description><Size>Diameter - 4.0 -4.5mm
Length – 10-20mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>190070</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ058</BillingCode><Name>Aurora Spinal System</Name><Description>Dual thread screw</Description><Size>5.5-6.0mm diameter x 24-28mm length</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>335884</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW732</BillingCode><PriorBillingCodes><PriorBillingCode>ER023</PriorBillingCode></PriorBillingCodes><Name>Cayman Thoracolumbar Plate System / Bone Screw</Name><Description>Self tapping screw, Ti</Description><Size>Length: 20mm to 60mm  Diameter:  5mm and 7mm, titanium</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>290395</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY020</BillingCode><Name>Slimplicity HP Screws</Name><Description>Screws</Description><Size>12mm - 18mm</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>287906</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ043</BillingCode><Name>Australis Spine System</Name><Description>Bone Screw</Description><Size>15mm-45mm</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>217033</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW773</BillingCode><PriorBillingCodes><PriorBillingCode>ER474</PriorBillingCode></PriorBillingCodes><Name>KEYS Supplemental Screw</Name><Description>Dual lead thread bone screw</Description><Size>5.5 - 6.0mm diameter, length 20-40mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>154442</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI481</BillingCode><PriorBillingCodes><PriorBillingCode>NK151</PriorBillingCode></PriorBillingCodes><Name>Fusion Cage Screws</Name><Description>Fusion Cage Screws</Description><Size>Multiple sizes to suit patient anatomy</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>295284</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI179</BillingCode><Name>Divergence Anterior Cervical Fusion Standalone System</Name><Description>Divergence anterior cervical fusion system Standalone screw</Description><Size>3.5mm x 9 -17mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY093</BillingCode><PriorBillingCodes><PriorBillingCode>EV035</PriorBillingCode></PriorBillingCodes><Name>ALIF cage screw</Name><Description>ALIF cage screw</Description><Size>Diameter 5.5 and 6mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>248233</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF105</BillingCode><Name>Alias Cage Screw</Name><Description>Alias Cage - Screw</Description><Size>12-17mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY092</BillingCode><PriorBillingCodes><PriorBillingCode>EV034</PriorBillingCode></PriorBillingCodes><Name>ACDF cage screw</Name><Description>ACDF cage screw</Description><Size>12-17mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>248233</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY006</BillingCode><PriorBillingCodes><PriorBillingCode>EV031</PriorBillingCode></PriorBillingCodes><Name>Evolution Altus Dual Thread Screw</Name><Description>Thoraco Lumbar Cage Dual Thread Bone Screw</Description><Size>diameter: 5.5 - 6mm  Length: 20 - 35mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>236041</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI170</BillingCode><Name>Divergence-L Anterior/Oblique Lumbar Fusion System </Name><Description>Self-drilling and Self-tapping Screws</Description><Size>20-40 mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI177</BillingCode><Name>Divergence Anterior Cervical Fusion Mini-Plate System</Name><Description>Divergence Miniplate Screw - Dual thread self drilling/self tapping screw</Description><Size>3.5mm x 9-24mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF168</BillingCode><Name>Spoiler ALIF Dual thread Screw</Name><Description>Dual Thread ALIF Cage Screw</Description><Size>5.5 and 6mm screws</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>246581</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF063</BillingCode><Name>Aurora Screw</Name><Description>Bone Screw</Description><Size>20-36mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>208160</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI178</BillingCode><Name>Divergence Anterior Cervical Fusion Standalone System</Name><Description>Divergence anterior cervical fusion system Standalone screw</Description><Size>4.0mm x 9 -17mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF156</BillingCode><Name>Advantage Dual Thread Screw</Name><Description>Dual thread ALIF cage screw</Description><Size>Diameter 5.5 and 6mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>246581</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI188</BillingCode><Name>PIVOX Oblique Lateral Spinal System</Name><Description>Bone Screw</Description><Size>Length: 20-50mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI057</BillingCode><Name>Atlantis Anterior Cervical Plate System - Bone Screw</Name><Description>Screws - Self-Tapping / Self-Drilling and Fixed / Variable Angle</Description><Size>Diameter: 4.0mm - 4.5mm; Length 11mm - 17mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI515</BillingCode><Name>Anteralign™ - Bone Screws</Name><Description>Titanium bone screw to be used with the Anteralign™ TL cage</Description><Size>Length: 20 mm - 50 mm; Width: 5 mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>422154</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF150</BillingCode><Name>XM Plate Screws</Name><Description>Dual thread screws for XM Plate</Description><Size>Diameter 5.5 &amp; 6.0mm, 20-32mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KN001</BillingCode><PriorBillingCodes><PriorBillingCode>JQ023</PriorBillingCode></PriorBillingCodes><Name>AMP Screw</Name><Description>Bone Screw; Ti Alloy</Description><Size>(5.5- 6.5)mm Diameter x (25 - 65)mm length </Size><SupplierCode>40401</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>398793</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV166</BillingCode><Name>3DP Interfixated ALIF Bolt</Name><Description>Bone Screw</Description><Size>5.0 - 6.0mm X 15-25mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>132498</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI041</BillingCode><Name>Fortilink®-SC Screws</Name><Description>Self drilling and self tapping bone screws</Description><Size>Diameter: 3.4-3.9mm  Length: 12-16mm</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>346071</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH706</BillingCode><Name>Ultio Laminoplasty Screw</Name><Description>Screw, self drilling, self tapping</Description><Size>4-20mm length</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>275605</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB004</BillingCode><Name>Bone Screws</Name><Description>Bone Screws</Description><Size>Diameter:2.0-4.35mm, Length: 6-18mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>214788</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV093</BillingCode><Name>Helix-T (Bone Screw)</Name><Description>Anterior cervical plate bone screw</Description><Size>4/4.5x11-19mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV044</BillingCode><Name>Helix Bone Screw</Name><Description>The Helix system, of which the Helix bone screw is a component, is intended for anterior screw fixation  of the cervical spine. These implants have been designed to provide stabilisation as an adjunct to cervical fusion. Indications for the use of this im</Description><Size>4.0mm x (11/13/15/17/19mm)
4.5mm x (13/15/17/19mm)</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>133401</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH747</BillingCode><PriorBillingCodes><PriorBillingCode>LM498</PriorBillingCode></PriorBillingCodes><Name>Sacral Screw</Name><Description>Sacral Screw</Description><Size>Diameter 6.5 &amp; 7.5mm  Length 30 - 70 mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>362890</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV096</BillingCode><Name>Brigade Bone Screw</Name><Description>Anterior plate bone screw</Description><Size>5.5/6.5 x 20-35mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI032</BillingCode><Name>Fortilink®-SA Screw</Name><Description>Self-drilling and self-tapping bone screws</Description><Size>Diameter 4.5mm-5.5mm  Length 20-35mm</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>346071</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY087</BillingCode><PriorBillingCodes><PriorBillingCode>DR032</PriorBillingCode></PriorBillingCodes><Name>Choice Spine Cervical Screw</Name><Description>Screw for cervical plate (Variable, Fixed &amp; Rescue)</Description><Size>4.0mm - 4.5mm x 10mm - 18mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>330080</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU015</BillingCode><Name>Tryptik 2 Screw</Name><Description>Self-tapping screws, self-drilling screws - variable and fixed angle</Description><Size>Diameter: 4.0mm, 4.5mm
Length: 12mm, 14mm, 16mm, 18mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>166154</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE628</BillingCode><Name>Zuma bone screw</Name><Description>Bone screw</Description><Size>5.5mm - 6.0mm x 20mm - 35mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>275780</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU136</BillingCode><Name>M.U.S.T Screws for Pedicle Hooks</Name><Description>Bone Screws</Description><Size>Ø 3,5; L 15 - 20 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>222456</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH087</BillingCode><Name>Ceplate Anterior Cervical System - Bone Screw </Name><Description>Screws - Self-Tapping / Self-Drilling and Fixed / Variable Angle</Description><Size>Diameter: 4.0mm - 4.5mm; Length 11mm - 17mm</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>366091</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW043</BillingCode><PriorBillingCodes><PriorBillingCode>ZI950</PriorBillingCode></PriorBillingCodes><Name>Timberline Lateral Fusion System</Name><Description>Bone Screws</Description><Size>30-60mm</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>287242</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU055</BillingCode><Name>Perla Posterior Occipito-Cervico-Thoracic fixation system - occipital screw</Name><Description>Occipital screw</Description><Size>Diameter: 4.5, 5 mm. Length: 6 - 16 mm.</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY299</BillingCode><Name>Spinal Fixation System – Screws</Name><Description>Vectra Screws - variable and fixed angle</Description><Size>Length 12-18 mm; Diameter 4.0, 4.5 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>293275</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB193</BillingCode><Name>PROVIDENCE Fixed Angle Screws</Name><Description>Fixed angled screws, self-drilling and self-tappiing</Description><Size>Length - 10mm to 26mm  Diameter - 4.2mm to 4.6mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>190070</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB033</BillingCode><Name>REVERE Bone Screw, Anterior Plate</Name><Description>Bone Screw</Description><Size>5.5mm - 7.5mm Diameter x 25mm - 50mm Length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY008</BillingCode><PriorBillingCodes><PriorBillingCode>EV011</PriorBillingCode></PriorBillingCodes><Name>Evolution ACDF Cage Bone Screw</Name><Description>Bone screw for fusion cages</Description><Size>4.0 diameter, 12-16mm; 4.5 diameter, 12-16mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>248233</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY065</BillingCode><PriorBillingCodes><PriorBillingCode>DR042</PriorBillingCode></PriorBillingCodes><Name>Bone Screws</Name><Description>Bone Screws</Description><Size>3-4mm, 12-14mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>330365</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JP005</BillingCode><PriorBillingCodes><PriorBillingCode>JA026</PriorBillingCode></PriorBillingCodes><Name>Stalif C</Name><Description>Stalif Screws</Description><Size>D: 4.0mm  L: 13 - 17mm</Size><SupplierCode>39934</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>196068</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY381</BillingCode><Name>Axon Occipital Fusion System</Name><Description>Occipital Screws 4.5mm / 5.0mm diameter
Titanium Alloy</Description><Size>Length 4 - 18mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>133401</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB107</BillingCode><Name>InterContinental HA Screws</Name><Description>HA Coated Bone Screws</Description><Size>5.5mm x 30mm - 60mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>190063</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ519</BillingCode><Name>AEGIS ALP</Name><Description>AEGIS ALP Bone Screws, Titanium</Description><Size>24-36mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>128257</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER188</BillingCode><Name>SIGNUS Contact Thoracolumbar Plating System-Expansion Screw</Name><Description>SIGNUS Contact Thoracolumbar Plating System-Expansion Screw</Description><Size>6 mm dia, 25-40 mm long in 5 mm increments</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Expansion Screw / Expansion Head Screw</Suffix><ARTGs><ARTG>216749</ARTG></ARTGs><MinimumBenefit>274</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER352</BillingCode><Name>Ulrich Anterior Distraction Device (ADDplus)-Screws, Osmium, expansion</Name><Description>Ulrich Anterior Distraction Device (ADDplus)-Screws, Osmium, expansion,  include bolt.</Description><Size>dia (4-5 mm) x length (12-18 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Expansion Screw / Expansion Head Screw</Suffix><ARTGs><ARTG>279702</ARTG></ARTGs><MinimumBenefit>274</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER163</BillingCode><Name>Signus Anterior Cervical Plate - Bone Screws</Name><Description>Provides stability in patients undergoing anterior cervical spine fusion procedures. It consists of a pre-contoured titanium plate, secured onto the spinal vertebrae by either fixed or variable angle colour coded screws. These screws have an integral lock</Description><Size>4.0-4.5mm diameter x 12-22mm length</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Expansion Screw / Expansion Head Screw</Suffix><ARTGs><ARTG>216749</ARTG></ARTGs><MinimumBenefit>274</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB121</BillingCode><Name>Assure-X Anterior Cervical Plate System - Screws</Name><Description>Variable Angle and Fixed Angle Self-drilling and Self-tapping Expansion Bone Screws</Description><Size>Diameter 4.2-4.6 mm, Length 10-20mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Expansion Screw / Expansion Head Screw</Suffix><ARTGs><ARTG>190070</ARTG></ARTGs><MinimumBenefit>274</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB116</BillingCode><Name>Unify Dynamic Anterior Cervical Plate System – Screws</Name><Description>Variable and fixed angle expanding titanium alloy screws</Description><Size>Diameter – 4.2mm and 4.6mm
Length – 10mm – 20mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Expansion Screw / Expansion Head Screw</Suffix><ARTGs><ARTG>190070</ARTG></ARTGs><MinimumBenefit>274</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV144</BillingCode><Name>Base (Screw)</Name><Description>Bone Screw</Description><Size>5.0-6.0mm diameter, 17.5-30mm length</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Expansion Screw / Expansion Head Screw</Suffix><ARTGs><ARTG>132498</ARTG></ARTGs><MinimumBenefit>274</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB158</BillingCode><Name>Aesculap Cervical System</Name><Description>Titanium with locking mechanism</Description><Size>Dia 4 - 4.5mm, length 10 - 28mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Expansion Screw / Expansion Head Screw</Suffix><ARTGs><ARTG>134538</ARTG></ARTGs><MinimumBenefit>274</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV106</BillingCode><Name>Decade Lateral Plate System (screw)</Name><Description>The Nuvasive Decade Lateral Plate System is indicated for use in the treatment of lumbar and lumbosacral (L1-S1) spine instability.</Description><Size>5.0-6.5mm diameter, length 15-75mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Expansion Screw / Expansion Head Screw</Suffix><ARTGs><ARTG>209200</ARTG></ARTGs><MinimumBenefit>274</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU132</BillingCode><Name>Mecta C Screws 2x</Name><Description>Expansion Head Screws</Description><Size>Diameter 4 - 4.5. Length 12 - 22 mm.</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Expansion Screw / Expansion Head Screw</Suffix><ARTGs><ARTG>222456</ARTG></ARTGs><MinimumBenefit>274</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU133</BillingCode><Name>Mecta C Screws 4x</Name><Description>Expansion Head Screws</Description><Size>Diameters 4 - 4.5. Length 12 - 22 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Expansion Screw / Expansion Head Screw</Suffix><ARTGs><ARTG>222456</ARTG></ARTGs><MinimumBenefit>274</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU131</BillingCode><Name>Mecta C Screws</Name><Description>Expansion Head Screws</Description><Size>Diameters 4 - 4.5. Length 12 - 22mm.</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Expansion Screw / Expansion Head Screw</Suffix><ARTGs><ARTG>222456</ARTG></ARTGs><MinimumBenefit>274</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH617</BillingCode><Name>HumanTech - Hero Cervical Plate System - Expansion Head Screws</Name><Description>Cervical Plate Expansion Head Screws</Description><Size>D: 4.0mm L: 12 - 22mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Expansion Screw / Expansion Head Screw</Suffix><ARTGs><ARTG>316053</ARTG></ARTGs><MinimumBenefit>274</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC008</BillingCode><PriorBillingCodes><PriorBillingCode>SF156</PriorBillingCode></PriorBillingCodes><Name>Advantage Dual Thread Screw</Name><Description>Dual thread ALIF cage screw</Description><Size>Diameter 5.5 and 6mm</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>246581</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH758</BillingCode><PriorBillingCodes><PriorBillingCode>LM423</PriorBillingCode></PriorBillingCodes><Name>Silex Bone Screw</Name><Description>Dual-Thread Sacroiliac Locking Screw</Description><Size>7mm x 30-70mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>228758</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH589</BillingCode><Name>Cervical Spine Truss System - Stand Alone  Starloc Screw</Name><Description>Starloc Screw</Description><Size>(3.5-3.85)mm diam x (12-16mm Length</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>252733</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI153</BillingCode><Name>ZEVO Anterior Cervical Plate System</Name><Description>Dual thread, self-drilling/self-tapping screw</Description><Size>Diameter: 3.5mm - 4.5mm; Length 10mm - 24mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC656</BillingCode><Name>Pyramid</Name><Description>Pyramid Bone Screws</Description><Size>6.5mm Diameter, 20 -60mm length in 5mm increments</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI176</BillingCode><Name>Divergence Anterior Cervical Fusion Mini-Plate System</Name><Description>Divergence Miniplate Screw - Dual thread self drilling/self tapping screw</Description><Size>4.0mm x 9-24mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY012</BillingCode><PriorBillingCodes><PriorBillingCode>EV027</PriorBillingCode></PriorBillingCodes><Name>Revolution Standalone ACDF bone screw</Name><Description>Anterior cervical fusion cage system Standalone screw</Description><Size>Diameter 4 - 4.5mm  Length 12 -17mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>236041</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC988</BillingCode><Name>Sovereign Spinal System - Screws</Name><Description>Sovereign Spinal System - Screws</Description><Size>20 - 35mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC613</BillingCode><Name>Vantage</Name><Description>Vantage Plates and Screws; ATL Screw</Description><Size>6.5 x 30-55mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY013</BillingCode><PriorBillingCodes><PriorBillingCode>EV022</PriorBillingCode></PriorBillingCodes><Name>Revolution ACDF Plate Screw</Name><Description>Anterior Cervical Bone Screws</Description><Size>Fixed and Variable Angle. Diameter 4 - 4.5mm. Length 10 - 20mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>236041</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB099</BillingCode><Name>CANOPY Laminoplasty System Screw</Name><Description>Bone and graft screw for Laminoplasty Plate</Description><Size>2.2mm - 3.0mm 
4mm - 12mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>219536</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK223</BillingCode><Name>Oasys-Occipito Cervico Thoracic System</Name><Description>Cortical Screws</Description><Size>Dia: 3.5mm x Length: 6mm - 24mm  Dia: 4.0mm x Length: 6mm - 54mm  Dia: 4.5mm x Length: 6mm - 16mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>279144</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM402</BillingCode><PriorBillingCodes><PriorBillingCode>NK007</PriorBillingCode></PriorBillingCodes><Name>Spider Cervical Plating System - Spider Screw</Name><Description>Titanium, Self Tapping and Self Drilling</Description><Size>4.0 - 4.25mm, lengths 12-16mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>159605</ARTG><ARTG>160750</ARTG><ARTG>170220</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER312</BillingCode><Name>Ulrich posterior OCT System (neon3)-Occipital Screws</Name><Description>Ulrich posterior OCT System (neon3)-Occipital screws, self tapping</Description><Size>dia (5-5.5 mm) x length (6-16 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>279706</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER572</BillingCode><PriorBillingCodes><PriorBillingCode>OF002</PriorBillingCode></PriorBillingCodes><Name>Azure Anterior Cervical Plate System</Name><Description>Bone Screws</Description><Size>4.0 &amp; 4.5mm diameter  12, 14, 16, 18mm length</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>195018</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM427</BillingCode><PriorBillingCodes><PriorBillingCode>NK103</PriorBillingCode></PriorBillingCodes><Name>Occipital Screws</Name><Description>Occipital Screws</Description><Size>Multiple sizes to suit patient anatomy</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>159605</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT009</BillingCode><Name>AXIS2 Screws</Name><Description>Cervical screws - self-tapping/self-drilling, fixed and variable angle</Description><Size>Diameter: 4.0mm, 4.5mm  Length: 12mm - 18mm</Size><SupplierCode>40227</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>320878</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER178</BillingCode><Name>SIGNUS DIPLOMAT DEFORMITY– Lamina Screw</Name><Description>DIPLOMAT DEFORMITY System – Lamina Screw</Description><Size>5.0;7.5;10.0 mm </Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>216751</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER374</BillingCode><Name>Ulrich Sacroiliac Joint Fixation Device</Name><Description>Ulrich Sacroiliac Joint Fixation Device-Bone Screw</Description><Size>dia (7.5-10 mm) x length (40-140 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Complex</Suffix><ARTGs><ARTG>279706</ARTG></ARTGs><MinimumBenefit>241</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC007</BillingCode><Name>Advantage Cage System, Screw</Name><Description>Cage Screw</Description><Size>4.5mm and 5mm</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Complex</Suffix><ARTGs><ARTG>268797</ARTG></ARTGs><MinimumBenefit>241</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW772</BillingCode><PriorBillingCodes><PriorBillingCode>ER473</PriorBillingCode></PriorBillingCodes><Name>KEYS Polyaxial Screw</Name><Description>Polyaxial screw</Description><Size>6.0 -7.0mm diameter, length 25-50mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Complex</Suffix><ARTGs><ARTG>154442</ARTG></ARTGs><MinimumBenefit>241</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE770</BillingCode><Name>NorthStar OCT</Name><Description>NorthStar OCT Occipital Screw  </Description><Size>4.0, 4.5mm Diameter  7-16mm Lengths  </Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ021</BillingCode><Name>Insignia Anterior Cervical Plating System</Name><Description>Screw,  fixed/variable angle,  Self-drilling/Self Tapping. single lead Ti Alloy</Description><Size>(4.0-4.5)mm diameter x (10-18)mm length </Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>398575</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER321</BillingCode><Name>Ulrich posterior OCT System (neon3)-Toggle</Name><Description>Ulrich posterior OCT System (neon3)-Toggle, incl. nut and washer</Description><Size>N/A</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Complex</Suffix><ARTGs><ARTG>279706</ARTG></ARTGs><MinimumBenefit>241</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC012</BillingCode><PriorBillingCodes><PriorBillingCode>BF014</PriorBillingCode></PriorBillingCodes><Name>Redmond Lumbar Cage System - Locking screw, closed</Name><Description>Titanium screw</Description><Size>Diameter: 5.5mm; Length: 15, 20, 25, 30, 35mm</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Closed</Suffix><ARTGs><ARTG>211536</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV099</BillingCode><Name>Archon Plate (Bone Screw)</Name><Description>The Archon system, of which the bone screw is a component, is intended for anterior screw fixation of the cervical spine. These implants have been designed to provide stabilisation as an adjunct to cervical fusion.</Description><Size>4/4.5 x 10-23mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Closed</Suffix><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC462</BillingCode><Name>Zephir</Name><Description>Cancellous Screw</Description><Size>13-17mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Closed</Suffix><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI483</BillingCode><PriorBillingCodes><PriorBillingCode>NK075</PriorBillingCode></PriorBillingCodes><Name>PASS Spinal System Screw</Name><Description>PASS Spinal System Closed Iliac Screw</Description><Size>all sizes</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Closed</Suffix><ARTGs><ARTG>295277</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY148</BillingCode><Name>Universal Spine System (USS)</Name><Description>Pedicle Hook Screw</Description><Size>Length 20- 40mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Closed</Suffix><ARTGs><ARTG>133401</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB053</BillingCode><Name>CORRIDOR Fixation System Screw Cannulated Screws</Name><Description>Bone Screws</Description><Size>3.5mm - 4.5 diameter. 3
0mm - 60mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>190041</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF100</BillingCode><Name>Advantage Cage System, Screw</Name><Description>Cage Screw</Description><Size>4.5mm and 5mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Complex</Suffix><ARTGs><ARTG>246581</ARTG></ARTGs><MinimumBenefit>241</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI320</BillingCode><Name>Titan Spine Bone Screws-locking</Name><Description>Titan Spine Endoskeleton TCS Bone Screws-locking</Description><Size>dia (3.5-3.8mm) x length (13-20mm)</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Complex</Suffix><ARTGs><ARTG>334300</ARTG></ARTGs><MinimumBenefit>241</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HC018</BillingCode><Name>KM Bone screw</Name><Description>Bone Screw</Description><Size>W:3.5-5.0mm  L:6-22mm</Size><SupplierCode>40349</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>201492</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FC012</BillingCode><Name>GL-DTRAX Bone Screw</Name><Description>Cortical screw</Description><Size>One Size</Size><SupplierCode>40377</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>290978</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW043</BillingCode><Name>WEGO Spinal Systems</Name><Description>Bone screws</Description><Size>All sizes</Size><SupplierCode>40252</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>330363</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC447</BillingCode><Name>UCSS</Name><Description>Cortical Screws </Description><Size>30 - 50mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC448</BillingCode><Name>UCSS</Name><Description>Cortical Lag Screws</Description><Size>36 - 50mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE653</BillingCode><Name>Vu aPOD Prime Bone Screw</Name><Description>Locking Bone Screw</Description><Size>6.0 and 6.5mm diameter
20, 25 and 30mm length</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>298002</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB059</BillingCode><Name>ZYFUSE Facet Fixation System Screw</Name><Description>Facet Screw</Description><Size>5.0 - 6.0mm diameter x 30 - 60mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>196053</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB058</BillingCode><Name>ZYFUSE Facet Fixation System Screw with washer</Name><Description>Facet Screw</Description><Size>5.0 - 6.0mm diameter x 30 - 60mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>196053</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC003</BillingCode><Name>WeCover Cervical System - Screw</Name><Description>Plate System - Screws</Description><Size>Self Drilling Screw Ø4.5 fixed angle 12mm - 22mm
Self Drilling Screw Ø4.5 variable angle 12mm - 22mm
Self Drilling Screw Ø4 fixed angle 12mm - 22mm
Self Drilling Screw Ø4 variable angle 12mm - 22mm
Self Tapping Screw Ø4.5 fixed angle 12mm - 22mm
Self Tapping Screw Ø4 fixed angle 12mm - 22mm
Self Tapping Screw Ø4 variable angle 12mm - 22mm</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>221268</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ121</BillingCode><PriorBillingCodes><PriorBillingCode>DZ088</PriorBillingCode></PriorBillingCodes><Name>CanAce Anterior Cervical Plating System</Name><Description>Spinal Fixation System - Screws</Description><Size>4.0mm / 4.5mm</Size><SupplierCode>40393</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>346438</ARTG><ARTG>346439</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC035</BillingCode><Name>Ulrich Anterior Cervical Plating System-Screws  </Name><Description>Plate Screws - Self Tapping, Self Drilling, Rescue</Description><Size>12-18mm</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>377912</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HC014</BillingCode><Name>Origin Screw</Name><Description>Origin Screw</Description><Size>6-26mm</Size><SupplierCode>40349</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>205325</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC019</BillingCode><PriorBillingCodes><PriorBillingCode>JA026</PriorBillingCode></PriorBillingCodes><Name>Stalif C</Name><Description>Stalif Screws</Description><Size>D: 4.0mm  L: 13 - 17mm</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>196068</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF170</BillingCode><Name>Hornet ALIF Screw</Name><Description>Hornet Screw</Description><Size>Multiple diameters and lengths</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Dual Thread</Suffix><ARTGs><ARTG>246581</ARTG></ARTGs><MinimumBenefit>401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU038</BillingCode><Name>Scarlet AL-T Bone Screw</Name><Description>Bone Screw</Description><Size>Diameter 5.0-5.5mm
Length 25-40mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>166154</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB011</BillingCode><Name>TRUSS® Thoracolumbar Fixed Angle Screws</Name><Description>Fixed Angle screw</Description><Size>5.5m and 6.5mm diameter x 22mm - 57mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>190063</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB145</BillingCode><Name>Coalition Anchor</Name><Description>Titanium Anchor for Coalition Spacer</Description><Size>12mm, 14mm and 15mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>190040</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BF011</BillingCode><Name>WinLoc Cervical Plate System - screw</Name><Description>Variable self drilling screw/self tapping screw/oversized screw, expandable screw</Description><Size>Length: 12mm, 14mm, 16mm, 18mm
Diameter:  4.0mm, 4.5mm</Size><SupplierCode>40171</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>218438</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB041</BillingCode><Name>XTEND Variable Angled Screws</Name><Description>Variable Angled Bone Screws</Description><Size>4.2, 4.6 and 5.1mm diameter x 10mm - 20mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>190070</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY478</BillingCode><Name>Uniplate ACP System</Name><Description>Rescue Screw</Description><Size>12-18mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>128257</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY479</BillingCode><Name>Uniplate ACP System</Name><Description>Primary Screw</Description><Size>12-18mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>97391</ARTG><ARTG>128257</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF169</BillingCode><Name>Wasp ACDF Screw</Name><Description>Wasp Cage - Screw</Description><Size>4.5 and 5mm diameter</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB013</BillingCode><Name>CITADEL® Anterior Variable Angled Bone Screws</Name><Description>Variable Angle screw</Description><Size>22m - 57mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>190969</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC310</BillingCode><Name>Centerpiece</Name><Description>TiMesh LP</Description><Size>Screw</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI462</BillingCode><Name>PASS LP System Screws</Name><Description>Sacral Screws, Iliosacral Screws</Description><Size>Diameter: 6.5mm - 8MM Length: 25mm - 95mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>295277</ARTG><ARTG>316001</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Description, Size</ChangeExplanation><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ138</BillingCode><Name>Evolution Spine EMERGE Plate System- Screws</Name><Description>Evolution Spine EMERGE Plate System- Screws, self-starting and self-drilling</Description><Size>diameter: 3.75-4.25 mm length: 10-26 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>445231</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH558</BillingCode><Name>Atlas (Anterior Odontoid Fixation System)</Name><Description>Cannulated Bone Screw</Description><Size>(4.0 - 4.5)mm diameter  x  (28-55)mm  length</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>275605</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB052</BillingCode><Name>ELLIPSE® Stabilization System Occipital Screw</Name><Description>Bone Screw</Description><Size>4.0mm to 4.5mm Diameter x 6mm - 16mm Length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY064</BillingCode><PriorBillingCodes><PriorBillingCode>DR041</PriorBillingCode></PriorBillingCodes><Name>Bone Screw </Name><Description>Bone screw, Dual Thread</Description><Size>Diameter (4.0mm); Length (20-35mm)</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>330365</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY009</BillingCode><PriorBillingCodes><PriorBillingCode>EV015</PriorBillingCode></PriorBillingCodes><Name>Evolution ALIF Cage Screw</Name><Description>ThoracoLumbar Cage Bone Screw</Description><Size>5.5mm Diameter, 20-35mm; 6.5mm Diameter, 20-35mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>248233</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI175</BillingCode><Name>Venture Screws</Name><Description>Self drilling and self tapping screws (fixed and variable angle)</Description><Size>4.0mm x 8mm - 21mm; 4.5mm x 8mm - 21mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB139</BillingCode><Name>Fortify® I-R Corpectomy Spacer System - Screws</Name><Description>Bone Screws, fixed or variable angles, self-tapping or self-drilling</Description><Size>4.2, 3.6, and 5.5mm diameter, 12-60mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>190055</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM462</BillingCode><PriorBillingCodes><PriorBillingCode>NK021</PriorBillingCode></PriorBillingCodes><Name>Fixcet Spinal Facet Screw</Name><Description>Spinal facet screw</Description><Size>25mm - 45mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><Suffix>Cannulated</Suffix><ARTGs><ARTG>160750</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB185</BillingCode><Name>Independence MIS Anchor</Name><Description>Lumbar anchor for use with the Independence Spacer</Description><Size>Diameter: 5.5mm  Length, 25mm, 27mm and 30mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>190071</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI498</BillingCode><Name>ZEVO Anterior Cervical Plate System</Name><Description>self-drilling/self-tapping screw</Description><Size>Diameter: 4.5mm; Length 13mm - 15mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB094</BillingCode><Name>PLYMOUTH Thoracolumbar Plate System Screw</Name><Description>Bone Screw</Description><Size>5.5mm - 6.5mm
22mm - 57mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>190063</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JP012</BillingCode><PriorBillingCodes><PriorBillingCode>JA025</PriorBillingCode></PriorBillingCodes><Name>Centinel Spine</Name><Description>Stalif Bone Screws</Description><Size>D: 4.5 - 6.0mm  L: 25 - 40mm</Size><SupplierCode>39934</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>196068</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI261</BillingCode><Name>Infinity Spinal System</Name><Description>Occipital Screws</Description><Size>Diameter 4.5 - 5.0mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB192</BillingCode><Name>PROVIDENCE Variable Angle Screws</Name><Description>Variable angled screws, self drilling and self tapping</Description><Size>Length -10mm to 26mm  Diameter - 4.2mm to 4.6mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>190070</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB010</BillingCode><Name>TRUSS® Thoracolumbar Variable Angle Screws</Name><Description>Variable Angle screw</Description><Size>5.5m and 6.5mm diameter x 22mm - 57mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>190063</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ513</BillingCode><Name>Skyline Cervical Plate System</Name><Description>Skyline anterior cervical screw. Titanium</Description><Size>Self tapping 3.8mm, 10-26mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>145290</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER459</BillingCode><Name>LnK Anterior Cervical Plate System/CastleLoc-P Anterior Cervical Plate System-Screw</Name><Description>LnK Anterior Cervical Plate System/CastleLoc-P Anterior Cervical Plate System-Screw, self tapping or self drilling; fixed or variable</Description><Size>dia (3.5-4.0mm) x length (12-24mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>286127</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY056</BillingCode><PriorBillingCodes><PriorBillingCode>DR039</PriorBillingCode></PriorBillingCodes><Name>Tesera Screws</Name><Description>Tesera Fusion Cage Screws</Description><Size>Dia. (3.5 - 5.0mm) x (12-35mm) Length </Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>354092</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY140</BillingCode><Name>AO/ASIF Spinal Implants</Name><Description>Locking Screws</Description><Size>Length 12 - 55mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>293275</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI501</BillingCode><Name>Centerpiece 2.0 – Bone Screw</Name><Description>Bone screws</Description><Size>Diameter (2.0mm-2.4mm); Length (3mm-9mm)  </Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107663</SubCategoryID><GroupID>108554</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>186</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BF008</BillingCode><Name>Smartloc Spinal Fixation System / Set Screw</Name><Description>Set screw for poyaxial pedicle screw</Description><Size>8mm diameter, 5mm height</Size><SupplierCode>40171</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>150778</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH452</BillingCode><Name>DSS Breaking Nut</Name><Description>The DSS Breaking Nut is a set screw that locks the DSS pedicle screw for final tightening. It is an integral part of the DSS pedicle screw system, is used every time and can not be used on its own.</Description><Size>One size only</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>151022</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV077</BillingCode><Name>X-CORE (Lock Screw)</Name><Description>Lock screw</Description><Size>Small and Large</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>132498</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI035</BillingCode><Name>HPS™ Set Screw</Name><Description>Set Screw</Description><Size>One size only</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>345870</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY035</BillingCode><Name>Reform MIS Set Screw</Name><Description>Set Screw</Description><Size>5.5</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>287905</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER664</BillingCode><Name>LnK AccelFix Spinal Fixation System-set screws</Name><Description>LnK AccelFix Spinal Fixation System set screws, star or hex type, Ti, sterile</Description><Size>Diameter: 8.7-9.7 mm  Height:     5.0-5.6 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>384815</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KB013</BillingCode><Name>AnyPlus and AnyPlus II Set Screw</Name><Description>Set Screw</Description><Size>One size only  </Size><SupplierCode>40247</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>353891</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK112</BillingCode><Name>XIA/Oasys Spine System</Name><Description>Buttress thread locking nut</Description><Size>3.5mm - 6mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>279144</ARTG><ARTG>279159</ARTG><ARTG>278581</ARTG><ARTG>279160</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KB004</BillingCode><PriorBillingCodes><PriorBillingCode>SV067</PriorBillingCode></PriorBillingCodes><Name>STERISPINE™ Set Screw</Name><Description>Sterile nut set screw or locking screw</Description><Size>One Size</Size><SupplierCode>40247</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>273286</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ024</BillingCode><Name>Centaur Set Screw, Centaur Screw System</Name><Description>Set Screw</Description><Size>Small, Standard and Large</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>217033</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER552</BillingCode><Name>Biedermann Motech MOSS Spinal Fixation System-Ti Lock Screw</Name><Description>Lock Screw  </Description><Size>Various sizes</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>337238</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM438</BillingCode><PriorBillingCodes><PriorBillingCode>NK119</PriorBillingCode></PriorBillingCodes><Name>Amendia Savannah T Pedicle Screw System-Set Screws</Name><Description>Pedicle Screw System-Set Screws</Description><Size>one size </Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>281992</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM509</BillingCode><Name>Break off set-screw</Name><Description>Break off set-screw</Description><Size>No size</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>366793</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER449</BillingCode><Name>LnK Spinal Fixation System/OpenLoc-L Spinal Fixation System-Set screws</Name><Description>LnK Spinal Fixation System/OpenLoc-L Spinal Fixation System-Set screws</Description><Size>dia (8.7-9.7mm) x height (5.0-5.6mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>286123</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER577</BillingCode><PriorBillingCodes><PriorBillingCode>OF016</PriorBillingCode></PriorBillingCodes><Name>Spinal Fixation System</Name><Description>Set Screw Spinal System</Description><Size>One size only</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>195012</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER514</BillingCode><PriorBillingCodes><PriorBillingCode>EU017</PriorBillingCode></PriorBillingCodes><Name>e.Spine locking screw</Name><Description>Titanium locking screw for e.Spine hooks and e.Spine pedicular screws</Description><Size>One size</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>171952</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KN002</BillingCode><PriorBillingCodes><PriorBillingCode>JQ024</PriorBillingCode></PriorBillingCodes><Name>AMP Plate Centre Screw</Name><Description>Cage locking Screw , Ti Alloy </Description><Size>10-20mm length </Size><SupplierCode>40401</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>398793</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY152</BillingCode><Name>Universal Spine System (USS)</Name><Description>Set Screw</Description><Size>Standard</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>133401</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI262</BillingCode><Name>Infinity Spinal System</Name><Description>Set screw</Description><Size>Standard, flat</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY090</BillingCode><PriorBillingCodes><PriorBillingCode>DR035</PriorBillingCode></PriorBillingCodes><Name>Z-Medicle Pedicle Screw System - Locking Screw</Name><Description>Z-Medicle Pedicle Screw System - Locking Screw</Description><Size>One Size</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>343676</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY078</BillingCode><PriorBillingCodes><PriorBillingCode>DR008</PriorBillingCode></PriorBillingCodes><Name>Life Spine Pedicle Screw System - Locking Cap</Name><Description>Life Spine Screw System (Nautilus, Avatar) - Locking Caps</Description><Size>One Size</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>321122</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW751</BillingCode><PriorBillingCodes><PriorBillingCode>ER213</PriorBillingCode></PriorBillingCodes><Name>K2M Spinal Systems Set Screws</Name><Description>Set Screw</Description><Size>Diameter: 5-9mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>293862</ARTG><ARTG>159828</ARTG><ARTG>154442</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER353</BillingCode><Name>Ulrich Anterior Distraction Device System (ADDplus)-Locking Screw</Name><Description>Ulrich Anterior Distraction Device System (ADDplus)-Locking Screw</Description><Size>one size</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>279702</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ062</BillingCode><Name>Centaur Spinal System</Name><Description>Setscrew</Description><Size>9mm-11.5mm</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>407189</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV001</BillingCode><Name>Everest</Name><Description>Breakoff Set Screw</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>154442</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM442</BillingCode><PriorBillingCodes><PriorBillingCode>NK057</PriorBillingCode></PriorBillingCodes><Name>Excella System Locking Cap</Name><Description>Excella Pedicle Screw System Locking Cap</Description><Size>one size</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>295225</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM414</BillingCode><PriorBillingCodes><PriorBillingCode>NK035</PriorBillingCode></PriorBillingCodes><Name>Certex Spinal Implant System Cap</Name><Description>Cap</Description><Size>One Size Only</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>160750</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU002</BillingCode><Name>Perla Posterior Cervico-Thoracic Fixation System - Set Screw</Name><Description>Set screws for Perla spinal fixation system: set screws, extended set screws, hexagonal set screws</Description><Size>One size only</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB147</BillingCode><Name>CAPITOL Locking Cap</Name><Description>Non-threading locking cap</Description><Size>One size only</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI468</BillingCode><PriorBillingCodes><PriorBillingCode>NK083</PriorBillingCode></PriorBillingCodes><Name>Locking Nut</Name><Description>Locking Nut</Description><Size>All sizes</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>295277</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY286</BillingCode><Name>USS llio-Sacral Fixation system</Name><Description>Locking Screw</Description><Size>one size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>133401</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB123</BillingCode><Name>CREO MIS Posterior Stabilization System - Locking Cap</Name><Description>Threaded Locking Cap</Description><Size>9mm diameter</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC615</BillingCode><Name>Vantage</Name><Description>Vantage Plates and Screws; Lock Nut</Description><Size>One Size Only</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN267</BillingCode><Name>SYMPHONY OCT System</Name><Description>Set screws and locking nut</Description><Size>One size</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>178040</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE762</BillingCode><Name>NorthStar OCT</Name><Description>NorthStar OCT Set Screw</Description><Size>One Size</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE666</BillingCode><Name>Mariner Set Screw</Name><Description>Set Screw</Description><Size>1 size</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW017</BillingCode><PriorBillingCodes><PriorBillingCode>ZI906</PriorBillingCode></PriorBillingCodes><Name>Virage Closure Top</Name><Description>Closure Top and dome nut</Description><Size>One Size</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>111775</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY440</BillingCode><Name>Synapse</Name><Description>Locking Screw</Description><Size>One size</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>293275</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY068</BillingCode><PriorBillingCodes><PriorBillingCode>DR050</PriorBillingCode></PriorBillingCodes><Name>Ulrich Medical Pedicle Screw System - Locking Screw</Name><Description>Ulrich Medical Pedicle Screw System - Locking Screw</Description><Size>One Size</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>365230</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU042</BillingCode><Name>Perla TL Posterior thoraco-lumbar fixation system - setscrew </Name><Description>Setscrew</Description><Size>one size</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY012</BillingCode><Name>Reform POCT Cap Screw</Name><Description>Cap Screw</Description><Size>One size only</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>287906</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER224</BillingCode><Name>SIGNUS Diplomat  Pedicle Screw System - Set Screw</Name><Description>SIGNUS Diplomat  Pedicle Screw System - Set Screw</Description><Size>dia 9.7mm x height 4.2mm </Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>216751</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM405</BillingCode><PriorBillingCodes><PriorBillingCode>NK010</PriorBillingCode></PriorBillingCodes><Name>Fortex Pedicle Screw Set Screw</Name><Description>Pedicle Screw Set</Description><Size>3.1mm height</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>159605</ARTG><ARTG>160750</ARTG><ARTG>170220</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BF017</BillingCode><Name>Redmond Lumbar Cage System - Locking Cap</Name><Description>Titanium locking cap</Description><Size>Diameter: 3mm; Length: 4mm or 6mm</Size><SupplierCode>40171</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>211536</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV022</BillingCode><Name>VuePoint screw (inner set)</Name><Description>Screw</Description><Size>Tulip &amp; Laminar Hook; 
Offset &amp; Occipital Connector; 
Parallel Rod Connector; 
Inline Rod Connector; 
Cross Connector</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>209198</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV032</BillingCode><Name>Traverse Lock Nut</Name><Description>The Traverse system, of which the Traverse lock nut  is a component, is indicated for use as an adjunct to fusion via a lateral or anterolateral surgical approach, above the bifurcation of the great vessels, in the treatment of thoracic and thoracolumbar </Description><Size>One Size</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>132467</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH456</BillingCode><Name>DSS Fusion Coupler Set Screw</Name><Description>The DSS Fusion Coupler set screw locks the telescoping fusion couplers rigidly in place. This set screw can only be used for this purpose, is used every case and can not be used for any other purpose.</Description><Size>DIA700-04 for 20mm - 22mm fusion coupler
DIA70022-04 for 22mm - 25mm / 25mm - 31mm / 31mm - 43mm fusion couplers</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>151022</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB230</BillingCode><Name>Aesculap Spinal System</Name><Description>Set Screw - titanium</Description><Size>All sizes</Size><SupplierCode>40020</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>134538</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH060</BillingCode><Name>Break off set screw and/or screw nut</Name><Description>Break off set screw, screw nut</Description><Size>5.5mm</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW028</BillingCode><Name>WEGO Spinal Systems </Name><Description>Set screws </Description><Size>All sizes</Size><SupplierCode>40252</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>330363</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH092</BillingCode><Name>Set Screw </Name><Description>Set Screw </Description><Size>Diameter : 9.5 mm &amp; 10 mm   Length : 4.5 mm - 9.3 mm </Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>380418</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE661</BillingCode><Name>Shoreline ACS Locking Cover</Name><Description>Locking cover for fixation of bone screws</Description><Size>5-12mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>298002</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH098</BillingCode><Name>RS8 Long Set Screw </Name><Description>RS8 Long Set Screw </Description><Size>Diameter : 9.5 mm / 10 mm   Length : 4.5 mm / 5.0 mm / 9.3 mm </Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>380418</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ042</BillingCode><Name>Invictus Set Screw </Name><Description>Locking Set Screw  Ti Alloy</Description><Size>3.5mm - 6.5mm  polyaxial screw set screws, open or closed</Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>398576</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB038</BillingCode><Name>DPS Spine System  Single Locking Nut</Name><Description>Locking nut for pedicle screw.</Description><Size>One size</Size><SupplierCode>40026</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>214788</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV113</BillingCode><Name>Reline (Lock Screw)</Name><Description>Lock Screw</Description><Size>Open or Closed</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI011</BillingCode><Name>Streamline TL/Streamline MIS - Set Screw</Name><Description>Set Screw for Locking Streamline TL polyaxial and fixed pedicle screws, offset connectors and parallel connectors and Streamline MIS Cannulated Polyaxial Screws</Description><Size>one size</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>233599</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ524</BillingCode><Name>VIPER Spine System</Name><Description>Viper Single Innie Set Screw</Description><Size>One size</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>178040</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ647</BillingCode><Name>Expedium Spine System</Name><Description>EXPEDIUM Dual Innie Setscrew and Correction Key</Description><Size>5.5-6.35</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>178040</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY107</BillingCode><Name>Carbon Fibre Cages</Name><Description>Stackable Cage Titanium Interface Screw Nuts</Description><Size>One size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>128257</ARTG><ARTG>128255</ARTG><ARTG>98094</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI459</BillingCode><Name>PASS Polyaxial Spine System</Name><Description>Breakaway Nut, Break off set screw, Revision Post and Nut Set Screw</Description><Size>One size</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>295277</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY039</BillingCode><PriorBillingCodes><PriorBillingCode>DE538</PriorBillingCode></PriorBillingCodes><Name>Jazz Claw Posterior Fixation System (Set Screw)</Name><Description>Set Screw</Description><Size>one size</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>200830</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU019</BillingCode><Name>Romeo 2/Romeo 2 MIS Posterior Thoraco-lumbar Fixation System - Set Screw</Name><Description>Set screw</Description><Size>One size only</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>198720</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ915</BillingCode><Name>Expedium Spine System</Name><Description>Si and Unitised Screw Set</Description><Size>4.35 -7.5mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>178040</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB154</BillingCode><Name>QUARTEX Locking Cap</Name><Description>Threaded locking cap</Description><Size>One size only</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER628</BillingCode><PriorBillingCodes><PriorBillingCode>OF071</PriorBillingCode></PriorBillingCodes><Name>SKYHAWK Set Screw</Name><Description>Set Screw for SKYHAWK Lateral Interbody Fusion System</Description><Size>One size only</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>206571</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER408</BillingCode><Name>LnK MIS Spinal System/PathLoc-L  MIS Spinal System-Set Screw</Name><Description>LnK MIS Spinal System/PathLoc-L MIS Spinal System-Set Screw</Description><Size>dia 9.7mm x height 5.6mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>286124</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV061</BillingCode><Name>Armada (Lock Screw)</Name><Description>Lock screw</Description><Size>One Size</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV085</BillingCode><Name>Precept (Lock Screw)</Name><Description>Lock Screw</Description><Size>one size</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI044</BillingCode><Name>HPS™ 2.0 Set Screw</Name><Description>Set Screw</Description><Size>One size only</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>345870</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH711</BillingCode><Name>Athena Nut</Name><Description>Buttress Locking Cap for poly axial tulip</Description><Size>Standard - one size only</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>337150</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH749</BillingCode><PriorBillingCodes><PriorBillingCode>LM496</PriorBillingCode></PriorBillingCodes><Name>Nut for Screw or connector</Name><Description>Nut for screw or connector</Description><Size>one size for each type</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>362890</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BF027</BillingCode><Name>Locking Element</Name><Description>Locking Element for Screws and Connectors</Description><Size>std or 45 degree</Size><SupplierCode>40171</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>288089</ARTG></ARTGs><Note>Only to be reimbursed when used in patients with spinal tumours requiring regular magnetic resonance imaging (MRI) and/or computerised tomography (CT) imaging and or adjuvant radiotherapy and/or proton therapy.</Note><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC394</BillingCode><Name>CD Horizon</Name><Description>Set screw</Description><Size>Each in one size</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC504</BillingCode><Name>CD Horizon</Name><Description>Breakoff Set Screw</Description><Size>25 - 55mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY186</BillingCode><Name>Posterior Cervical System</Name><Description>Nut</Description><Size>One size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>133919</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY010</BillingCode><Name>Katana Setscrew</Name><Description>The Katana Pedicle Screw System is intended to provide immobilization and stabilisation of spinal segments in skeletally mature patients, as an adjunct to fusion in the thoracic, lumbar and sacral spine.</Description><Size>standard</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>396083</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI522</BillingCode><Name>CD Horizon™ ModuLeX™ 5.5 Spinal System - Set Screw </Name><Description>Set Screw</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>422155</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY383</BillingCode><Name>Synmesh</Name><Description>Locking Screw, Low Profile, For Synmesh End Rings</Description><Size>Small, Large</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>133401</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY100</BillingCode><PriorBillingCodes><PriorBillingCode>JG012</PriorBillingCode></PriorBillingCodes><Name>VENTOTENE Set Screw</Name><Description>Standard Cannulated</Description><Size>9.8mm diameter</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>397231</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC399</BillingCode><Name>TSRH Spinal Implant System</Name><Description>3D - Nut, Eyebolt locknot, locknut 1/2 inch, locking screws, double hex, flush break, universal breakoff</Description><Size>Each in one size</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC667</BillingCode><Name>SiLo</Name><Description>Set Screw</Description><Size>One Size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC674</BillingCode><Name>CD HORIZON Spinal System - Set Screw</Name><Description>Set Screw</Description><Size>3.5mm - 6.35mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC546</BillingCode><Name>Vertex Spinal System</Name><Description>Set screw</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC609</BillingCode><Name>CD Horizon Spinal System</Name><Description>Percutaneous Set Screw</Description><Size>4.5 to 6.35mm dia</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF107</BillingCode><Name>Freedom Set Screw</Name><Description>Freedom Set Screw</Description><Size>5.5mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>203838</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB190</BillingCode><Name>CREO DLX Threaded Locking Cap</Name><Description>Threaded Locking Cap</Description><Size>One Size Only</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VB008</BillingCode><Name>Lumfix Set Screw</Name><Description>Std or Saddle </Description><Size>9.9 mm outer diameter , 5.5 or 6mm rod  </Size><SupplierCode>40229</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>327225</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ656</BillingCode><Name>SI Set Screw - Expedium Anterior Spine System</Name><Description>Single Innie Set Screw - Titanium</Description><Size>one size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>97391</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF172</BillingCode><Name>Freedom Posterior Set Screw</Name><Description>Freedom Posterior Set Screw</Description><Size>Various</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>203838</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY308</BillingCode><Name>Axon Spinal System</Name><Description>Locking Set screw</Description><Size>One size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>133401</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ942</BillingCode><Name>Moss Miami Spinal System</Name><Description>Inner and outer screw, nuts and set screws</Description><Size>3 - 6.5mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>128257</ARTG><ARTG>145010</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB023</BillingCode><Name>REVERE Locking Cap</Name><Description>Locking Cap</Description><Size>4.5, 5.5 and 6.35mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY011</BillingCode><PriorBillingCodes><PriorBillingCode>EV040</PriorBillingCode></PriorBillingCodes><Name>BA Posterior Set Screw</Name><Description>BA Posterior Set Screw</Description><Size>Various</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>329318</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU107</BillingCode><Name>M.U.S.T. Set Screw</Name><Description>Set Screw</Description><Size>One Size</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>196964</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC016</BillingCode><PriorBillingCodes><PriorBillingCode>BF017</PriorBillingCode></PriorBillingCodes><Name>Redmond Lumbar Cage System - Locking Cap</Name><Description>Titanium locking cap</Description><Size>Diameter: 3mm; Length: 4mm or 6mm</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>211536</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH581</BillingCode><Name>Venus Spinal Fixation System - Nut/Set Screw/Locking Screw</Name><Description>Venus - Nut/Set Screw/Locking Screw</Description><Size>Various Sizes</Size><SupplierCode>40113</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>316187</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW001</BillingCode><Name>WEGO Spinal Systems </Name><Description>Break off set screw </Description><Size>5.5 mm</Size><SupplierCode>40252</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>330363</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ102</BillingCode><Name>RESPONSE Spine System – Set Screw</Name><Description>Set Screw</Description><Size>Small, Large</Size><SupplierCode>40325</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>233454</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH574</BillingCode><Name>Samson - Expandable Vertebral Body Replacement - End Plate Screw</Name><Description>End Plate Screw</Description><Size>One Size</Size><SupplierCode>40113</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>316057</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HC027</BillingCode><Name>G2S Nut</Name><Description>locking nut</Description><Size>Nut</Size><SupplierCode>40349</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>274075</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE671</BillingCode><Name>icotec Pedicle System Set Screw</Name><Description>Set screw</Description><Size>one size only</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>283854</ARTG><ARTG>283853</ARTG></ARTGs><Note>Only to be reimbursed when used in patients with spinal tumours requiring regular magnetic resonance imaging (MRI) and/or computerised tomography (CT) imaging and or adjuvant radiotherapy and/or proton therapy.</Note><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IB003</BillingCode><Name>Vertefix II Locking Screw</Name><Description>Set/Locking Screw</Description><Size>One size only</Size><SupplierCode>40009</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>188902</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW018</BillingCode><PriorBillingCodes><PriorBillingCode>ZI995</PriorBillingCode></PriorBillingCodes><Name>Vitality Spine System - Set Screw</Name><Description>SET SCREW</Description><Size>One size only</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>287242</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ122</BillingCode><Name>RESPONSE Spine System - BandLoc Screw</Name><Description>Set Screw</Description><Size>Large</Size><SupplierCode>40325</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>233454</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HC032</BillingCode><Name>SAXXO NUT</Name><Description>NUT</Description><Size>NUT 9.1 ,NUT 9.8 </Size><SupplierCode>40349</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>331780</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU162</BillingCode><Name>MUST MINI Screws</Name><Description>Set Screw / Locking Screw</Description><Size>Varius</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>291175</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JA016</BillingCode><PriorBillingCodes><PriorBillingCode>OH351</PriorBillingCode></PriorBillingCodes><Name>Medyssey set screw</Name><Description>Set screw</Description><Size>9.5 - 10mm</Size><SupplierCode>40213</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>148858</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ145</BillingCode><Name>Evolution Spine Whistler Modular Pedicle Screw System-Locking Cap</Name><Description>Evolution Spine Whistler Modular Pedicle Screw System-Locking Cap, solid or cannulated</Description><Size>for 5.5 or 6.0 mm rods</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>445290</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER335</BillingCode><Name>Ulrich Pedicle Screw System-Locking screws</Name><Description>Ulrich Pedicle Screw System (cosmicMIA, uCentum, flamenco)-Locking screws</Description><Size>various</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>279706</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY174</BillingCode><Name>Universal Spine System (USS)</Name><Description>Nut</Description><Size>Standard</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>293275</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER437</BillingCode><Name>LnK Posterior Cervical Fixation System/CastleLoc-S Posterior Cervical Fixation System-Set screw</Name><Description>LnK Posterior Cervical Fixation System/CastleLoc-S Posterior Cervical Fixation System-Set screw</Description><Size>Dia (6-7 mm) x Height (3.6-3.7 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>286122</ARTG><ARTG>384816</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER189</BillingCode><Name>SIGNUS Contact Thoracolumbar Plating System-Locking Crown</Name><Description>SIGNUS Contact Thoracolumbar Plating System-Locking Crown</Description><Size>M12 x 0.75 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>216749</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER627</BillingCode><PriorBillingCodes><PriorBillingCode>OF061</PriorBillingCode></PriorBillingCodes><Name>Centurion Set Screw</Name><Description>Universal set screw</Description><Size>One size only</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>195012</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY003</BillingCode><Name>Reform Locking Cap</Name><Description>Locking Cap</Description><Size>3.5mm to 5.5mm</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>287905</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER313</BillingCode><Name>Ulrich posterior OCT System (neon3)-Locking Screw</Name><Description>Ulrich posterior OCT System (neon3)-Locking Screw, nut</Description><Size>N/A</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>279706</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH486</BillingCode><Name>DSS HP Spinal System - Set Screw</Name><Description>Set Screw</Description><Size>one size</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>186733</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KB005</BillingCode><PriorBillingCodes><PriorBillingCode>SV072</PriorBillingCode></PriorBillingCodes><Name>Set Screw</Name><Description>Set screw with cross connector kit</Description><Size>One Size</Size><SupplierCode>40247</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>273286</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER181</BillingCode><Name>SIGNUS DIPLOMAT DEFORMITY – Shear Nut</Name><Description>DIPLOMAT DEFORMITY – Shear Nut</Description><Size>N/A</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>216751</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY796</BillingCode><Name>Vertebral Body Replacement System</Name><Description>Endplate Screw</Description><Size>One Size</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>133398</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ916</BillingCode><Name>Mountaineer Spinal System</Name><Description>Inner screws and out nuts</Description><Size>One size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>128255</ARTG><ARTG>145290</ARTG><ARTG>128257</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HC017</BillingCode><Name>KM Nut</Name><Description>Nut</Description><Size>Various sizes</Size><SupplierCode>40349</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>201492</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ106</BillingCode><PriorBillingCodes><PriorBillingCode>SQ127</PriorBillingCode><PriorBillingCode>SQ127</PriorBillingCode></PriorBillingCodes><Name>NEO Pedicle Screw System - Set Screw</Name><Description>Titanium Alloy</Description><Size>Diameter: 5.0mm - 7.0mm</Size><SupplierCode>40483</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>289017</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT013</BillingCode><Name>SOLFIX2 Set Screw</Name><Description>Set screw</Description><Size>One size</Size><SupplierCode>40227</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>320880</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER141</BillingCode><Name>Signus Pedicle Screw System-Set Screw</Name><Description>Set Screw - as part of Signus Pedicle Screw System Construct</Description><Size>N/A</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>216751</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER287</BillingCode><Name>Premia Spine Versalink Fixation System-Ring Nut/set screws</Name><Description>Premia Spine Versalink Fixation System-Nut/set screws</Description><Size>N/A</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108555</GroupID><ARTGs><ARTG>267145</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI484</BillingCode><PriorBillingCodes><PriorBillingCode>NK073</PriorBillingCode></PriorBillingCodes><Name>PASS Pedicle Spine System Connector</Name><Description>PASS Pedicle Spine System offset connector</Description><Size>5.5 &amp; 6.0mm rod</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108556</GroupID><ARTGs><ARTG>295277</ARTG></ARTGs><MinimumBenefit>179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB214</BillingCode><Name>CREO® Side Loading Locking Sleeve</Name><Description>Integrated nut and sleeve</Description><Size>5.5-6.0mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108556</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW445</BillingCode><Name>Oasys-Occipito Cervico Thoracic System (Saddle)</Name><Description>Saddle Connector</Description><Size>one size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108556</GroupID><ARTGs><ARTG>279144</ARTG></ARTGs><MinimumBenefit>179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE699</BillingCode><Name>NorthStar / Sierra OCT Occipital Clamp</Name><Description>Occipital Clip / Eyelet</Description><Size>One Size</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108556</GroupID><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY151</BillingCode><Name>Universal Spine System (USS)</Name><Description>Sleeve</Description><Size>5 – 6 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108556</GroupID><ARTGs><ARTG>293275</ARTG></ARTGs><MinimumBenefit>179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN260</BillingCode><Name>SYMPHONY OCT System</Name><Description>Cross connector head adapter</Description><Size>One size</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108556</GroupID><ARTGs><ARTG>178040</ARTG></ARTGs><MinimumBenefit>179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY057</BillingCode><PriorBillingCodes><PriorBillingCode>DR038</PriorBillingCode></PriorBillingCodes><Name>Tesera Locking Devices</Name><Description>Locking Cap/Locking Plate for Tesera Cage Systems</Description><Size>Single size per locking mechanism</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108557</GroupID><ARTGs><ARTG>354092</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Description, Size</ChangeExplanation><MinimumBenefit>391</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY701</BillingCode><Name>Spinal Fixation System</Name><Description>Cap</Description><Size>One size</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108557</GroupID><ARTGs><ARTG>293275</ARTG><ARTG>293276</ARTG></ARTGs><MinimumBenefit>391</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER578</BillingCode><PriorBillingCodes><PriorBillingCode>OF020</PriorBillingCode></PriorBillingCodes><Name>Unity Lumbar Plate</Name><Description>Unity Cover Plate</Description><Size>17-28mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108557</GroupID><ARTGs><ARTG>195018</ARTG></ARTGs><MinimumBenefit>391</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI514</BillingCode><Name>Anteralign™ - Mini Plate</Name><Description>Standard and offset miniplate with titanium bolt to be used with the Anteralign™ TL cage</Description><Size>Width: 12 mm; Length: 20 mm, 23 mm; Offset: 0 mm, 2.5 mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108557</GroupID><ARTGs><ARTG>422151</ARTG></ARTGs><MinimumBenefit>391</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH073</BillingCode><Name>CARMEN Anterior Cervical Cover Plate ( One plate with three screws ) </Name><Description>The CARMEN plate and bone screw components are intended for anterior inter-body screw fixation from C2-TI. The plate and bone screw components are indicated for use together with the Carmen Anterior Cage in the temporary stabilization of the anterior spine during the development of spinal fusions in patients with: 1) degenerative disc disease (as defined by neck pain of discogenic origin with degeneration of the disc confirmed by patient history and radio-graphic studies), 2) trauma (including fractures), 3) tumors, 4) deformity (defined as kyphosis, lordosis, or scoliosis), 5) pseudoarthrosis, and/or 6) failed previous fusions.</Description><Size>Plate Size : Length : 18 mm - 20 mm;  Width : 13.6 mm - 14.2 mm     Bone Screw Size : Diameter : 3.5 mm ; 4.0 mm;  Length :  12 mm - 17 mm</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108557</GroupID><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>391</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ039</BillingCode><Name>Invictus OCT Tulip</Name><Description>Occipital Plate Tulip,  Ti Alloy</Description><Size>Single or Dual Tulip </Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108557</GroupID><ARTGs><ARTG>398576</ARTG></ARTGs><MinimumBenefit>391</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW044</BillingCode><PriorBillingCodes><PriorBillingCode>ZI952</PriorBillingCode></PriorBillingCodes><Name>Timberline Lateral Fusion System</Name><Description>Cover Plate</Description><Size>2 and 4 hole</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108557</GroupID><ARTGs><ARTG>287242</ARTG></ARTGs><MinimumBenefit>391</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE632</BillingCode><Name>Zuma Spinal System Locking Cover</Name><Description>Locking Cover</Description><Size>10mm - 20mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108557</GroupID><ARTGs><ARTG>275780</ARTG></ARTGs><MinimumBenefit>391</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER340</BillingCode><Name>Ulrich Pedicle Screw System-Locking cap</Name><Description>Ulrich Pedicle Screw System (uCentum/uBase)-Locking cap assembly (dual innie screw, nut, washer)</Description><Size>one size</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108558</GroupID><ARTGs><ARTG>279706</ARTG></ARTGs><MinimumBenefit>560</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY448</BillingCode><Name>Spinal Fixation System</Name><Description>Locking Cap</Description><Size>One Size</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108558</GroupID><ARTGs><ARTG>133401</ARTG><ARTG>293275</ARTG><ARTG>293276</ARTG></ARTGs><MinimumBenefit>560</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB061</BillingCode><Name>REVLOK Fenestrated Screw System Locking Cap</Name><Description>Locking Cap</Description><Size>One Size</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108558</GroupID><ARTGs><ARTG>196054</ARTG></ARTGs><MinimumBenefit>560</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB088</BillingCode><Name>CREO Stabilization System Locking Cap</Name><Description>The CREO Stabilization System implants are non-cervical spinal fixation devices intended for posterior pedicle screw fixation, posterior hook fixation or anterolateral fixation.</Description><Size>4.75 and 5.5</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108558</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><Note>The Prostheses List (PL) billing code does not cover the use of the device for vertebral body tethering (VBT) for the management of adolescent idiopathic scoliosis (AIS).</Note><MinimumBenefit>560</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB039</BillingCode><Name>DPS Spine System  Double Locking Cap and Nut</Name><Description>Locking Cap and Nut</Description><Size>One size only</Size><SupplierCode>40026</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108558</GroupID><ARTGs><ARTG>214788</ARTG></ARTGs><MinimumBenefit>560</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN276</BillingCode><Name>SYMPHONY OCT System</Name><Description>Multipoint System - Adapter Connector Plate and Screws</Description><Size>Standard, Angled, Left, Right, Long; 6-16mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108558</GroupID><ARTGs><ARTG>178040</ARTG></ARTGs><MinimumBenefit>560</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KN003</BillingCode><PriorBillingCodes><PriorBillingCode>JQ025</PriorBillingCode></PriorBillingCodes><Name>AMP Plate </Name><Description>Antmigration Plate for ATEC Cages,  Ti Alloy</Description><Size>Size 4 to 23  - (19.35 to 36.3)mm length, 1 or 2 screw hole. </Size><SupplierCode>40401</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108558</GroupID><ARTGs><ARTG>398793</ARTG></ARTGs><MinimumBenefit>560</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ694</BillingCode><Name>Mountaineer OCT Spinal System -Lateral washer plate</Name><Description>Titanium Occipital - Lateral Washer Plate</Description><Size>One size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108558</GroupID><ARTGs><ARTG>194063</ARTG></ARTGs><MinimumBenefit>560</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB048</BillingCode><Name>ELLIPSE Stabilization System, Locking Cap</Name><Description>Locking Cap</Description><Size>One Size</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108558</GroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>560</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB019</BillingCode><Name>REVOLVE Stabilization Locking Cap</Name><Description>Locking Cap</Description><Size>One Size</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108558</GroupID><ARTGs><ARTG>190043</ARTG></ARTGs><MinimumBenefit>560</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB067</BillingCode><Name>BEACON™ Stabilization System Clamp</Name><Description>Clamp</Description><Size>5.5mm and 6.35mm small, medium, large</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108559</GroupID><ARTGs><ARTG>219169</ARTG></ARTGs><MinimumBenefit>686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY101</BillingCode><PriorBillingCodes><PriorBillingCode>JG013</PriorBillingCode></PriorBillingCodes><Name>VENTOTENE Modular Tulip</Name><Description>Standard Polyaxial Short</Description><Size>13.9mm diameter</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108559</GroupID><ARTGs><ARTG>397231</ARTG></ARTGs><MinimumBenefit>686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY002</BillingCode><Name>Reform Tulip Head</Name><Description>Tulip Head</Description><Size>12.5mm/17mm</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108559</GroupID><ARTGs><ARTG>287905</ARTG></ARTGs><MinimumBenefit>686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI263</BillingCode><Name>Infinity Spinal System</Name><Description>Occipital Screw Connectors</Description><Size>Standard, offset, open angle</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108559</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER553</BillingCode><Name>Biedermann Motech MOSS Spinal Fixation System-Ti Polyaxial head</Name><Description>Tulip Screw Head, standard,/reduction,modular</Description><Size>Various sizes  </Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108559</GroupID><ARTGs><ARTG>337238</ARTG></ARTGs><MinimumBenefit>686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY036</BillingCode><Name>Reform MIS Tulip</Name><Description>Tulip</Description><Size>5.5mm</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108559</GroupID><ARTGs><ARTG>287905</ARTG></ARTGs><MinimumBenefit>686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER223</BillingCode><Name>SIGNUS Diplomat Pedicle Screw System - Screw Head (Tulip)</Name><Description>SIGNUS Diplomat Pedicle Screw System - Screw Head (Tulip)</Description><Size>dia 12.5 mm x height 14.9-150 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108559</GroupID><ARTGs><ARTG>216751</ARTG></ARTGs><MinimumBenefit>686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW019</BillingCode><PriorBillingCodes><PriorBillingCode>ZI911</PriorBillingCode></PriorBillingCodes><Name>Virage Cable Connector</Name><Description>Cable Connector</Description><Size>One Size</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108559</GroupID><ARTGs><ARTG>111775</ARTG></ARTGs><MinimumBenefit>686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE665</BillingCode><Name>Mariner Pedicle Screw Modular Head</Name><Description>Polyaxial, Extended, Deformity and Trauma Heads</Description><Size>One size each</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108559</GroupID><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER580</BillingCode><PriorBillingCodes><PriorBillingCode>OF022</PriorBillingCode></PriorBillingCodes><Name>Firebird Phoenix screw heads</Name><Description>Modular screw heads; various sizes including reduction heads</Description><Size>Body Top Loading, NXG Body Top Loading, Top loaded Body-Slotted, Body Closed, Body Reduction - All one size only  Body Offset - 8mm, 11mm, 14mm  Short, standard and tall (open and closed)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108559</GroupID><ARTGs><ARTG>195012</ARTG></ARTGs><MinimumBenefit>686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB068</BillingCode><Name>BEACON™ Stabilizer System Connector</Name><Description>Connector</Description><Size>5.5mm and 6.35mm small, medium, large, offset</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108559</GroupID><ARTGs><ARTG>219169</ARTG></ARTGs><MinimumBenefit>686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB101</BillingCode><Name>CREO AMP™ Tulip</Name><Description>Tulip Head</Description><Size>4.75mm and 5.5mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108559</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU054</BillingCode><Name>Perla TL Posterior thoraco-lumbar fixation system - screw head</Name><Description>Polyaxial screw heads, Reduction screw heads</Description><Size>one size each</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108559</GroupID><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB124</BillingCode><Name>CREO MIS Posterior Stabilization System - Screw Head</Name><Description>Modular Polyaxial Screw Head</Description><Size>10mm and 30mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108559</GroupID><ARTGs><ARTG>196054</ARTG></ARTGs><MinimumBenefit>686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI521</BillingCode><Name>CD Horizon™ ModuLeX™ 5.5 Spinal System - Tulip Head</Name><Description>Tulip Head</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108559</GroupID><ARTGs><ARTG>422155</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC608</BillingCode><Name>TSRH</Name><Description>Connector</Description><Size>Small, Medium, Large</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108559</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV140</BillingCode><Name>Reline (Mod Tulip)</Name><Description>Tulip Screw</Description><Size>One size</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108559</GroupID><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH710</BillingCode><Name>Athena Cup</Name><Description>Modular Polyaxial tulip heads, available in standard, reduction and MIS reduction</Description><Size>Standard, Reduction, MIS Reduction</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108559</GroupID><ARTGs><ARTG>337150</ARTG></ARTGs><MinimumBenefit>686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ147</BillingCode><Name>Evolution Spine Whistler Modular Pedicle Screw System-Pedicle Screw Tulip</Name><Description>Evolution Spine Whistler Modular Pedicle Screw System-Pedicle Screw Tulip, polyaxial, standard/MI/reduction</Description><Size>5.5 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108559</GroupID><ARTGs><ARTG>445290</ARTG></ARTGs><MinimumBenefit>686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV086</BillingCode><Name>Precept (Tulip)</Name><Description>Tulip screw</Description><Size>5.5mm/6.25mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108559</GroupID><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV141</BillingCode><Name>Reline (Mod Reduction Tulip)</Name><Description>Tulip Screw</Description><Size>One size</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108559</GroupID><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ040</BillingCode><Name>Invictus Modular Tulip </Name><Description>Polyaxial.  Ti Alloy</Description><Size>Std, std Reduction,  Extended tab reduction </Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108559</GroupID><ARTGs><ARTG>398576</ARTG></ARTGs><MinimumBenefit>686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC985</BillingCode><Name>Vertex Spinal System</Name><Description>Connectors</Description><Size>Small, medium, large</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108559</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY178</BillingCode><Name>Spinal Fixation System</Name><Description>Pedicle screw head</Description><Size>5 - 6mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108559</GroupID><ARTGs><ARTG>293276</ARTG><ARTG>293275</ARTG></ARTGs><MinimumBenefit>686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY146</BillingCode><Name>Universal Spine System (USS)</Name><Description>Cross Link Rod</Description><Size>40-80mm length </Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108560</GroupID><ARTGs><ARTG>133401</ARTG></ARTGs><MinimumBenefit>349</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU028</BillingCode><Name>Romeo 2  Posterior Thoraco-lumbar Fixation System - Transverse Rod</Name><Description>Transverse rod</Description><Size>Length: 20mm, 30mm, 40mm, 50mm, 60mm, 70mm, 80mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108560</GroupID><ARTGs><ARTG>198720</ARTG></ARTGs><MinimumBenefit>349</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV161</BillingCode><Name>Reline Small Stature Iliac Saddle</Name><Description>Pelvic Saddle Hook</Description><Size>5.0mm to 6.0mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108561</GroupID><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>349</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER180</BillingCode><Name> SIGNUS DIPLOMAT DEFORMITY – Clip</Name><Description>DIPLOMAT DEFORMITY System-Clip</Description><Size>N/A</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108561</GroupID><ARTGs><ARTG>216751</ARTG></ARTGs><MinimumBenefit>349</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY382</BillingCode><Name>Occipito-Cervical Fusion System</Name><Description>Occipital Clamp Titanium Alloy</Description><Size>1 or 2 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108561</GroupID><ARTGs><ARTG>293275</ARTG></ARTGs><MinimumBenefit>349</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB162</BillingCode><Name>QUARTEX Occipital Clamp</Name><Description>Occipital Clamps</Description><Size>3.5mm to 4.0mm, short and long</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108561</GroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>349</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU160</BillingCode><Name>MUST MINI Cross connector Clamp</Name><Description>Cross connector Clamp</Description><Size>one size only</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108561</GroupID><ARTGs><ARTG>291175</ARTG></ARTGs><MinimumBenefit>349</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB109</BillingCode><Name>SILC™ PET Band</Name><Description>PET Band</Description><Size>4 -6mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108562</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>757</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY040</BillingCode><PriorBillingCodes><PriorBillingCode>DE532</PriorBillingCode></PriorBillingCodes><Name>Jazz Sublaminar Band</Name><Description>Sublaminar Band for use with Jazz Claw Connector</Description><Size>1 size</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108562</GroupID><ARTGs><ARTG>200830</ARTG></ARTGs><MinimumBenefit>757</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI297</BillingCode><Name>Translace Spinal Tethering System</Name><Description>Tether, tether connector, set screws</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108562</GroupID><Suffix>Complex</Suffix><ARTGs><ARTG>312380</ARTG></ARTGs><MinimumBenefit>757</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW750</BillingCode><PriorBillingCodes><PriorBillingCode>ER174</PriorBillingCode></PriorBillingCodes><Name>Nile Alternative Fixation System - Tether, Connector, Set Screws</Name><Description>Woven Braid, polyester; Clamp, Titanium; Set Screw, Titanium</Description><Size>(3-4)mm width, 60cm strap length, (50-110)mm leader, Size 20 </Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108562</GroupID><Suffix>Complex</Suffix><ARTGs><ARTG>154442</ARTG></ARTGs><MinimumBenefit>757</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI479</BillingCode><PriorBillingCodes><PriorBillingCode>NK096</PriorBillingCode></PriorBillingCodes><Name>LigaPASS Spinal System - Sublaminar cables and connectors</Name><Description>The connectors and cables/bands work together as a bone anchor to provide stabilisation during the development of solid bony fusion and aid repair of bone fractures.</Description><Size>Connector: 20.8mm to 23mm; Band: 970mm to 1060mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108562</GroupID><Suffix>Complex</Suffix><ARTGs><ARTG>312320</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Description, Size</ChangeExplanation><MinimumBenefit>757</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ123</BillingCode><Name>RESPONSE Spine System - BandLoc, BandLoc Duo</Name><Description>Clamp and Band Assembly</Description><Size>Single, Dual Band</Size><SupplierCode>40325</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108562</GroupID><ARTGs><ARTG>292961</ARTG></ARTGs><MinimumBenefit>757</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY014</BillingCode><PriorBillingCodes><PriorBillingCode>EV024</PriorBillingCode></PriorBillingCodes><Name>NAJA ligament correction system</Name><Description>Braid and Connector</Description><Size>5.5 and 6mm diameter, left side and right side.</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108562</GroupID><ARTGs><ARTG>273278</ARTG></ARTGs><MinimumBenefit>757</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY042</BillingCode><PriorBillingCodes><PriorBillingCode>DE574</PriorBillingCode></PriorBillingCodes><Name>Jazz Posterior Fixation System - Multipurpose Connector</Name><Description>Polyester braid, connector and set screw</Description><Size>5.5mm diameter</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108562</GroupID><ARTGs><ARTG>200830</ARTG></ARTGs><MinimumBenefit>757</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY041</BillingCode><PriorBillingCodes><PriorBillingCode>DE573</PriorBillingCode></PriorBillingCodes><Name>Jazz Posterior Fixation System</Name><Description>System of Polyester Braid, connector and locking screw</Description><Size>4mm braid, 3.5-6mm connector</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108562</GroupID><ARTGs><ARTG>200830</ARTG></ARTGs><MinimumBenefit>757</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV159</BillingCode><Name>Versatie Band</Name><Description>PET Band</Description><Size>4.5mm - 5.5mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107664</SubCategoryID><GroupID>108562</GroupID><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>757</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT015</BillingCode><Name>SOLFIX2 Rod Connector</Name><Description>Rod connectors: long and square</Description><Size>One size of each</Size><SupplierCode>40227</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>320880</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER515</BillingCode><PriorBillingCodes><PriorBillingCode>EU006</PriorBillingCode></PriorBillingCodes><Name>e.Spine connector</Name><Description>Titanium connector for rods of diameter 5.5 mm</Description><Size>Straight (axial connexion), Open domino (parallel connexion), Closed domino (parallel connexion)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>171952</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE713</BillingCode><Name>Mariner Outrigger</Name><Description>Mariner Outrigger Inline Connectors</Description><Size>Axial, Closed  Closed, Axial with Rod (40-500mm)</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU149</BillingCode><Name>M.U.S.T. Connectors</Name><Description>Domino &amp; In-line Connectors</Description><Size>5.5 mm and 6.35 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>222457</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE714</BillingCode><Name>Mariner Outrigger</Name><Description>Mariner Outrigger Variable Connectors</Description><Size>8 &amp; 10mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY005</BillingCode><Name>Reform Dominoes</Name><Description>Dominoes - Axial and Parallel</Description><Size>Diameter 3.5mm to 6.0mm</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>287905</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER532</BillingCode><Name>E.SPINE System</Name><Description>TANIT SI Connector, sterile or non-sterile</Description><Size>one size</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><Suffix>Complex</Suffix><ARTGs><ARTG>171952</ARTG></ARTGs><MinimumBenefit>913</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER629</BillingCode><PriorBillingCodes><PriorBillingCode>OF066</PriorBillingCode></PriorBillingCodes><Name>Centurion Rod Connectors</Name><Description>Parallel Rod Connector, Axial Rod Connector and Lateral Offset Adaptor</Description><Size>3.5mm by 5.5mm and 10mm offset (Lateral Adaptor)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>195012</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW386</BillingCode><Name>Xia Spine System</Name><Description>Rod Clamp - Parallel, Axial</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>279150</ARTG><ARTG>279159</ARTG><ARTG>279160</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY184</BillingCode><Name>Monarch Spinal System</Name><Description>Dual Rod Connectors End to End or Side by Side</Description><Size>4.75 to 6.35mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>145010</ARTG><ARTG>97391</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN265</BillingCode><Name>SYMPHONY OCT System</Name><Description>Axial and parallel connectors</Description><Size>3.5-6.35mm </Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>178040</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY147</BillingCode><Name>Universal Spine System (USS)</Name><Description>Connectors</Description><Size>Parallel, In-line, Transverse, SS, 15 - 25mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>133401</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF106</BillingCode><Name>Freedom Axial Connector</Name><Description>Axial Connectors</Description><Size>2 and 4 hole</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>203838</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB177</BillingCode><Name>CREO ADDITION-Inline Connectors</Name><Description>In-line Closed Connector</Description><Size>5.5-6.35 to 5.5-6.35
5.5-6.0 to 5.5-6.0</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU050</BillingCode><Name>Perla TL Posterior thoraco-lumbar fixation system - parallel connector</Name><Description>Parallel connector</Description><Size>Diameter: 5.5, 6mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY082</BillingCode><PriorBillingCodes><PriorBillingCode>DR012</PriorBillingCode></PriorBillingCodes><Name>Life Spine Pedicle Screw System - Inline Connector</Name><Description>Life Spine Pedicle Screw System - Inline Connector, Axial or Parallel</Description><Size>Inline, Slimline, Domino or Wedding Band (3.5-5.5)mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>321122</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB102</BillingCode><Name>CREO AMP™ Sacral Plate</Name><Description>Sacral Plate</Description><Size>One size</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU022</BillingCode><Name>Romeo 2 Posterior Thoraco-lumbar Fixation System - Parallel Rod Connector, Axial Rod Connector</Name><Description>Parallel rod connector, axial rod connector</Description><Size>one size only</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>198720</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY015</BillingCode><Name>Katana Connectors</Name><Description>In-Line Connectors</Description><Size>5.5mm to 6.35mm  5.5mm to 5.5mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>396083</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER581</BillingCode><PriorBillingCodes><PriorBillingCode>OF082</PriorBillingCode></PriorBillingCodes><Name>Orthofix In-Line Connector</Name><Description>Axial In-Line Connector with Rod</Description><Size>One size only</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>195012</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER227</BillingCode><Name>SIGNUS Diplomat Pedicle Screw System - Parallel Connector</Name><Description>SIGNUS Diplomat Pedicle Screw System - Parallel Connector</Description><Size>5.5 mm x (5.5-6.0 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>216751</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH049</BillingCode><Name>Domino Rod Connector</Name><Description>Rod connector</Description><Size>S, M &amp; L</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY016</BillingCode><PriorBillingCodes><PriorBillingCode>EV045</PriorBillingCode></PriorBillingCodes><Name>BA Posterior Screw Domino Connector</Name><Description>BA Posterior Screw Domino Connector</Description><Size>Various Sizes</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>329318</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI461</BillingCode><PriorBillingCodes><PriorBillingCode>NK072</PriorBillingCode></PriorBillingCodes><Name>PASS LP System - Connectors</Name><Description>Connectors</Description><Size>5.5 &amp; 6.0 mm rods</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>316001</ARTG><ARTG>295277</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Description</ChangeExplanation><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW021</BillingCode><PriorBillingCodes><PriorBillingCode>ZI996</PriorBillingCode></PriorBillingCodes><Name>Vitality Spine system - Rod Connectors</Name><Description>Tandem rod connectors</Description><Size>5.5/6.0mm &amp; 3.5mm</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>287242</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH055</BillingCode><Name>Connector</Name><Description>Rod to Rod</Description><Size>3.5mm to 5.5mm</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU158</BillingCode><Name>MUST MINI Rod To Rod Connector</Name><Description>Rod To Rod Connector</Description><Size>3.5-5.5</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>291175</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH585</BillingCode><Name>Venus Spinal System - In-line/Domino Connectors</Name><Description>Venus Spinal System - In-line/Domino Connectors</Description><Size>4.5 / 5.5mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>316187</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB158</BillingCode><Name>QUARTEX Inline Connectors</Name><Description>In-line connectors</Description><Size>4.0mm-4.0mm and 4.0mm-6.5mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC542</BillingCode><Name>Vertex Spinal System</Name><Description>Connector</Description><Size>Length 10 - 13mm; diameter 3.2 - 6.35mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU003</BillingCode><Name>Perla Posterior Cervico-Thoracic Fixation System - Parallel Connector</Name><Description>Parallel rod connectors</Description><Size>Diameter: 3.5/3.5mm; 3.5/5.4mm; 3.5/5.5mm; 3.5/6mm  </Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB073</BillingCode><Name>ELLIPSE Stabilization System In-line Connector</Name><Description>Connector</Description><Size>3.5mm - 6.35mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB028</BillingCode><Name>REVERE ADDITION In-line Connectors</Name><Description>Connector, in-line</Description><Size>4.5mm, 5.5mm and 6.35mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC407</BillingCode><Name>CD Horizon</Name><Description>Domino</Description><Size>3.2mm, 3.5mm, 4.5mm, 5,5mm, 6.35mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB178</BillingCode><Name>CREO ADDITION In-line Connectors with Integrated Rod</Name><Description>In-line Closed Connector with Integrated Rod</Description><Size>5.5 Rod, 5.5-6.35, 400mm
6.0 Rod, 5.5-6.35, 400mm
6.35 Rod, 5.5-6.35, 400mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC409</BillingCode><Name>CD Horizon</Name><Description>Domino &amp; Axial Connector</Description><Size>4.5mm, 5.5mm and 6.35mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB056</BillingCode><Name>REVERE ADDITION In-line Rod Connectors with Integral Rod</Name><Description>IN-line Connector with integral rod</Description><Size>5.5mm-6.5mm 160-200mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW722</BillingCode><PriorBillingCodes><PriorBillingCode>ER011</PriorBillingCode></PriorBillingCodes><Name>K2M Spinal Systems</Name><Description>Axial connectors, in-line, parallel, open and closed face</Description><Size>3.5 – 6.5mm rods</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>159828</ARTG><ARTG>154442</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER228</BillingCode><Name>SIGNUS Diplomat Pedicle Screw System - Sleeve</Name><Description>SIGNUS Diplomat Pedicle Screw System - Sleeve</Description><Size>Diameter 5.5 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>216751</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER338</BillingCode><Name>Ulrich Pedicle Screw System-inline connector</Name><Description>Ulrich Pedicle Screw System (flamenco)-inline connectors, axial or parallel</Description><Size>dia 5.5 mm to (5.5-6.0 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>279706</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER452</BillingCode><Name>LnK Spinal Fixation System/OpenLoc-L Spinal Fixation System-Connector, in line</Name><Description>LnK Spinal Fixation System/OpenLoc-L Spinal Fixation System-Connector, in line, parallel and domino, accommodates rods of 5.0, 5.5, 6.0 and 6.35 in diameter</Description><Size>length (14-40mm) x width (8-16mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>286123</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER546</BillingCode><Name>Biedermann Motech MOSS Spinal Fixation System-Ti In-line Connector</Name><Description>Side by side / end to end connectors  </Description><Size>Various sizes</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>337238</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ920</BillingCode><Name>Moss Miami Spinal System</Name><Description>Axial Connector</Description><Size>4/4mm to 5/7mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>145010</ARTG><ARTG>97391</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI264</BillingCode><Name>Infinity Spinal System</Name><Description>In-line connector - Axial Domino</Description><Size>Enables connection from 3.2 - 6.0mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF181</BillingCode><Name>Freedom Posterior Screw Domino Connector</Name><Description>Freedom Posterior Screw Domino Connector</Description><Size>Various Sizes</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>203838</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB075</BillingCode><Name>ELLIPSE® Stabilization System Lateral Connector</Name><Description>Connector</Description><Size>3.5mm to 10.0mm - 3.5mm - 6.5mm Rod</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER660</BillingCode><Name>LnK AccelFix Spnal Fixation System-connector-in line</Name><Description>LnK AccelFix Spnal Fixation System-connector-axial straight or domino</Description><Size>Diameter 1&amp;2, 5.2-6.5mm, Length 16-40mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>384815</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ101</BillingCode><PriorBillingCodes><PriorBillingCode>SQ193</PriorBillingCode></PriorBillingCodes><Name>NEO Pedicle Screw System - Inline Connector</Name><Description>Parallel connector, Iliac connector</Description><Size>40-70mm</Size><SupplierCode>40483</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>289017</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH093</BillingCode><Name>Rod Connector </Name><Description>Rod Connector </Description><Size>Diameter : 5.5 mm - 5.5 mm / 5.5 mm - 6.0 mm / 6.0 mm - 6.0 mm   </Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>380418</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB369</BillingCode><Name>Aesculap Spinal System</Name><Description>In-Line Connector</Description><Size>All Sizes</Size><SupplierCode>40020</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>134538</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV021</BillingCode><Name>VuePoint inline connector</Name><Description>In-line connector</Description><Size>3.5mm x (3.5/4.5/6.5)mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>209198</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV160</BillingCode><Name>VersaTie Clamp</Name><Description>Inline connector</Description><Size>5.0-6.0mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV066</BillingCode><Name>Armada</Name><Description>In-line connector</Description><Size>3.5/5.5/6.35 x 5.5mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH760</BillingCode><PriorBillingCodes><PriorBillingCode>LM418</PriorBillingCode></PriorBillingCodes><Name>Certex Spinal Implant System Connector</Name><Description>Connector</Description><Size>3.5mm x 22-26mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>160750</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV135</BillingCode><Name>Reline (Rod to Rod Connector)</Name><Description>Rod-to-Rod Connector</Description><Size>To fit 4.5 - 6.5 mm rod diameter</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI015</BillingCode><Name>Streamline TL- Parallel Connectors</Name><Description>Parallel Connectors for rods of 5.5mm diameter (Titanium Alloy)</Description><Size>One size of open parallel connector; one size of closed parallel connector</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>233599</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ025</BillingCode><Name>Centaur Screw System</Name><Description>In Line Connectors</Description><Size>5.5/6.35mm</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>217033</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VB004</BillingCode><Name>Lumfix Rod connector </Name><Description>Domino (parallel) rod connectoro - open or closed </Description><Size>(5.5 - 6.0)mm rod  x (5-5 -6.0)mm Rod </Size><SupplierCode>40229</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>327225</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER314</BillingCode><Name>Ulrich posterior OCT System (neon3)-Connector, axial/parallel</Name><Description>Ulrich posterior OCT System (neon3)-Connector, axial/parallel</Description><Size>one size</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>279706</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER526</BillingCode><Name>LnK Posterior Cervical Fixation System/CastleLoc-S Posterior Cervical Fixation System-Connector</Name><Description>LnK Posterior Cervical Fixation System/CastleLoc-S Posterior Cervical Fixation System-Axial Rod/Side Rod to Rod Connector, Right Side/Left Side Rod to Rod Connector</Description><Size>height (8.0-12.8mm) x width (13.5-19.0mm); accomodates rod size 3.6-6.1mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>384816</ARTG><ARTG>286122</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UL001</BillingCode><Name>Precision Axial Connector</Name><Description>Axial Connectors</Description><Size>2 and 4 hole</Size><SupplierCode>40197</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>229115</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF014</BillingCode><Name>Centaur Screw System</Name><Description>In Line Connectors</Description><Size>5.5/6.35mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>166153</ARTG><ARTG>203838</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ635</BillingCode><Name>Expedium Spine System – Dual Rod Connector</Name><Description>Dual Rod Connector</Description><Size>4.75, 5.5 &amp; 6.35mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>97391</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB108</BillingCode><Name>SILC™ Clamp</Name><Description>Inline connector</Description><Size>4.5 -6.35mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW032</BillingCode><Name>Equinox Spinal Systems</Name><Description>In Line Connectors</Description><Size>3 mm to 6.5 mm</Size><SupplierCode>40252</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>330363</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ098</BillingCode><Name>RESPONSE Spine System – Inline Connector</Name><Description>Inline Connector</Description><Size>40-80mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>233454</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW020</BillingCode><PriorBillingCodes><PriorBillingCode>ZI910</PriorBillingCode></PriorBillingCodes><Name>Virage Closed Rod Connector</Name><Description>Closed Rod Connector</Description><Size>3.5 to 5.5mm</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>111775</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ047</BillingCode><Name>Invictus Spinal Fixation System - Connectors</Name><Description>Open/Open , Open/Closed,  Open/Side, Closed/Side, Closed/Closed, Domino Revision, Modular Satellite Axial Revision, Tulip. Ti Alloy</Description><Size>11-18mm, 30-60mm</Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108563</GroupID><ARTGs><ARTG>398576</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Description, Size</ChangeExplanation><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW721</BillingCode><PriorBillingCodes><PriorBillingCode>ER010</PriorBillingCode></PriorBillingCodes><Name>K2M Spinal Systems</Name><Description>Offset connectors, Open or Closed</Description><Size>Length: 10mm - 100mm, Degree connector angle: -15 - +15</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>154442</ARTG><ARTG>159828</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM451</BillingCode><PriorBillingCodes><PriorBillingCode>NK105</PriorBillingCode></PriorBillingCodes><Name>Offset Connectors</Name><Description>Offset Connectors</Description><Size>Multiple to suit patient anatomy</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>159605</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW392</BillingCode><Name>Xia Spine System</Name><Description>Sacral Block</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>279150</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV029</BillingCode><Name>VuePoint offset connector</Name><Description>Offset connector</Description><Size>11mm, 25mm, 30mm, 45° Acute Angle - Offset Lateral Connector, 
3.5mm x (3.5/4.5/5.5/6.25mm) - Offset Rod-to-Rod connector, 
Eyelet Connector (Occipital) - One Size</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>209198</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE761</BillingCode><Name>NorthStar OCT</Name><Description>NorthStar OCT Offset Connector</Description><Size>Parallel, Top Loading; Dual, Parallel, Top Loading; Parallel, Side Loading/Variable; Open Lateral Offset</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ099</BillingCode><Name>RESPONSE Spine System – Offset Connector</Name><Description>Closed, Open Lateral</Description><Size>20-80mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>233454</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH074</BillingCode><Name>Kumafix Connector with Nut </Name><Description>Connector with Nut </Description><Size>Connector Degree : 0;  7; 14   Left and Right    Nut Size : 6 mm</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JA010</BillingCode><PriorBillingCodes><PriorBillingCode>OH350</PriorBillingCode></PriorBillingCodes><Name>Medyssey Spinal Fixation System</Name><Description>Crosslink</Description><Size>41 - 66mm</Size><SupplierCode>40213</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>148858</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE794</BillingCode><Name>Mariner Connectors</Name><Description>Mariner Offset Connectors</Description><Size>5.5mm  15mm-200mm Lengths  </Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH094</BillingCode><Name>Lateral Connector </Name><Description>Lateral Connector </Description><Size>Diameter ： 5.5 mm &amp; 6.0 mm   Length : 20 mm - 60 mm </Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>380418</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW023</BillingCode><PriorBillingCodes><PriorBillingCode>ZI997</PriorBillingCode></PriorBillingCodes><Name>Vitality Spine System - Iliac Lateral Connector</Name><Description>Open and Closed Iliac Lateral Connector</Description><Size>20mm - 50mm</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>287242</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ045</BillingCode><Name>Invictus  Offset Connector </Name><Description>Side Loading  or Open or Closed or Offset .Ti Alloy, CoCr</Description><Size>10-200mm </Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>398576</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER582</BillingCode><PriorBillingCodes><PriorBillingCode>OF080</PriorBillingCode></PriorBillingCodes><Name>Orthofix Offset Connectors</Name><Description>Side/Top Loading, Side/Side Loading, Side/Front Loading, Front/Front Loading, Small Side/Front Loading</Description><Size>Standard, 16mm and 18mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>195012</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER453</BillingCode><Name>LnK Spinal Fixation System/OpenLoc-L Spinal Fixation System-Connector, offset</Name><Description>LnK Spinal Fixation System/OpenLoc-L Spinal Fixation System-Connector, offset; open or closed; standard or knurled; standard or hex profile</Description><Size>dia (6.2-6.5mm) x length (overall) (26-67mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>286123</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER339</BillingCode><Name>Ulrich Pedicle Screw System-Offset connector</Name><Description>Ulrich Pedicle Screw System (uCentum, flamenco)-Offset connector</Description><Size>for dia 6mm x length (15-60 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>279706</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER226</BillingCode><Name>SIGNUS Diplomat Pedicle Screw System - Offset Connector</Name><Description>SIGNUS Diplomat Pedicle Screw System - Offset Connector</Description><Size>dia 5.5 mm x length (15-40 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>216751</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER551</BillingCode><Name>Biedermann Motech MOSS Spinal Fixation System-Ti Offset Connector</Name><Description>Offset Connector  </Description><Size>dia 5.5-6.0mm  </Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>337238</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER528</BillingCode><Name>LnK Posterior Cervical Fixation System/CastleLoc-S Posterior Cervical Fixation System-Connector</Name><Description>LnK Posterior Cervical Fixation System/CastleLoc-S Posterior Cervical Fixation System-Lateral Connector/Connector stopper, non-sterile or sterile</Description><Size>rod dia 3.6 mm x offset length (10-20mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>384816</ARTG><ARTG>286122</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT011</BillingCode><Name>SOLFIX2 Offset Connectors</Name><Description>Offset connectors</Description><Size>Short, long</Size><SupplierCode>40227</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>320880</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VB003</BillingCode><Name>Lumfix Rod Connector </Name><Description>Lateral Rod connector, open or closed, straight or curved , monopolar or polyaxial </Description><Size>5.5 or 6mm rod system,  (15 - 50)mm lleg length </Size><SupplierCode>40229</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>327225</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE712</BillingCode><Name>Mariner Outrigger</Name><Description>Mariner Outrigger Offset Connectors</Description><Size>Parallel/Closed, Parallel/Side Loading, Parallel/Top Loading, Parallel/Closed/Side Loading, Parallel/Top/Side Loading, Parallel/Top/Offset, Side Loading with Rod  </Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE817</BillingCode><Name>NorthStar OCT Hinged Rod</Name><Description>NorthStar OCT Hinged Rod allows for optimal rod angulation in occipito-cervical fusions.</Description><Size>Ti Hinged Rod, 3.5mm and 4.0mm Left and Right.  </Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU157</BillingCode><Name>MUST MINI Lateral Connector</Name><Description>Lateral Connector</Description><Size>Diameter 3.5  Lenght 10 ÷ 30  mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>291175</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW024</BillingCode><PriorBillingCodes><PriorBillingCode>ZI998</PriorBillingCode></PriorBillingCodes><Name>Vitality Spine System - Tandem rod connectors</Name><Description>Tandem rod connectors</Description><Size>5.5/6.0mm &amp; 3.5mm</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>287242</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER630</BillingCode><PriorBillingCodes><PriorBillingCode>OF024</PriorBillingCode></PriorBillingCodes><Name>Firebird lateral offsets</Name><Description>lateral offsets in lengths from 8mm-80mm. Titanium.</Description><Size>15, 20, 25, 30, 35, 80mm; 8mm-35mm in 3mm increments</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>195012</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER661</BillingCode><Name>LnK AccelFix Spinal Fixation System-connector, offset</Name><Description>AccelFix Spinal Fixation System offset connector, Ti, sterile, straight or angled, standard or hex, open or closed, with or without knurling</Description><Size>Diameter: 5.5-6.5 mm  Length:    26-67 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>384815</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER315</BillingCode><Name>Ulrich posterior OCT System (neon3)-Connector, offset</Name><Description>Ulrich posterior OCT System (neon3)-Connector, offset, square or parallel, left or right</Description><Size>length (7-20 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>279706</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW391</BillingCode><Name>Xia Spine System</Name><Description>Connector - Axial, Dual, Offset</Description><Size>4.5mm - 6mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>279151</ARTG><ARTG>279159</ARTG><ARTG>279150</ARTG><ARTG>279160</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH748</BillingCode><PriorBillingCodes><PriorBillingCode>LM497</PriorBillingCode></PriorBillingCodes><Name>Sacral Plates</Name><Description>Sacral Plates</Description><Size>Left and Right 60° and 90°</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>362890</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW044</BillingCode><Name>WEGO Spinal Systems </Name><Description>Lateral Connectors</Description><Size>20 mm to 65 mm long</Size><SupplierCode>40252</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>330363</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY017</BillingCode><PriorBillingCodes><PriorBillingCode>EV041</PriorBillingCode></PriorBillingCodes><Name>BA Posterior Screw Lateral Offset Connector</Name><Description>BA Posterior Screw Lateral Offset Connector</Description><Size>10-25mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>329318</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF109</BillingCode><Name>Freedom Domino Connector</Name><Description>Parallel Axial Connectors</Description><Size>2 and 4 hole</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>203838</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI265</BillingCode><Name>Infinity Spinal System</Name><Description>Offset connector: Offset Domino, Lateral, Multi Axial Screw Extension</Description><Size>Enables connection from 3.2 - 6.35mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF110</BillingCode><Name>Freedom Offset Connector</Name><Description>Offset Connectors</Description><Size>15, 20, 25, 30, 35mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>203838</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU027</BillingCode><Name>Romeo 2 Posterior Thoraco-lumbar Fixation System - Iliac Connector</Name><Description>Iliac connector</Description><Size>Length: 15mm, 20mm, 30mm, 40mm, 50mm, 60mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>198720</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY310</BillingCode><Name>Axon Spinal System</Name><Description>transverse bar</Description><Size>one size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>133401</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB157</BillingCode><Name>QUARTEX Lateral Connectors</Name><Description>Lateral Connectors</Description><Size>standard, short, long, extra long for 3.5mm and 4.0mm rods</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ607</BillingCode><Name>Expedium Spine System</Name><Description>Lateral Connector, Open or Closed with/without rod</Description><Size>4.5-6.35mm x 20 -500mm length</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>145290</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY012</BillingCode><Name>CerviFix Posterior Cervical System</Name><Description>Clamp</Description><Size>Left, Right, Medial, Lateral, Pedicle, Lamina</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>133401</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB156</BillingCode><Name>QUARTEX Parallel Connectors</Name><Description>Parallel Connector</Description><Size>4.0mm Rod to 4.0-6.5mm Rod</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN266</BillingCode><Name>SYMPHONY OCT System</Name><Description>Lateral offset and cable connectors</Description><Size>One size</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>178040</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY288</BillingCode><Name>USS llio-Sacral Fixation system</Name><Description>Sacral clamp</Description><Size>One size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>133401</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB176</BillingCode><Name>CREO Offset Connectors</Name><Description>Threaded Head Offset Connectors</Description><Size>15mm-150mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU045</BillingCode><Name>Perla TL Posterior thoraco-lumbar fixation system - lateral connector, axial connector</Name><Description>Lateral connector (open or closed), axial connector</Description><Size>Lateral connector: Length: 15 - 60mm. Diameter: 5.5, 6mm  Axial connector: Diameter: 5.5, 6mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY081</BillingCode><PriorBillingCodes><PriorBillingCode>DR011</PriorBillingCode></PriorBillingCodes><Name>Life Spine Pedicle Screw System - Offset Connector</Name><Description>Life Spine Pedicle Screw System - Offset Connector (Open or Closed)</Description><Size>dia 5.5mm x length (20-40)mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>321122</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC676</BillingCode><Name>SiLo</Name><Description>Lateral Connector</Description><Size>10-40mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY287</BillingCode><Name>USS llio-Sacral Fixation system</Name><Description>Transconnecting bar</Description><Size>One size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>133401</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB074</BillingCode><Name>ELLIPSE® Stabilization System Lateral Connector</Name><Description>Connector</Description><Size>Std, Short, medium, long</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC668</BillingCode><Name>CD HORIZON Spinal System - Lateral Connector</Name><Description>Lateral Connector</Description><Size>10mm - 100mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ739</BillingCode><Name>Expedium Spine system</Name><Description>Open and closed Polyaxial connectors with or without end tab</Description><Size>5.5 x 6.35 x 20-200mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>97391</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB072</BillingCode><Name>ELLIPSE Stabilization System Parallel Connector</Name><Description>Connector</Description><Size>3.5mm to 4.0 - 6.5mm Rod</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF173</BillingCode><Name>Freedom Posterior Screw Lateral Offset Connector</Name><Description>Freedom Posterior Screw Lateral Offset Connector</Description><Size>10-25mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>203838</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY070</BillingCode><PriorBillingCodes><PriorBillingCode>DR052</PriorBillingCode></PriorBillingCodes><Name>Ulrich Medical Pedicle Screw System - Connectors</Name><Description>Ulrich Medical Pedicle Screw System - Connectors</Description><Size>4.0mm-6.0mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>365230</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB188</BillingCode><Name>CREO DLX Offset Connectors</Name><Description>Head, Closed and Open Offset Connectors</Description><Size>15mm to 150mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU004</BillingCode><Name>Perla Posterior Cervico-Thoracic Fixation System -  Axial Connector, Lateral Connector</Name><Description>Axial connectors, lateral connectors</Description><Size>Axial - Diameter: 3.5/3.5mm  Lateral - small, large</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB179</BillingCode><Name>CREO ADDITION - Offset Connectors</Name><Description>Offset connectors with various configurations</Description><Size>5.5-6.35 to 5.5-6.35mm, 12mm Wide
5.5-6.35 to 5.5-6.35mm, 9mm Wide
5.5-6.35mm
5.5mm Top Loading
5.5-6.0mm Head to 5.5mm Top Loading
5.5-6.0mm Head to 5.5-6.35mm Open, 12mm Wide
5.5-6.0mm to 5.5-6.0mm, 12mm Wide</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ026</BillingCode><Name>Centaur Lateral Connector, Centaur Screw System</Name><Description>Cross Connector - Rod to Rod</Description><Size>20-500mm</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>217033</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM447</BillingCode><PriorBillingCodes><PriorBillingCode>NK062</PriorBillingCode></PriorBillingCodes><Name>Excella System Offset Connecter</Name><Description>Excella Pedicle Screw System offset connector</Description><Size>25 to 45 mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>295225</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER583</BillingCode><PriorBillingCodes><PriorBillingCode>OF081</PriorBillingCode></PriorBillingCodes><Name>Orthofix Bypass Connector</Name><Description>Offset Connector with Integrated Rod</Description><Size>16mm - 34mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>195012</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV049</BillingCode><Name>Armada (Offset Connectors)</Name><Description>Offset connector</Description><Size>5.5mm x 20-120mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV114</BillingCode><Name>Reline (Offset Connector)</Name><Description>Offset Connector</Description><Size>10-60mm length for 4.5-6.5 mm diameter rod, Ti and CoCr</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB370</BillingCode><Name>Aesculap Spinal System</Name><Description>Offset Connector</Description><Size>All Sizes</Size><SupplierCode>40020</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>134538</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI014</BillingCode><Name>Streamline TL - Offset Connectors</Name><Description>Lateral Offset Connectors in lengths of 15-30mm (Titanium Alloy).</Description><Size>15,20 &amp; 30 mm lengths available. Connects to a 5.5mm diameter rod</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>233599</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH745</BillingCode><PriorBillingCodes><PriorBillingCode>LM500</PriorBillingCode></PriorBillingCodes><Name>Rod or Post Connector</Name><Description>Rod or Post Connector and set screws</Description><Size>Rod Connectors for 5.5 &amp; 6mm rods  Sacral Connectors for 5.5 &amp; 6mm rods  Post connector - one size  </Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>362890</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI518</BillingCode><Name>ModuLeX 5.5. Spinal System - Connector  </Name><Description>Connector</Description><Size>Diameter: 4.5-6mm </Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>422155</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB029</BillingCode><Name>REVERE ADDITION Offset Rod Connectors with Integral Rod</Name><Description>Offset Connector with integral rod</Description><Size>5.5mm - 6.5 mm, 20mm - 200mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI469</BillingCode><PriorBillingCodes><PriorBillingCode>NK084</PriorBillingCode></PriorBillingCodes><Name>Offset Connector</Name><Description>Offset Connector</Description><Size>All sizes</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>295277</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH047</BillingCode><Name>Connector</Name><Description>Lateral Connector</Description><Size>10-60mm Length</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW022</BillingCode><PriorBillingCodes><PriorBillingCode>ZI907</PriorBillingCode></PriorBillingCodes><Name>Virage Lateral Offset Connector</Name><Description>Offset Connector</Description><Size>10mm and 25mm</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>111775</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH056</BillingCode><Name>Rod Plate</Name><Description>Plate</Description><Size>3.5 mm to single occipital screw</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH058</BillingCode><Name>Lateral Connector</Name><Description>Closed</Description><Size>10-20mm Length</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB027</BillingCode><Name>REVERE ADDITION Offset Connectors</Name><Description>Connector, offset</Description><Size>4.5, 5.5 and 6.35mm Diameter, 15-150mm Length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU135</BillingCode><Name>M.U.S.T Lateral Connectors</Name><Description>Lateral Connectors</Description><Size>20 - 150 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>222457</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH586</BillingCode><Name>Venus Spinal System - Lateral Connector</Name><Description>Venus Spinal System - Lateral Connector</Description><Size>15-50mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108564</GroupID><ARTGs><ARTG>316187</ARTG></ARTGs><MinimumBenefit>705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB013</BillingCode><Name>DPS Spine System - Hook</Name><Description>Hook for spinal fixation system.</Description><Size>Laminar and Pedicle; Diameter 5.5/6.0mm, Width - Broad, narrow; Left and Right</Size><SupplierCode>40026</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>214788</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB002</BillingCode><Name>Aesculap Hook System</Name><Description>Pedicle, Lamina, Thoracic and Offset Hooks</Description><Size>All Sizes</Size><SupplierCode>40020</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>134538</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV058</BillingCode><Name>Armada (Hook - Various)</Name><Description>Hook</Description><Size>Pedicle - Small/Medium, 5.5mm

Lamina - 6/8/10mm x 5.5mm

Angled - 5.5mm

Offset - 5.5mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV030</BillingCode><Name>VuePoint hook (laminar)</Name><Description>Hook (laminar)</Description><Size>5.0mm, 6.0mm, 7.0mm, 8.0mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>209198</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV110</BillingCode><Name>Reline (Hook)</Name><Description>Hook</Description><Size>4-12mm
Lamina Narrorw, Lamina Wide, Lamina Down Narrow, Lamina Down Wide, Trans Process Narrow, Trans Process Wide, Lamina Up Narrow, Lamina Up Wide, Lamina Tall Narrow, Pedicle, Thoracic, Offset Left, Offset Right, Angle Left, Angle Right, Offset Angle Left, Offset Angle Right, Sidewinder Left, Sidewinder Right</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER317</BillingCode><Name>Ulrich posterior OCT System (neon3)-Hooks</Name><Description>Ulrich posterior OCT System (neon3)-Hooks, counter hooks, right/left, short/long</Description><Size>short to long</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>279706</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ028</BillingCode><Name>Centaur Hook, Centaur Screw System</Name><Description>Open hook</Description><Size>various</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>217033</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW723</BillingCode><PriorBillingCodes><PriorBillingCode>ER013</PriorBillingCode></PriorBillingCodes><Name>K2M Spinal Systems</Name><Description>Lumbar Thoracic or Cervical Hooks; open or closed</Description><Size>Various blade and throat sizes</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>159828</ARTG><ARTG>154442</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER336</BillingCode><Name>Ulrich Pedicle Screw System-Hooks</Name><Description>Ulrich Pedicle Screw System (uCentum, flamenco)-Hooks, pedicle,lamina, offset (left or right)</Description><Size>width (5-9 mm) x length (5-11 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>279706</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER634</BillingCode><PriorBillingCodes><PriorBillingCode>OF064</PriorBillingCode></PriorBillingCodes><Name>Centurion Cervical Hooks</Name><Description>Cervical Hooks</Description><Size>4.5mm and 6.0mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>195012</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK222</BillingCode><Name>Oasys-Occipito Cervico Thoracic System</Name><Description>Hook</Description><Size>Standard, Standard Short, Standard Tall, Offset Right, Offset Left</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>279144</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM415</BillingCode><PriorBillingCodes><PriorBillingCode>NK036</PriorBillingCode></PriorBillingCodes><Name>Certex Spinal Implant System Hooks</Name><Description>Hook</Description><Size>4.5-6mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>160750</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER550</BillingCode><Name>Biedermann Motech MOSS Spinal Fixation System-Ti Hooks </Name><Description>Pedicle Hook, Laminar Hook</Description><Size>Various sizes</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>337238</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER667</BillingCode><Name>LnK AccelFix Spinal Fixation System-hooks</Name><Description>AccelFix Spinal Fixation System hooks standard, pedicle, angled or offset, Ti, sterile</Description><Size>Diameter: 5.6-6.2 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>384815</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER633</BillingCode><PriorBillingCodes><PriorBillingCode>OF027</PriorBillingCode></PriorBillingCodes><Name>Blackstone - Posterior Hook</Name><Description>Titanium</Description><Size>Large/Angled/Offset/Left/Right/Narrow/Wide/ThoracicLaminar/Lumbar Laminar</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>195012</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY006</BillingCode><Name>Reform Hooks</Name><Description>Hooks and Reduction Hooks</Description><Size>Various</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>287905</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER517</BillingCode><PriorBillingCodes><PriorBillingCode>EU003</PriorBillingCode></PriorBillingCodes><Name>e.Spine Hook</Name><Description>Titanium Spine hook</Description><Size>Transverse process. Pedicular, Lumbar laminar, Thoracic laminar, Right offset lumbar laminar, Left offset lumbar laminar and raised body lumbar laminar hook, Progressive blade (small, medium, large), Pedicle (small, medium, large), Reduced blade (small, medium, large), Large blade (small, medium, large), and Laminar (Left offset - Reduced, Right offset - Reduced)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>171952</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW405</BillingCode><Name>Xia Spine System</Name><Description>Hooks</Description><Size>Laminar and Pedicle Hooks</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>279150</ARTG><ARTG>279159</ARTG><ARTG>279160</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU161</BillingCode><Name>MUST MINI Hooks</Name><Description>Hooks</Description><Size>4.5-6.0 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>291175</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH583</BillingCode><Name>Venus - Spinal Fixation System - Hooks</Name><Description>Venus Hooks</Description><Size>4 - 9mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>316187</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH057</BillingCode><Name>Hook</Name><Description>Laminar</Description><Size>5.5 mm &amp; 7.0 mm</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI473</BillingCode><PriorBillingCodes><PriorBillingCode>NK088</PriorBillingCode></PriorBillingCodes><Name>Laminar Hooks</Name><Description>Laminar Hooks</Description><Size>All sizes</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>295277</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB049</BillingCode><Name>ELLIPSE® Stabilization System Hooks</Name><Description>Hooks</Description><Size>5 - 7mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB103</BillingCode><Name>CREO AMP™ Lamina Clamp</Name><Description>Lamina clamp</Description><Size>Small, medium, large</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM450</BillingCode><PriorBillingCodes><PriorBillingCode>NK065</PriorBillingCode></PriorBillingCodes><Name>Excella System Hook</Name><Description>Excella Pedicle Screw System Hook</Description><Size>7 to 9mm x 6 to 9mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>295225</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT010</BillingCode><Name>SOLFIX2 Hook</Name><Description>Pedicle, lamina and TP hooks</Description><Size>Small, medium, large, pedicle marker, angle left, angle right, large groove, small groove, offset left, offset right</Size><SupplierCode>40227</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>320880</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER179</BillingCode><Name>  SIGNUS DIPLOMAT DEFORMITY System – Lamina Hook    </Name><Description>DIPLOMAT DEFORMITY System with lamina hook</Description><Size>5.0;7.5;10.0 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>216751</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ036</BillingCode><Name>Invictus TL Hooks</Name><Description>Lamina, Pedicle, Offset, Angled  Ti Alloy</Description><Size>(5.5 - 6.0)mm rod diameter x 5.5 - 12.5 mm length </Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>398576</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE790</BillingCode><Name>Mariner Hooks</Name><Description>Lamina, Pedicle, Angled &amp; Offset Hooks</Description><Size>5.5-10.5 Heights  4.5-9.0 Widths  </Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ097</BillingCode><Name>RESPONSE Spine System – Hook</Name><Description>Pedicle, Laminar, Thoracic</Description><Size>Open - Closed 
Narrow- Wide 
Left – Right 
Offset 5-11mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>233454</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW029</BillingCode><PriorBillingCodes><PriorBillingCode>ZI912</PriorBillingCode></PriorBillingCodes><Name>Virage Hooks</Name><Description>Virage Hooks</Description><Size>6mm and 8mm</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>111775</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE767</BillingCode><Name>NorthStar OCT</Name><Description>NorthStar OCT Hook</Description><Size>4.5 &amp; 6.0mm  </Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW019</BillingCode><Name>WEGO Spinal Systems</Name><Description>Hooks - various</Description><Size>Small, medium, large</Size><SupplierCode>40252</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>330363</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU134</BillingCode><Name>M.U.S.T. Hooks</Name><Description>Hooks: Pedicle, Narrow, Extended Body, Wide Bladed, Offset L&amp;R, Angled L&amp;R</Description><Size>Various sizes</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>222457</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY080</BillingCode><PriorBillingCodes><PriorBillingCode>DR010</PriorBillingCode></PriorBillingCodes><Name>Life Spine Pedicle Screw System - Hooks</Name><Description>Life Spine Pedicle Screw System - Hooks (Pedicle, Laminar, Offset Left/Right)</Description><Size>Small, Medium &amp; Large in Standard, Wide, Narrow &amp; Reduced</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>321122</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI464</BillingCode><PriorBillingCodes><PriorBillingCode>NK077</PriorBillingCode></PriorBillingCodes><Name>PASS LP System - Hooks</Name><Description>Pedicle Hook, Counter-Hooks, Hook Claws</Description><Size>One size</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>295277</ARTG><ARTG>316001</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Description, Size</ChangeExplanation><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU006</BillingCode><Name>Perla Posterior Cervico-Thoracic Fixation System - Hook</Name><Description>Straight hooks, offset hooks (left/right)</Description><Size>One size only</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW758</BillingCode><PriorBillingCodes><PriorBillingCode>ER211</PriorBillingCode></PriorBillingCodes><Name>Mesa Hooks</Name><Description>Thoracic and Lumbar hooks</Description><Size>Various blade and throat sizes</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><Suffix>Integrated Locking Mechanism</Suffix><ARTGs><ARTG>154442</ARTG></ARTGs><MinimumBenefit>913</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI267</BillingCode><Name>Infinity Spinal System</Name><Description>Laminar Hook</Description><Size>4.5 - 6.0mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB025</BillingCode><Name>REVERE Hooks</Name><Description>Hook - various</Description><Size>small, medium, large</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ761</BillingCode><Name>Moss Miami (Titanium)</Name><Description>Slotted Hook</Description><Size>One Size</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>145010</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY045</BillingCode><PriorBillingCodes><PriorBillingCode>DE539</PriorBillingCode></PriorBillingCodes><Name>Jazz Claw Posterior Fixation System (Hook)</Name><Description>Left and Right Hook</Description><Size>Standard and large hook</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>200830</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY438</BillingCode><Name>Expedium Spine System</Name><Description>Hooks, Right, Left, Angled, Offset, Extended, Reduced Bladed</Description><Size>5 - 12 mm including narrow - wide</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>178040</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY046</BillingCode><PriorBillingCodes><PriorBillingCode>DE570</PriorBillingCode></PriorBillingCodes><Name>Jazz Claw Posterior Fixation System (Hook)</Name><Description>Left and Right Hook</Description><Size>Standard and large hook</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>200830</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU044</BillingCode><Name>Perla TL Posterior thoraco-lumbar fixation system - hook </Name><Description>Hook laminar, hook angled, hook offset, hook pedicular</Description><Size>various</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF012</BillingCode><Name>Centaur Hook, Centaur Screw System</Name><Description>Open hook</Description><Size>various</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>203838</ARTG><ARTG>166153</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY568</BillingCode><Name>Spinal Fixation System</Name><Description>Pedicle and Lamina Hooks, straight, angled, off-set</Description><Size>Small, Medium, Large</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>133401</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB187</BillingCode><Name>CREO DLX Hook</Name><Description>Hooks-Thoracic, Laminar, Transverse Process and Pedicle</Description><Size>Small,  Medium,  Large,  Right Large  Left Large  Right Medium  Left Medium  Offset Right  Offset Left  30 degree Offset Right  30 degree Offset Left</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC406</BillingCode><Name>CD HORIZON Spinal System - Hook</Name><Description>Hook - various</Description><Size>Extra Small - Large</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC591</BillingCode><Name>Vertex Reconstructive System Laminar Hook</Name><Description>Composition -  titanium alloy</Description><Size>4.5 - 6.0mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY021</BillingCode><Name>Katana Hook</Name><Description>The Katana Pedicle Screw System is intended to provide immobilization and stabilisation of spinal segments in skeletally mature patients, as an adjunct to fusion in the thoracic, lumbar and sacral spine.</Description><Size>Small, Medium, Large, Wide, Narrow, Pedicle</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>396083</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB085</BillingCode><Name>CREO Stabilization System Hook</Name><Description>The CREO Stabilization System implants are non-cervical spinal fixation devices intended for posterior pedicle screw fixation, posterior hook fixation or anterolateral fixation.</Description><Size>4.75 and 5.5; small, medium and large</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB155</BillingCode><Name>QUARTEX Hooks</Name><Description>Left and Right Inline Hooks</Description><Size>One size only</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF182</BillingCode><Name>Freedom Posterior Screw Hook</Name><Description>Freedom Posterior Screw Hook</Description><Size>Thick and Thin</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>203838</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU020</BillingCode><Name>Romeo 2 Posterior Thoraco-lumbar Fixation System - Hook</Name><Description>Laminar hook, pedicular hook, offset (left/right), angled (left/right)</Description><Size>Small, large, extended</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>198720</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN280</BillingCode><Name>SYMPHONY OCT System</Name><Description>Hook Left, Right, Centre</Description><Size>Short - Long</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107666</SubCategoryID><GroupID>108566</GroupID><ARTGs><ARTG>178040</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV147</BillingCode><Name>MAGEC Spinal Bracing and Distraction System</Name><Description>Magnetically controlled growing rods</Description><Size>Actuator length: 70-90.mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108570</GroupID><ARTGs><ARTG>231043</ARTG></ARTGs><MinimumBenefit>13442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU108</BillingCode><Name>M.U.S.T. Rods</Name><Description>Straight, Pre-Bent and Pre-Contoured Rods</Description><Size>5.5; length 35 - 600mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>196964</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE637</BillingCode><Name>Malibu Spinal System ESS CoNiCr Rods</Name><Description>Rod CoNiCr Precontored</Description><Size>5.5mm x 100mm - 600mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HC031</BillingCode><Name>SAXXO ROD</Name><Description>ROD</Description><Size>35-400mm</Size><SupplierCode>40349</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>331780</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW034</BillingCode><PriorBillingCodes><PriorBillingCode>ZA002</PriorBillingCode></PriorBillingCodes><Name>Vitality Spine System - Rods</Name><Description>Straight and contoured rods titanium and CoCR</Description><Size>5.5 x 25mm - 5.5 x 510mm &amp; 6 x 25mm - 6 x 510mm</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>287242</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BF029</BillingCode><Name>Rods</Name><Description>Straight</Description><Size>6mm x (32-300)mm</Size><SupplierCode>40171</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>288089</ARTG></ARTGs><Note>Only to be reimbursed when used in patients with spinal tumours requiring regular magnetic resonance imaging (MRI) and/or computerised tomography (CT) imaging and or adjuvant radiotherapy and/or proton therapy.</Note><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB371</BillingCode><Name>Aesculap Spinal System</Name><Description>Pre-bent Rods - Titanium Alloy</Description><Size>All Sizes</Size><SupplierCode>40020</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>134538</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY037</BillingCode><Name>Reform POCT </Name><Description>Occipital Rod</Description><Size>3.5mm Diameter</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>287906</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU007</BillingCode><Name>Perla Posterior Cervico-Thoracic Fixation System - Rod</Name><Description>Straight rods, pre-bent rods - Titanium or cobalt chromium</Description><Size>Diameter: 3.5mm  Length: 20mm, 25mm, 30mm, 35mm, 40mm, 45mm, 50mm, 55mm, 60mm, 65mm, 70mm, 75mm, 80mm, 85mm, 90mm, 100mm, 110mm, 120mm, 240mm, 350mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI269</BillingCode><Name>Infinity Spinal System</Name><Description>Pre - curved rod</Description><Size>Length 25 - 200mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IB004</BillingCode><Name>Vertefix II Alignment Rod</Name><Description>Alignment Rod</Description><Size>Diameters: 5.5 Length: 50, 75, 100, 125, 150, 200, 300mm</Size><SupplierCode>40009</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>188902</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF111</BillingCode><Name>Freedom Systems Rods</Name><Description>Freedom System Rods, Straight and Curved</Description><Size>Diameter 5.5mm, Lengths 40-500mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>203838</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB125</BillingCode><Name>CREO MIS Posterior Stabilization System</Name><Description>Titanium alloy and cobalt chrome straight and curved rods</Description><Size>30-500mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ644</BillingCode><Name>Extra long rod - Expendium Anterior Spine System</Name><Description>Rod - Titanium</Description><Size>5.5mm x 450mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>97391</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI270</BillingCode><Name>Infinity Spinal System</Name><Description>Straight Rod</Description><Size>Length 120 - 600 mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY578</BillingCode><Name>Expedium Spine System</Name><Description>Rods</Description><Size>Length 30–600 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>178040</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN113</BillingCode><Name>Mountaineer Spine System</Name><Description>OC Adjustable Rod</Description><Size>3.5mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>145010</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN169</BillingCode><Name>VIPER Spinal System</Name><Description>Spinal Rods</Description><Size>30-480mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>128257</ARTG><ARTG>97391</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU048</BillingCode><Name>Perla TL Posterior thoraco-lumbar fixation system - rod </Name><Description>Straight rods, pre-bent rods - Titanium or colbalt chromium</Description><Size>Diameter:  5.5, 6mm. Length: 30 - 550mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI524</BillingCode><Name>CD Horizon™ ModuLeX™ 5.5 Spinal System - Rod</Name><Description>Rod</Description><Size>Diameter: 5.5mm; Length 25mm - 120mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>422153</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY025</BillingCode><PriorBillingCodes><PriorBillingCode>EV039</PriorBillingCode></PriorBillingCodes><Name>BA Posterior Screw Rod</Name><Description>BA Posterior Screw Rod  Straight/PreBent  CrCo/Titanium</Description><Size>Ø3.5 to 5.5  20-500mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>329318</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY047</BillingCode><PriorBillingCodes><PriorBillingCode>DE527</PriorBillingCode></PriorBillingCodes><Name>Jazz Posterior Fixation System Rod</Name><Description>Straight, contoured and transition rods, titanium and cobalt chrome</Description><Size>4mm - 6mm diameter, 70mm - 600mm length</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>200830</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW035</BillingCode><PriorBillingCodes><PriorBillingCode>ZI914</PriorBillingCode></PriorBillingCodes><Name>Virage Rods</Name><Description>Virage Rods</Description><Size>3.5mm x 25-400mm</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>111775</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE594</BillingCode><Name>Newport MIS Rod</Name><Description>MIS bulleted pre-contoured rod</Description><Size>35-80 (5mm incr.)
90-110 (10mm incr.)</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE705</BillingCode><Name>Mariner MIS Rods</Name><Description>Mariner MIS Rods</Description><Size>5.5mm - 6.0mm Diameter.  20-450mm Length.</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH079</BillingCode><Name>ZINA MIS Rod </Name><Description>ZINA MIS Spine System - Rod  </Description><Size>Diameter x Length ( mm )   5.5×30    5.5×35    5.5×40    5.5×45    5.5×50  5.5×55  5.5×60  5.5×65  5.5×70  5.5×75  5.5×80  5.5×85  5.5×90  5.5×95  5.5×100  5.5×110  5.5×120  5.5×130  5.5×140  5.5×150  5.5×160  5.5×170  5.5×180  5.5×190  5.5×200  5.5×210  5.5×220  5.5×230  5.5×240  5.5×250  5.5×300  5.5×350  5.5×400  5.5×450  5.5×500  </Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH097</BillingCode><Name>RS8 Long Rod </Name><Description>RS8 Long Rod </Description><Size>Straight &amp; Curved   Diameter : 5.5 mm &amp; 6.0 mm   Length : 30 - 500 mm</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>380418</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE670</BillingCode><Name>icotec Pedicle System Rod</Name><Description>Pre-bent and straight rods</Description><Size>5.5, 5.7, mm &amp; 6.0mm diameter   30-500 mm Length</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>283854</ARTG><ARTG>283853</ARTG></ARTGs><Note>Only to be reimbursed when used in patients with spinal tumours requiring regular magnetic resonance imaging (MRI) and/or computerised tomography (CT) imaging and or adjuvant radiotherapy and/or proton therapy.</Note><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ043</BillingCode><Name>Invictus Rod </Name><Description>Rod, straight, curved Ti Alloy or CoCr</Description><Size>(3.5 - 6.0) mm diameter x  (20-600)mm length</Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>398576</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ105</BillingCode><PriorBillingCodes><PriorBillingCode>SQ128</PriorBillingCode><PriorBillingCode>SQ128</PriorBillingCode></PriorBillingCodes><Name>NEO Pedicle Screw System - Rod</Name><Description>Shaped, Titanium Alloy</Description><Size>30mm - 100mm length</Size><SupplierCode>40483</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>289017</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JA015</BillingCode><PriorBillingCodes><PriorBillingCode>OH352</PriorBillingCode></PriorBillingCodes><Name>Novel/Zenius Rods</Name><Description>Rod</Description><Size>5.5, 6.0, 6.5</Size><SupplierCode>40213</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>148858</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH078</BillingCode><Name>Kumafix Rod </Name><Description>Rod </Description><Size>Length : 30-500 mm </Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV025</BillingCode><Name>VuePoint rod</Name><Description>Rod</Description><Size>60mm x 3.5mm, 120mm x 3.5mm, 240mm x 3.5mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>209198</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BF005</BillingCode><Name>Smartloc Spinal Fixation System / Fixation Rod</Name><Description>Fixation Rod for Smartloc Spinal Fixation System</Description><Size>40mm - 80mm</Size><SupplierCode>40171</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>150778</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB372</BillingCode><Name>Aesculap Spinal System</Name><Description>Straight Rods - Titanium Alloy</Description><Size>All Sizes</Size><SupplierCode>40020</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>134538</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV136</BillingCode><Name>Reline System (Tapered Rod)</Name><Description>Tapered Rod</Description><Size>5.0- 6.0mm diameter, and 300-500mm length, Ti and CoCr</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI010</BillingCode><Name>Streamline MIS- Rods</Name><Description>Titanium Alloy straight and pre-bent Rods</Description><Size>Titanium 5.5mm pre-bent rod lengths range from 35-80mm in 5mm increments and 90-200 in 10mm increments; straight rod lengths range from 35-80mm in 5mm increments and 90-200 250mm in 10mm increments, 300 &amp; 350mm.</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>233599</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH712</BillingCode><Name>Athena Rod</Name><Description>titanium alloy rods in both straight and curved </Description><Size>Diameter 5.5mm  Lengths 25mm -700mm  </Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>337150</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ148</BillingCode><Name>Evolution Spine Whistler Modular Pedicle Screw System-Rods</Name><Description>Evolution Spine Whistler Modular Pedicle Screw System-Rods, straight, bent, bullet-nosed, Ti or CoCr</Description><Size>Diameter: 5.5 or 6.0 mm Length: 30-500 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>445291</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH582</BillingCode><Name>Venus Spinal Fixation System - Rods</Name><Description>Venus - Rods</Description><Size>D 4.0 - 5.5mm L 40-480mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>316187</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ249</BillingCode><Name>KHEIRON Spinal Fixation System</Name><Description>K-ROD patient specific shaped rods</Description><Size>5.5 and 6mm diameter</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Shaped</Suffix><ARTGs><ARTG>362890</ARTG></ARTGs><MinimumBenefit>555</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH051</BillingCode><Name>Rod</Name><Description>Rods</Description><Size>80 - 240mm Length</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE667</BillingCode><Name>Mariner Rod</Name><Description>Pre-contoured and straight rods</Description><Size>5.5 &amp; 6.0mm diameter   20mm - 600mm Length</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE772</BillingCode><Name>NorthStar OCT</Name><Description>NorthStar OCT Rod</Description><Size>3.5, 4.0mm Diameter  30mm-500mm Lengths</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ101</BillingCode><Name>RESPONSE Spine System – Rod</Name><Description>CoCr, Ti</Description><Size>500mm-600mm Length</Size><SupplierCode>40325</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>233454</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HC028</BillingCode><Name>G2S rods</Name><Description>Rod</Description><Size>L: 40-154mm</Size><SupplierCode>40349</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>274075</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW031</BillingCode><Name>WEGO Spinal Systems </Name><Description>Rods</Description><Size>All sizes</Size><SupplierCode>40252</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>330363</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH044</BillingCode><Name>Rod</Name><Description>Rod</Description><Size>30-500mm Length</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM437</BillingCode><PriorBillingCodes><PriorBillingCode>NK118</PriorBillingCode></PriorBillingCodes><Name>Amendia Savannah-T Pedicle Screw System-Rods</Name><Description>Pedicle Screw System-Rods, Straight and curved</Description><Size>dia 5.5 mm x length (30-500 mm)</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>281992</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU056</BillingCode><Name>Perla Posterior Occipito-Cervico-Thoracic fixation system - adjustable occipital rod</Name><Description>Adjustable occipital rod (titanium)</Description><Size>Small, Medium</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY088</BillingCode><PriorBillingCodes><PriorBillingCode>DR033</PriorBillingCode></PriorBillingCodes><Name>Z-Medical Pedicle Screw System - Rods</Name><Description>Z-Medical Pedicle Screw System - Rods 5.5mm, Straight &amp; Curved (Open or Percutaneous)</Description><Size>dia (5.5)mm x length (20-500)mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>343676</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI470</BillingCode><PriorBillingCodes><PriorBillingCode>NK085</PriorBillingCode></PriorBillingCodes><Name>Straight rods</Name><Description>Straight rods</Description><Size>All sizes</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>295277</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN268</BillingCode><Name>SYMPHONY OCT System</Name><Description>Straight, hinged, and pre-lordosed rods</Description><Size>3.5-4.0mm diameter</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>178040</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC396</BillingCode><Name>TSRH Spinal Implant System</Name><Description>3D - Rod</Description><Size>Length 20-120mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC440</BillingCode><Name>CD Horizon</Name><Description>Eclipse:  4.5mm Rod</Description><Size>40 - 600mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC404</BillingCode><Name>CD HORIZON Spinal System - Rod</Name><Description>Rod</Description><Size>20mm - 600mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB212</BillingCode><Name>CREO® Side Loading Rod</Name><Description>Curved, straight and offset rods</Description><Size>Length: 20mm- 600mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB076</BillingCode><Name>REVERE Rods</Name><Description>Rod, precurved and straight</Description><Size>30mm-600mm in 4.5mm 5.5mm and 6.35mm diameter</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM417</BillingCode><PriorBillingCodes><PriorBillingCode>NK038</PriorBillingCode></PriorBillingCodes><Name>Certex Spinal Implant System Transitional Rod</Name><Description>Transitional Rod</Description><Size>3.5mm - 5.5mm x100mm - 500mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Dual Diameter</Suffix><ARTGs><ARTG>160750</ARTG></ARTGs><MinimumBenefit>432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB091</BillingCode><Name>CREO Stabilization Tapered Rod</Name><Description>The CREO Stabilization System implants are non-cervical spinal fixation devices intended for posterior pedicle screw fixation, posterior hook fixation or anterolateral fixation.</Description><Size>4.75 and 5.5
600mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Dual Diameter</Suffix><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB152</BillingCode><Name>QUARTEX Tapered Rods</Name><Description>Tapered rods which transition in diameter.</Description><Size>Diameter 3.5mm &amp; 4.0mm transitioning up to 6.5mm 
Length 350mm -500mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Dual Diameter</Suffix><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV026</BillingCode><Name>VuePoint rod (transition)</Name><Description>Transition Rod</Description><Size>3.5mm to 5.5mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Dual Diameter</Suffix><ARTGs><ARTG>209198</ARTG></ARTGs><MinimumBenefit>432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER285</BillingCode><Name>Premia Spine Versalink Fixation System-Rods (shaped)</Name><Description>Premia Spine Versalink Fixation System-Rods (shaped)</Description><Size>offset and angle (0-30 degrees), length (40-90) mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Shaped</Suffix><ARTGs><ARTG>267145</ARTG></ARTGs><MinimumBenefit>555</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW765</BillingCode><PriorBillingCodes><PriorBillingCode>ER243</PriorBillingCode></PriorBillingCodes><Name>MESA Rail</Name><Description>CoCr and Ti shaped beam rail rods</Description><Size>Diameter: 4.5-5.5mm Length: 375-500mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Shaped</Suffix><ARTGs><ARTG>154442</ARTG></ARTGs><MinimumBenefit>555</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT017</BillingCode><Name>SOLFIX2 Pre-bent Rods</Name><Description>Pre-bent (soft rods, minimally invasive rods)</Description><Size>Diameter: 5.5mm, 6mm,  Length: 35mm - 500mm</Size><SupplierCode>40227</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Shaped</Suffix><ARTGs><ARTG>320880</ARTG></ARTGs><MinimumBenefit>555</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY385</BillingCode><Name>Speciality Rods</Name><Description>Scoliosis / J/S Rod, Precontoured, Titanium / Stainless Steel</Description><Size>5mm, 6mm diameter. Left / Right 50mm - 500mm length</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Shaped</Suffix><ARTGs><ARTG>293276</ARTG><ARTG>133401</ARTG><ARTG>293275</ARTG></ARTGs><MinimumBenefit>555</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN293</BillingCode><Name>SYMPHONY OCT System</Name><Description>Offset rods</Description><Size>3.5-5.5mm Diameter</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Shaped</Suffix><ARTGs><ARTG>178040</ARTG></ARTGs><MinimumBenefit>555</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI478</BillingCode><PriorBillingCodes><PriorBillingCode>NK095</PriorBillingCode></PriorBillingCodes><Name>Curved Rods</Name><Description>Curved Rods</Description><Size>All sizes</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Shaped</Suffix><ARTGs><ARTG>295277</ARTG></ARTGs><MinimumBenefit>555</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN114</BillingCode><Name>EXPEDIUM Spinal System</Name><Description>Pre-Shaped Rod</Description><Size>4.5 - 7.5mm Diameter</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Shaped</Suffix><ARTGs><ARTG>178040</ARTG><ARTG>128257</ARTG><ARTG>205380</ARTG><ARTG>97391</ARTG></ARTGs><MinimumBenefit>555</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB180</BillingCode><Name>CREO ADDITION Headed Rods</Name><Description>Headed, shaped rods of various configurations</Description><Size>Diameter - 5.5mm
Length - 40mm - 230mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Shaped</Suffix><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>555</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB077</BillingCode><Name>REVERE Rods Preshaped</Name><Description>Pre-shaped Rods</Description><Size>4.5, 5.5 - 6.35mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Shaped</Suffix><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>555</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI454</BillingCode><Name>UNiD™ Rods </Name><Description>Curved rods that are preshaped to be patient specific</Description><Size>diameter: 3.5/5.5-6.0mm length: 120 - 750mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Shaped</Suffix><ARTGs><ARTG>368750</ARTG></ARTGs><MinimumBenefit>555</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV137</BillingCode><Name>Reline System (Curved Rod)</Name><Description>Curved Rod</Description><Size>5.0- 6.0mm diameter, and 300- 500mm length, CoCr and Ti</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Shaped</Suffix><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>555</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BF028</BillingCode><Name>Rods, Curved</Name><Description>curved and S shaped rods, carbon fiber reinforced polymer</Description><Size>6.0mm x (30-300)mm length</Size><SupplierCode>40171</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Shaped</Suffix><ARTGs><ARTG>288089</ARTG></ARTGs><Note>Only to be reimbursed when used in patients with spinal tumours requiring regular magnetic resonance imaging (MRI) and/or computerised tomography (CT) imaging and or adjuvant radiotherapy and/or proton therapy.</Note><MinimumBenefit>555</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH750</BillingCode><PriorBillingCodes><PriorBillingCode>LM495</PriorBillingCode></PriorBillingCodes><Name>Curved Rod</Name><Description>Curved Rod</Description><Size>Diameter 5.5 or 6 mm  Length 150 to 450 mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Shaped</Suffix><ARTGs><ARTG>362890</ARTG></ARTGs><MinimumBenefit>555</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH744</BillingCode><PriorBillingCodes><PriorBillingCode>LM510</PriorBillingCode></PriorBillingCodes><Name>Curved Rods</Name><Description>Curved Rods</Description><Size>35 to 90 mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Shaped</Suffix><ARTGs><ARTG>366793</ARTG></ARTGs><MinimumBenefit>555</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE818</BillingCode><Name>BlackArmor Carbon Fibre/PEEK Curved / Multicurved Rods</Name><Description>The BlackArmor material is a combination of continuous, high-strength carbon-  fiber-reinforced PEEK and a procedure developed by icotec – Injection Moulding CFM (Composite Flow Moulding). The result is a non-metallic implant component with an interwoven 3D fibre architecture that provides unmatched  strength and endurance. BlackArmor® is radiolucent in all diagnostic imaging modes (MRI, CT and X-ray) and will therefore not create imaging artifacts; a significant clinical benefit in the postoperative monitoring of anatomical structures and other forms of treatment.</Description><Size>Curved and Multicurved rods,    Diameter: 6.0mm  Radius: 120mm, 450mm  Length: 40mm-300mm  </Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Shaped</Suffix><ARTGs><ARTG>283853</ARTG></ARTGs><Note>Only to be reimbursed when used in patients with spinal tumours requiring regular magnetic resonance imaging (MRI) and/or computerised tomography (CT) imaging and or adjuvant radiotherapy and/or proton therapy.</Note><MinimumBenefit>555</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ156</BillingCode><Name>Response Spine System - S Rod</Name><Description>Pre-Contoured S-Rods, Shaped, CoCr, Ti</Description><Size>5.5 &amp; 6.0mm diameter  350 - 500mm  Small, Med, Large</Size><SupplierCode>40325</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Shaped</Suffix><ARTGs><ARTG>233454</ARTG></ARTGs><MinimumBenefit>555</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ035</BillingCode><Name>Invictus Shaped Rod</Name><Description>OCT Prebent, S,  Z  and J rods </Description><Size>(5.5 - 6.0)mm diameter x (300-600)mm lemgth , CoCr Ti Alloy</Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Shaped</Suffix><ARTGs><ARTG>398576</ARTG></ARTGs><MinimumBenefit>555</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER641</BillingCode><PriorBillingCodes><PriorBillingCode>OF063</PriorBillingCode></PriorBillingCodes><Name>Centurion Occipital Rods</Name><Description>Titanium or Cobalt Chrome Occipital Rod</Description><Size>3.5mm, 110°, 120°, 135°</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>195012</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY004</BillingCode><Name>Reform Rods</Name><Description>Straight and Lordotic Curved Rods</Description><Size>Length 20mm to 600mm</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>287905</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM409</BillingCode><PriorBillingCodes><PriorBillingCode>NK015</PriorBillingCode></PriorBillingCodes><Name>Capless Li Pedicle screw system - rod</Name><Description>Titanium rod. Straight and pre- bent</Description><Size>Straight and pre- bent, multiple sizes, 40-300mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>160750</ARTG><ARTG>170220</ARTG><ARTG>159605</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER663</BillingCode><Name>LnK AccelFix Spinal Fixation System-Rods</Name><Description>AccelFix Spinal Fixation System Ti Rods, shaped ends, straight or curved, standard or MIS and single or double stopper features. sterile</Description><Size>Diameter: 5.0-6.5 mm  Length:     40-612 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>384815</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER177</BillingCode><Name>SIGNUS DIPLOMAT DEFORMITY – Rod</Name><Description>DIPLOMAT DEFORMITY System – Rod</Description><Size>5.5x500 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>216751</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER284</BillingCode><Name>Premia Spine Versalink Fixation System-Rods (straight or bent)</Name><Description>Premia Spine Versalink Rods (straight or bent)</Description><Size>dia 6 mm, length (40-180) mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>267145</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER447</BillingCode><Name>LnK Spinal Fixation System/OpenLoc-L Spinal Fixation System-Rods</Name><Description>LnK Spinal Fixation System/OpenLoc-L Spinal Fixation System-Rods; straight or curved; Titanium or CoCr alloy</Description><Size>dia (5.0-6.35mm) x length (40-600mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>286123</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ050</BillingCode><Name>Centaur Screw System</Name><Description>Percutaneous Rods</Description><Size>30mm-480mm</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>217033</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VB005</BillingCode><Name>Lumfix Rod</Name><Description>Rod, Strasight, Curved  with or without end stop. Titanium or coCr</Description><Size>(5.5 - 6.0)mm diameter x (35-500)mm length </Size><SupplierCode>40229</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>327225</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER225</BillingCode><Name>SIGNUS DIPLOMAT Pedicle Screw System - Rod-Straight or Curved</Name><Description>SIGNUS DIPLOMAT Pedicle Screw System - Rod-Straight or Curved</Description><Size>dia 5.5 mm x length (30-150 mm)  dia 5.5 mm x length (150/200/250/300/500 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>216751</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW727</BillingCode><PriorBillingCodes><PriorBillingCode>ER018</PriorBillingCode></PriorBillingCodes><Name>Mesa/Denali/Everest Rod</Name><Description>Straight and Contoured, CoCr, Ti Rods</Description><Size>Length: 25mm - 600 mm; Diameter: 3.5mm - 6.5 mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>154442</ARTG><ARTG>159828</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY010</BillingCode><Name>Reform POCT Rod</Name><Description>Rod - Straight and Curved</Description><Size>Length 20mm to 350mm</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>287906</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT012</BillingCode><Name>SOLFIX2 Rods</Name><Description>Rods (straight soft rods, straight hard rods)</Description><Size>Diameter: 5.5mm, 6mm,  Length: 35mm - 500mm</Size><SupplierCode>40227</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>320880</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY077</BillingCode><PriorBillingCodes><PriorBillingCode>DR007</PriorBillingCode></PriorBillingCodes><Name>Life Spine Pedicle Screw System - Rod, Dual Diameter</Name><Description>Life Spine Pedicle Screw System (Nautilus, Avatar) - Rod, Dual Diameter</Description><Size>(3.5-5.5) Various Lengths</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Dual Diameter</Suffix><ARTGs><ARTG>321122</ARTG></ARTGs><MinimumBenefit>432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI471</BillingCode><PriorBillingCodes><PriorBillingCode>NK086</PriorBillingCode></PriorBillingCodes><Name>Dual diameter rod</Name><Description>Dual diameter rod</Description><Size>All sizes</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Dual Diameter</Suffix><ARTGs><ARTG>295277</ARTG></ARTGs><MinimumBenefit>432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN264</BillingCode><Name>SYMPHONY OCT System</Name><Description>Dual diameter rods</Description><Size>3.5-6.35mm diameter</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Dual Diameter</Suffix><ARTGs><ARTG>178040</ARTG></ARTGs><MinimumBenefit>432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB045</BillingCode><Name>ELLIPSE Stabilization System, Tapered Rod</Name><Description>Dual Diameter Rod</Description><Size>3.5mm ti 4.0mm - 6.5mm x 350mm - 500mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Dual Diameter</Suffix><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU008</BillingCode><Name>Perla Posterior Cervico-Thoracic Fixation System - Transition Rod</Name><Description>Transition rods - Titanium or cobalt chromium</Description><Size>Diameter: 3.5/5.4 to 6.0 mm  Length: 300mm, 600mm  </Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Dual Diameter</Suffix><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY446</BillingCode><Name>CerviFix Posterior Cervical System</Name><Description>Rod: Tapered</Description><Size>3.5/5.0 - 3.5/6.0 dual diameter, 300 -500mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Dual Diameter</Suffix><ARTGs><ARTG>133401</ARTG></ARTGs><MinimumBenefit>432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI168</BillingCode><Name>CD HORIZON SOLERA Spinal System </Name><Description>Apex and Tapered Rods</Description><Size>4.75mm to 6.3mm diameter</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Dual Diameter</Suffix><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW033</BillingCode><PriorBillingCodes><PriorBillingCode>ZI916</PriorBillingCode></PriorBillingCodes><Name>Virage Rods</Name><Description>Virage Dual Diameter Rods</Description><Size>3.5/5.5mm x 450mm</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Dual Diameter</Suffix><ARTGs><ARTG>111775</ARTG></ARTGs><MinimumBenefit>432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE800</BillingCode><Name>NorthStar Transition Rod</Name><Description>Transition Rod</Description><Size>3.5mm, 4.0mm – 5.5mm, 6.0mm Diameters  500mm Length  </Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Dual Diameter</Suffix><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ044</BillingCode><Name>Invictus Dual Diameter Rod </Name><Description>Straight, Dual Diameter , Ti Alloy  or CoCr </Description><Size>(3.5 or 4.0 or 5.5 )mm to (5.5 or 6.0)mm diameters  x (200 - 600) mm length </Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Dual Diameter</Suffix><ARTGs><ARTG>398576</ARTG></ARTGs><MinimumBenefit>432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU156</BillingCode><Name>MUST MINI Transition Rod</Name><Description>Transition Rod</Description><Size>Diameter 3.5 / 5.5 &amp; 3.5 / 4.0
Lenght 120 ÷ 600 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Dual Diameter</Suffix><ARTGs><ARTG>291175</ARTG></ARTGs><MinimumBenefit>432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER334</BillingCode><Name>Ulrich Pedicle Screw System-Rods</Name><Description>Ulrich Pedicle Screw System (cosmicMIA, uCentum,flamenco)-Rods, straight, curved and scoliosis, open or percutaneous.</Description><Size>dia (5.5-6.0 mm) x length (30-500 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>279706</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW483</BillingCode><Name>ES2 Spinal System, Rod</Name><Description>Hex end rods</Description><Size>5.5mm x 20 - 600mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>278581</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ104</BillingCode><PriorBillingCodes><PriorBillingCode>SQ126</PriorBillingCode><PriorBillingCode>SQ126</PriorBillingCode></PriorBillingCodes><Name>NEO Pedicle Screw System - Rod</Name><Description>Straight, Titanium Alloy, CoCr</Description><Size>30mm - 500mm length</Size><SupplierCode>40483</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>289017</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE638</BillingCode><Name>Malibu Spinal System Rods</Name><Description>Rod</Description><Size>5.5mm x 30mm - 600mm  6.35mm x 100mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU155</BillingCode><Name>MUST MINI Rod</Name><Description>Rod</Description><Size>Diameter 3.5  Lenght 30 - 350 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>291175</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HC020</BillingCode><Name>KM Rod</Name><Description>Rod</Description><Size>40-400mm</Size><SupplierCode>40349</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>201492</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH090</BillingCode><Name>Rod </Name><Description>Rod </Description><Size>Diameter ： 5.5 mm &amp; 6.0 mm  Length : 30 mm - 500 mm   </Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>380418</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW755</BillingCode><PriorBillingCodes><PriorBillingCode>ER201</PriorBillingCode></PriorBillingCodes><Name>K2M Spinal Systems-Transitional Rod</Name><Description>Transitional Rod</Description><Size>3.5-(4.5 /5.5)mm x (300-600)mm length or 5.5/5.5mm x 495 rod/rail</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Dual Diameter</Suffix><ARTGs><ARTG>159828</ARTG><ARTG>154442</ARTG></ARTGs><MinimumBenefit>432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER556</BillingCode><Name>Biedermann Motech MOSS Spinal Fixation System-Multiple diameter rod  </Name><Description>Dual Diameter Transition Rods, Ti or CoCr  </Description><Size>Ø 3.0 - Ø6.0mm range in various sizes  </Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Dual Diameter</Suffix><ARTGs><ARTG>337238</ARTG></ARTGs><MinimumBenefit>432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY030</BillingCode><Name>Reform POCT Rod</Name><Description>Transition Rod</Description><Size>Lengths 250mm - 650mm</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Dual Diameter</Suffix><ARTGs><ARTG>287905</ARTG></ARTGs><MinimumBenefit>432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW655</BillingCode><Name>Xia Spine System</Name><Description>Transition Rods</Description><Size>4.5 mm transitioning to 5.5mm and 6.0mm.   Titanium Alloy and Vitallium</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Dual Diameter</Suffix><ARTGs><ARTG>279160</ARTG></ARTGs><MinimumBenefit>432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW654</BillingCode><Name>OASYS Spine System</Name><Description>Transition Rods</Description><Size>3.5mm transitioning to 4.5mm, 5.5mm and 6.0mm.  Ti Alloy and Vitallium</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Dual Diameter</Suffix><ARTGs><ARTG>279144</ARTG></ARTGs><MinimumBenefit>432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER341</BillingCode><Name>Ulrich Pedicle Screw System-Rod, dual diameter</Name><Description>Ulrich Pedicle Screw System (flamenco)-Rod, hybrid</Description><Size>dia 5.5 mm /4.5 mm, length 400 mm;  dia 5.5 mm /6.0 mm, length 400 mm; dia 5.5 mm /6.25 mm, length 400 mm; dia 5.5 mm /6.25 mm, (threaded), length 400 mm; dia 4.0/6.0 mm, length 200 mm; dia 4.0/6.0 mm, length 400 mm  </Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Dual Diameter</Suffix><ARTGs><ARTG>279706</ARTG></ARTGs><MinimumBenefit>432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER505</BillingCode><Name>LnK Posterior Cervical Fixation System/ CastleLoc-S Posterior Cervical Fixation System-Rod, dual dia</Name><Description>LnK Posterior Cervical Fixation System/ CastleLoc-S Posterior Cervical Fixation System-Rod, dual diameter transitional rod, non-sterile or sterile</Description><Size>3.5 mm transitioning to (4.5-6.0 mm) x overall rod length (300-550) mm)  Rod segment L1 can range between 100-200 mm and Rod segment 2 can range between 100-400 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><Suffix>Dual Diameter</Suffix><ARTGs><ARTG>286122</ARTG><ARTG>384816</ARTG></ARTGs><MinimumBenefit>432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER519</BillingCode><PriorBillingCodes><PriorBillingCode>EU002</PriorBillingCode></PriorBillingCodes><Name>e.Spine Rod</Name><Description>Spine straight or pre-bend rods</Description><Size>Diameter 5.5mm; Lengths:
Titanium or CoCr Straight rods 40, 50, 60, 70, 80, 90, 110, 130, 160, 220, 440, 500, 600mm;
Titanium Pre-bend rods: 40, 50, 60, 70, 80, 90mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>171952</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV088</BillingCode><Name>Precept (Rod)</Name><Description>Rod</Description><Size>15-600mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH485</BillingCode><Name>Paradigm  Spinal System</Name><Description>DSS/ HPS Rod, Titanium alloy</Description><Size>5.5mm diameter rod  Length: 20mm to 300mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>186733</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB007</BillingCode><Name>DPS Spine System - Rod</Name><Description>Rods for posterior pedicle screw fixation system.</Description><Size>Diameter 5/5.5/6mm; Length 40-500mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>214788</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV116</BillingCode><Name>Reline (Rod)</Name><Description>Rod</Description><Size>4.5-6mm diameter, and 15-600mm length, Ti and CoCr</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI048</BillingCode><Name>HPS™ Rod</Name><Description>straight and pre-bent Rods</Description><Size>20-300mm</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>345870</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV060</BillingCode><Name>Armada (Rod)</Name><Description>Rod</Description><Size>5.5mm x (25/30/35/40/45/50/55/60/65/70/75/80/85/90/100/120)

300/500mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH751</BillingCode><PriorBillingCodes><PriorBillingCode>LM494</PriorBillingCode></PriorBillingCodes><Name>Straight Rod</Name><Description>Straight Rod</Description><Size>Diameter 5.5 or 6 mm  Length 35 - 505 mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>362890</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV028</BillingCode><Name>VuePoint rod (pre-bent)</Name><Description>Pre-bent rod</Description><Size>80-240mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>209198</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI017</BillingCode><Name>Streamline TL/Quantum- Rods</Name><Description>Titanium Alloy and Cobalt Chrome (CoCr) Spinal Rods</Description><Size>Titanium 5.5mm pre-bent rod lengths range from 35-150mm in 5mm increments; Titanium 5.5mm straight rod lengths of 35mm, 40-110mm in 10mm increments, and with hex end in lengths of 120mm, 150mm, 200mm, 400mm and 600mm. CoCr 5.5mm straight rod with hex end in lengths of 200mm, 400mm, and 600mm.</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>233599</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY084</BillingCode><PriorBillingCodes><PriorBillingCode>DR014</PriorBillingCode></PriorBillingCodes><Name>Life Spine Pedicle Screw System - Rods</Name><Description>Life Spine Pedicle Screw System (Naultilus, Avatar) - Rods, Straight, Curved and Deformity, open or percutaneous (Ti or CoCr).</Description><Size>dia. (5.5) x length (25-600)</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>321122</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB148</BillingCode><Name>CAPITOL Curved Rod</Name><Description>Pre-lordosed Rods</Description><Size>3.5mm diameter 25-120mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF171</BillingCode><Name>Freedom Posterior Screw Rod</Name><Description>Freedom Posterior Screw Rod  Straight/PreBent  CrCo/Titanium</Description><Size>Ø3.5 to 5.5  20-500mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>203838</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER592</BillingCode><PriorBillingCodes><PriorBillingCode>OF073</PriorBillingCode></PriorBillingCodes><Name>Firebird Rods</Name><Description>Firebird Rods - straight and pre-lordosed, titanium and CoCr</Description><Size>35mm-600mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>195012</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER407</BillingCode><Name>LnK MIS Spinal System/PathLoc-L MIS Spinal System-Rods</Name><Description>LnK MIS Spinal System/PathLoc-L MIS Spinal System-Rods, bullet and hex shaped ends, straight or curved</Description><Size>dia (5.5-6.0mm) x length (35-600mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>286124</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY143</BillingCode><Name>Universal Spine System (USS)</Name><Description>Rods</Description><Size>Length 40 - 500mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>133401</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU060</BillingCode><Name>Perla Posterior Occipito-Cervico-Thoracic fixation system - occipital rod</Name><Description>Occipital rod - Titanium or cobalt chromium</Description><Size>3.5 x 220 - 90mm or 3.5 x 120 - 90 mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU021</BillingCode><Name>Romeo 2/Romeo 2 MIS Posterior Thoraco-lumbar Fixation System - Rod, Percutaneous Rod</Name><Description>Rod, percutaneous rod</Description><Size>Rod -  Diameter 5.4mm  Length: pre-bent: 30mm, 35mm, 40mm, 45mm, 50mm, 55mm, 60mm, 70mm, 80mm, 90mm; straight: 100mm, 120mm, 140mm, 160mm, 180mm, 200mm, 220mm, 240mm, 350mm, 500mm, 550mm  Percutaneous Rod -  Diameter: 5.4mm  Length:   pre-bent - 30mm, 35mm, 40mm, 45mm, 50mm, 55mm, 60mm, 65mm, 70mm, 75mm, 80mm, 85mm, 90mm;   straight - 100mm, 110mm, 120mm, 130mm, 140mm, 150mm, 160mm, 170mm, 180mm, 190mm, 200mm, 210mm, 220mm, 230mm, 240mm, 250mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>198720</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY564</BillingCode><Name>Spinal Fixation System</Name><Description>Matrix Rods</Description><Size>20mm - 500mm length</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>293275</ARTG><ARTG>293276</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER139</BillingCode><Name>Signus Pedicles Screw System - Rod</Name><Description>Titanium Rod- as part of the Signus Pedicle Screw System Construct</Description><Size>6.0mm x 30mm - 100mm in 5mm increments 6.0mm x 108mm - 204mm in 12 mm increments</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>216751</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KB007</BillingCode><PriorBillingCodes><PriorBillingCode>SV069</PriorBillingCode></PriorBillingCodes><Name>STERISPINE™ PS Sterile Connecting Rod</Name><Description>Sterile rod available in straight and prebent versions.</Description><Size>Pre bent rods-5.5mm   Lengths (mm): 30-100    Straight Rods-5.5mm  Lengths (mm): 100-380</Size><SupplierCode>40247</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>273288</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW389</BillingCode><Name>Xia / Mantis Spine System</Name><Description>Rod</Description><Size>Diameter: 5.5mm - 6mm.  
Length: 20mm - 600mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>139620</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC587</BillingCode><Name>CD Horizon Spinal System</Name><Description>Percutaneous Rod</Description><Size>20mm to 600mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY067</BillingCode><PriorBillingCodes><PriorBillingCode>DR049</PriorBillingCode></PriorBillingCodes><Name>Ulrich Medical Pedicle Screw System - Rods</Name><Description>Ulrich Medical Pedicle Screw System - Rods</Description><Size>5.5/6.0 - 35mm-500mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>365230</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ648</BillingCode><Name>Pre-cut rod - Expedium Anterior Spine System</Name><Description>Rod - Titanium</Description><Size>Diameter 5.5mm x lengths 45-150mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>97391</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB182</BillingCode><Name>CREO ADDITION - Z Rods</Name><Description>Z pre-shaped rods</Description><Size>Diameter 5.5-6.35mm
12mm Offset
100-200mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB189</BillingCode><Name>CREO DLX Rods</Name><Description>Curved, Straight and Hex-ended Rods</Description><Size>Diameter: 6.35mm  Length: 20mm-600mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU059</BillingCode><Name>Perla TL Posterior thoraco-lumbar fixation system - percutaneous rod </Name><Description>Percutaneous straight rods, pre-bent rods - Titanium</Description><Size>Diameter:  5.5, 6mm. Length: 30 - 250mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY094</BillingCode><PriorBillingCodes><PriorBillingCode>EV028</PriorBillingCode></PriorBillingCodes><Name>Katana Rod</Name><Description>The Katana Rod, part of the Katana Pedicle Screw System is intended to provide immobilization and stabilisation of spinal segments in skeletally mature patients, as an adjunct to fusion in the thoracic, lumbar and sacral spine. These are specialty rods for use in procedures such as the treatment for scoliosis.</Description><Size>Titanium or CrCo straight rods.  300 and 500mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>236041</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB020</BillingCode><Name>REVOLVE Stabilization System Rods</Name><Description>Rod</Description><Size>5.5mm diameter 40mm - 300mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>190043</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ033</BillingCode><Name>Centaur Rod</Name><Description>Standard</Description><Size>30-480mm</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>217033</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM416</BillingCode><PriorBillingCodes><PriorBillingCode>NK037</PriorBillingCode></PriorBillingCodes><Name>Certex Spinal Implant System Rod</Name><Description>Rod</Description><Size>3.5mm x 30-500mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>160750</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY102</BillingCode><PriorBillingCodes><PriorBillingCode>JG011</PriorBillingCode></PriorBillingCodes><Name>VENTOTENE Rods</Name><Description>Straight and Pre-Bended</Description><Size>5.5mm diameter  35-450mm length</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>397231</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER436</BillingCode><Name>LnK Posterior Cervical Fixation System/CastleLoc-S Posterior Cervical Fixation System-Rod</Name><Description>LnK Posterior Cervical Fixation System/CastleLoc-S Posterior Cervical Fixation System-Rod,straight or pre-bent, non-sterile or sterile</Description><Size>Dia 3.5mm x Length (20-240 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>384816</ARTG><ARTG>286122</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER640</BillingCode><PriorBillingCodes><PriorBillingCode>OF062</PriorBillingCode></PriorBillingCodes><Name>Centurion Rods</Name><Description>Titanium or Cobalt Chrome Rods and Transition Rods</Description><Size>3.5mm diameter and 70mm, 120mm, and 200mm in length (Rods)  3.5mm – 5.5mm and 200/200mm, 200/300mm and 300/300mm in length (Transition Rods)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>195012</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI460</BillingCode><Name>PASS LP System - Rod</Name><Description>Pre-bent rods and straight rods</Description><Size>Diameter: 5.5mm - 6.0mm Length: 30mm - 400mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>316001</ARTG><ARTG>295277</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Description, Size</ChangeExplanation><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB087</BillingCode><Name>CREO Stabilization System Rod</Name><Description>The CREO Stabilization System implants are non-cervical spinal fixation devices intended for posterior pedicle screw fixation, posterior hook fixation or anterolateral fixation.</Description><Size>4.75 and 5.5 diameter
15mm - 600mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB151</BillingCode><Name>QUARTEX Rods</Name><Description>Ttianium alloy and cobalt chrome alloy curved and straight rods</Description><Size>3.5 and 4.0mm diameter, 25-500mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ760</BillingCode><Name>Moss Miami (Titanium)</Name><Description>Swedge Rod</Description><Size>One Size</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>145010</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB046</BillingCode><Name>ELLIPSE Stabilization System, Rod</Name><Description>Rod</Description><Size>3.5mm Diameter x 40mm - 240mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY024</BillingCode><Name>Katana Rods</Name><Description>Pre-Lordosed and Straight Rods - Ti and CoCr</Description><Size>Curved and Straight Rods  Length: 25mm – 160mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>396083</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK224</BillingCode><Name>Oasys-Occipito Cervico Thoracic System</Name><Description>Rods - Ti-6A1-4V or Vitallium</Description><Size>Diameter 3.5mm, Length 25mm-350mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>94635</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER319</BillingCode><Name>Ulrich posterior OCT System (neon3)-Rods</Name><Description>Ulrich posterior OCT System (neon3)-Rods, Titanium or Co-CR, straight or curved</Description><Size>dia 4 mm x length (20-400 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>279706</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER448</BillingCode><Name>LnK Spinal Fixation System/OpenLoc-L Spinal Fixation System-Rods, shaped</Name><Description>LnK Spinal Fixation System/OpenLoc-L Spinal Fixation System-Rods, shaped ends and single or double stopper features</Description><Size>dia (5.0-6.35mm) x length (40-600mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>286123</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM443</BillingCode><PriorBillingCodes><PriorBillingCode>NK058</PriorBillingCode></PriorBillingCodes><Name>Excella Systems Rods</Name><Description>Pedicle Screw System Rods, Straight and curved</Description><Size>5.5 &amp; 6mm diameter  35 to 600mm length</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>295225</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI248</BillingCode><Name>Vertex Spinal System</Name><Description>Rods</Description><Size>20-600mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER593</BillingCode><PriorBillingCodes><PriorBillingCode>OF083</PriorBillingCode></PriorBillingCodes><Name>Orthofix Z Rod</Name><Description>Pre-bent Z Rod</Description><Size>Standard, 16mm, 18mm Offset  150mm X150mm, 150mm X 300mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>195012</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KB011</BillingCode><Name>AnyPlus and AnyPlus II Rods</Name><Description>Straight and Pre-bent Rods</Description><Size>Diameter: 5.5mm  Length: 40-200mm</Size><SupplierCode>40247</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>353891</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW735</BillingCode><PriorBillingCodes><PriorBillingCode>ER027</PriorBillingCode></PriorBillingCodes><Name>Caspian OCT Spinal System - Rod</Name><Description>cervico-thoracic posterior rigid fixation system - Rod</Description><Size>Diameter: 3.5mm Length: 1.80mm - 240mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>159828</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER286</BillingCode><Name>Premia Spine Versalink Fixation System-Cross Bar</Name><Description>Premia Spine Versalink Fixation System-Cross Bar</Description><Size>one size</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>267145</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ065</BillingCode><Name>Centaur Spinal System </Name><Description>Rods</Description><Size>Diameter 5.5mm x 30mm - 480mm Length</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>407189</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER549</BillingCode><Name>Biedermann Motech MOSS Spinal Fixation System-Rod </Name><Description>Rod, Ti or CoCr, straight or curved, bullet or hexagonal end </Description><Size>Ø4.5mm -Ø6.0mm diameter, 30 - 600mm length, Ti and CoCr  </Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108572</GroupID><ARTGs><ARTG>337238</ARTG></ARTGs><MinimumBenefit>340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH457</BillingCode><Name>DSS Fusion Coupler</Name><Description>The DSS Fusion Coupler is a telescoping coupler that rigidly joins the DSS pedicle screws.</Description><Size>20mm - 22mm
22mm - 25mm
25mm - 31mm
31mm - 43mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108573</GroupID><ARTGs><ARTG>151022</ARTG></ARTGs><MinimumBenefit>1056</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER320</BillingCode><Name>Ulrich posterior OCT System (neon3)-Plate-rod</Name><Description>Ulrich posterior OCT System (neon3)-Occipital plate, lateral, with rod</Description><Size>One size</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107669</SubCategoryID><GroupID>108575</GroupID><ARTGs><ARTG>279706</ARTG></ARTGs><MinimumBenefit>1905</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY445</BillingCode><Name>CerviFix Posterior Cervical System</Name><Description>Occipital Plate Rod</Description><Size>one size</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107669</SubCategoryID><GroupID>108575</GroupID><ARTGs><ARTG>133401</ARTG></ARTGs><MinimumBenefit>1905</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC543</BillingCode><Name>Vertex Spinal System</Name><Description>Plate/rod</Description><Size>80 - 240mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107669</SubCategoryID><GroupID>108575</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>1905</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW024</BillingCode><Name>WEGO Spinal Systems</Name><Description>Washer</Description><Size>Various</Size><SupplierCode>40252</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108576</GroupID><ARTGs><ARTG>330363</ARTG></ARTGs><MinimumBenefit>218</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH584</BillingCode><Name>Venus - Spinal Fixation System - Washers</Name><Description>Venus Washers</Description><Size>STD, SP</Size><SupplierCode>40113</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108576</GroupID><ARTGs><ARTG>316187</ARTG></ARTGs><MinimumBenefit>218</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB032</BillingCode><Name>REVERE Blocking Plate, Anterior Screw</Name><Description>Blocking Plate</Description><Size>One Size</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108576</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>218</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB168</BillingCode><Name>REVERE Anterior Staple System - Washer</Name><Description>Washers and Stackable Washers</Description><Size>5.5mm - 8.5mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108576</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>218</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY150</BillingCode><Name>Universal Spine System (USS)</Name><Description>Washers</Description><Size>Pointed, Flat, 4.2 - 7mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108576</GroupID><ARTGs><ARTG>133921</ARTG></ARTGs><MinimumBenefit>218</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ649</BillingCode><Name>Washer &amp; Single Hole Staple - Expedium Anterior Spine System</Name><Description>Washer and Single Hole Staple - Titanium</Description><Size>One size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108576</GroupID><ARTGs><ARTG>97391</ARTG></ARTGs><MinimumBenefit>218</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI463</BillingCode><Name>PASS Spinal System</Name><Description>Sacral Plate</Description><Size>one size</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108576</GroupID><ARTGs><ARTG>295277</ARTG></ARTGs><MinimumBenefit>218</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW739</BillingCode><PriorBillingCodes><PriorBillingCode>ER033</PriorBillingCode></PriorBillingCodes><Name>ARI Anterior Staple System - Washer</Name><Description>The ARI Anterior Staple System - washer</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108576</GroupID><ARTGs><ARTG>154442</ARTG></ARTGs><MinimumBenefit>218</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ034</BillingCode><Name>Centaur Screw System, Centaur Washer</Name><Description>Washer</Description><Size>1 size</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108576</GroupID><ARTGs><ARTG>217033</ARTG></ARTGs><MinimumBenefit>218</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ770</BillingCode><Name>Expedium Spine System</Name><Description>Washer</Description><Size>Various</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108576</GroupID><ARTGs><ARTG>97391</ARTG></ARTGs><MinimumBenefit>218</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER594</BillingCode><PriorBillingCodes><PriorBillingCode>OF072</PriorBillingCode></PriorBillingCodes><Name>Blackstone Washers</Name><Description>Titanium</Description><Size>2mm, 3mm, 4mm, 5mm, 6mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108576</GroupID><ARTGs><ARTG>195012</ARTG></ARTGs><MinimumBenefit>218</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH453</BillingCode><Name>DSS Washer</Name><Description>The DSS Washer is a washer that is an integral part of the DSS construct. The DSS construct can  not be used without the washer nor can the washer be used as a separate implant.</Description><Size>One size only</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108576</GroupID><ARTGs><ARTG>151022</ARTG></ARTGs><MinimumBenefit>218</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH757</BillingCode><PriorBillingCodes><PriorBillingCode>LM424</PriorBillingCode></PriorBillingCodes><Name>Silex Washer</Name><Description>Silex Washer</Description><Size>13mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108576</GroupID><ARTGs><ARTG>228758</ARTG></ARTGs><MinimumBenefit>218</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH753</BillingCode><PriorBillingCodes><PriorBillingCode>LM466</PriorBillingCode></PriorBillingCodes><Name>Silex Sacroiliac Joint Fusion System</Name><Description>Washers for the Silex Sacroiliac Joint Fusion System</Description><Size>11, 13 &amp; 15mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108576</GroupID><ARTGs><ARTG>228758</ARTG></ARTGs><MinimumBenefit>218</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH451</BillingCode><Name>DSS Spacer</Name><Description>The DSS Spacer is an integral component of the DSS pedicle screw construct. It is used on the mono-axial DSS screw and is used each time a screw is placed. It can not be used on its own.</Description><Size>One size only</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108576</GroupID><ARTGs><ARTG>151022</ARTG></ARTGs><MinimumBenefit>218</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW029</BillingCode><Name>WEGO Spinal Systems</Name><Description>Staple</Description><Size>Various</Size><SupplierCode>40252</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108577</GroupID><ARTGs><ARTG>330363</ARTG></ARTGs><MinimumBenefit>380</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ771</BillingCode><Name>Expedium Spine System</Name><Description>Staple</Description><Size>Various</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108577</GroupID><ARTGs><ARTG>97391</ARTG></ARTGs><MinimumBenefit>380</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY027</BillingCode><Name>Katana Staple</Name><Description>The Katana Pedicle Screw System is intended to provide immobilization and stabilisation of spinal segments in skeletally mature patients, as an adjunct to fusion in the thoracic, lumbar and sacral spine.</Description><Size>13-25mm, Caudal, Rostral, Single</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108577</GroupID><ARTGs><ARTG>396083</ARTG></ARTGs><MinimumBenefit>380</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ657</BillingCode><Name>Single Hole Staple - Expedium Anterior Spine System</Name><Description>Single Hole Staple - Titanium</Description><Size>One Size Only</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108577</GroupID><ARTGs><ARTG>97391</ARTG></ARTGs><MinimumBenefit>380</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB181</BillingCode><Name>REFLECT Staple</Name><Description>Three prong threaded staple</Description><Size>5.0 mm - 7.5 mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108577</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><Note>The Prostheses List (PL) billing code does not cover the use of the device for vertebral body tethering (VBT) for the management of adolescent idiopathic scoliosis (AIS).</Note><MinimumBenefit>380</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC614</BillingCode><Name>Vantage</Name><Description>Vantage Plates and Screws; Staple (rostral/caudal)</Description><Size>One Size Only</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108577</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>380</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC437</BillingCode><Name>CD-Horizon</Name><Description>Staples</Description><Size>10 - 30mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108577</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>380</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB031</BillingCode><Name>REVERE Integrated Staple Head Plate</Name><Description>Integrated Staple Head Plate</Description><Size>small, medium, large, x-large</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108577</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>380</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB167</BillingCode><Name>REVERE Anterior Single Staple</Name><Description>Single anterior staple constructed of Titanium Alloy</Description><Size>small, medium, large</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108577</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>380</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ044</BillingCode><Name>Centaur Screw System, Centaur Staple</Name><Description>Staple</Description><Size>small - extra large</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108577</GroupID><ARTGs><ARTG>217033</ARTG></ARTGs><MinimumBenefit>380</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB166</BillingCode><Name>REVERE Anterior Dual Staple</Name><Description>Dual Anterior Staple constructed of Titanium Alloy</Description><Size>small, medium, large, x-large</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108577</GroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>380</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ643</BillingCode><Name>Dual Hole Staple - Expendium Anterior Spine System</Name><Description>Dual Hole Staple - Titanium</Description><Size>Small to Xlarge - 4 sizes</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108577</GroupID><ARTGs><ARTG>97391</ARTG></ARTGs><MinimumBenefit>380</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW738</BillingCode><PriorBillingCodes><PriorBillingCode>ER032</PriorBillingCode></PriorBillingCodes><Name>ARI Anterior Staple System - Staple</Name><Description>A non-cervical anterolateral thoracolumbar screw stabilization as an adjunct to fusion.</Description><Size>Single Hole Design and Dual Hole Design: 13mm, Left &amp; Right; 16mm, Left &amp; Right; 18mm, Left &amp; Right.</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108577</GroupID><ARTGs><ARTG>154442</ARTG></ARTGs><MinimumBenefit>380</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK242</BillingCode><Name>Xia Spinal System</Name><Description>Titanium or Stainless Steel</Description><Size>Single Hole Staple; Dual Hole Staples (Caudal/Rostral) - Small, Medium, Large</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108577</GroupID><ARTGs><ARTG>94635</ARTG></ARTGs><MinimumBenefit>380</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW774</BillingCode><PriorBillingCodes><PriorBillingCode>ER475</PriorBillingCode></PriorBillingCodes><Name>KEYS Anterior Staple</Name><Description>Staple</Description><Size>13-18mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107670</SubCategoryID><GroupID>108577</GroupID><ARTGs><ARTG>154442</ARTG></ARTGs><MinimumBenefit>380</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC436</BillingCode><Name>CD-Horizon</Name><Description>C-ring</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107671</SubCategoryID><GroupID>108578</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>306</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY145</BillingCode><Name>Universal Spine System (USS)</Name><Description>Half Ring</Description><Size>SS, Standard, Self-Holding</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107671</SubCategoryID><GroupID>108578</GroupID><ARTGs><ARTG>133401</ARTG></ARTGs><MinimumBenefit>306</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FC010</BillingCode><Name>GL-DTRAX Cervical Cage- T</Name><Description>Titanium Cervical Cage</Description><Size>One Size</Size><SupplierCode>40377</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108581</GroupID><ARTGs><ARTG>293579</ARTG></ARTGs><MinimumBenefit>1317</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FC009</BillingCode><Name>GL -DTRAX Cervical Cage- B</Name><Description>Cervical Cage with integral fixation.</Description><Size>One Size</Size><SupplierCode>40377</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108581</GroupID><ARTGs><ARTG>293579</ARTG></ARTGs><MinimumBenefit>1317</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ020</BillingCode><Name>ZygoLoc</Name><Description>Facet Fusion Cage</Description><Size>3-15mm</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108581</GroupID><ARTGs><ARTG>217031</ARTG></ARTGs><MinimumBenefit>1317</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FC008</BillingCode><Name>GL-DTRAX Expandable Cage System</Name><Description>Expandable titanium cage</Description><Size>One Size</Size><SupplierCode>40377</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108581</GroupID><ARTGs><ARTG>290977</ARTG></ARTGs><MinimumBenefit>1317</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JP001</BillingCode><PriorBillingCodes><PriorBillingCode>JA021</PriorBillingCode></PriorBillingCodes><Name>Pro-Disc L Superior Plate Component</Name><Description>Pro-Disc L Superior Plate Component</Description><Size>3 Degree, 6 Degree, 11 Degree, Medium, Large</Size><SupplierCode>39934</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108583</GroupID><ARTGs><ARTG>323814</ARTG></ARTGs><MinimumBenefit>3891</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JP002</BillingCode><PriorBillingCodes><PriorBillingCode>JA022</PriorBillingCode></PriorBillingCodes><Name>Pro-Disc L Inferior Plate Component</Name><Description>Pro-Disc L Inferior Plate Component</Description><Size>0 Degree, 6 Degree, 8 Degree, Medium, Large</Size><SupplierCode>39934</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108583</GroupID><ARTGs><ARTG>323814</ARTG></ARTGs><MinimumBenefit>3891</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC029</BillingCode><PriorBillingCodes><PriorBillingCode>JA033</PriorBillingCode></PriorBillingCodes><Name>Spine Solutions Prodisc</Name><Description>Artificial mechanical disc, superior plate component</Description><Size>3 Degree, 6 Degree, 11 Degree, Medium, Large</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108583</GroupID><ARTGs><ARTG>299018</ARTG></ARTGs><MinimumBenefit>3891</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC030</BillingCode><PriorBillingCodes><PriorBillingCode>JA034</PriorBillingCode></PriorBillingCodes><Name>Spine Solutions Prodisc</Name><Description>Artificial mechanical disc, inferior plate component</Description><Size>0 Degree, 3 Degree, 8 Degree,Medium, Large</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108583</GroupID><ARTGs><ARTG>299018</ARTG></ARTGs><MinimumBenefit>3891</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC027</BillingCode><PriorBillingCodes><PriorBillingCode>JA021</PriorBillingCode></PriorBillingCodes><Name>Pro-Disc L Superior Plate Component</Name><Description>Pro-Disc L Superior Plate Component</Description><Size>3 Degree, 6 Degree, 11 Degree, Medium, Large</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108583</GroupID><ARTGs><ARTG>323814</ARTG></ARTGs><MinimumBenefit>3891</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC028</BillingCode><PriorBillingCodes><PriorBillingCode>JA022</PriorBillingCode></PriorBillingCodes><Name>Pro-Disc L Inferior Plate Component</Name><Description>Pro-Disc L Inferior Plate Component</Description><Size>0 Degree, 6 Degree, 8 Degree, Medium, Large</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108583</GroupID><ARTGs><ARTG>323814</ARTG></ARTGs><MinimumBenefit>3891</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC031</BillingCode><PriorBillingCodes><PriorBillingCode>JA023</PriorBillingCode></PriorBillingCodes><Name>Pro-Disc L - Core Component - Polyethylene Inlay</Name><Description>Pro-Disc L - Core Component - Polyethylene Inlay</Description><Size>10, 12, 14mm, Medium, Large</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108584</GroupID><ARTGs><ARTG>323814</ARTG></ARTGs><MinimumBenefit>1065</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC032</BillingCode><PriorBillingCodes><PriorBillingCode>JA035</PriorBillingCode></PriorBillingCodes><Name>Spine Solutions Prodisc</Name><Description>Artificial mechanical disc, polyethylene inlay</Description><Size>10,12,14mm, Medium, Large</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108584</GroupID><ARTGs><ARTG>299018</ARTG></ARTGs><MinimumBenefit>1065</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JP003</BillingCode><PriorBillingCodes><PriorBillingCode>JA023</PriorBillingCode></PriorBillingCodes><Name>Pro-Disc L - Core Component - Polyethylene Inlay</Name><Description>Pro-Disc L - Core Component - Polyethylene Inlay</Description><Size>10, 12, 14mm, Medium, Large</Size><SupplierCode>39934</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108584</GroupID><ARTGs><ARTG>323814</ARTG></ARTGs><MinimumBenefit>1065</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP513</BillingCode><Name>Stackable Corpectomy CFRP Cage System</Name><Description>Stackable Cage</Description><Size>Xsmall-Xlarge</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108587</GroupID><ARTGs><ARTG>98094</ARTG></ARTGs><MinimumBenefit>3529</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC632</BillingCode><Name>Verte-Stack</Name><Description>XS Centre Piece. Stackable Corpectomy Device.</Description><Size>Height 5-50mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108587</GroupID><ARTGs><ARTG>169501</ARTG></ARTGs><MinimumBenefit>3529</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV145</BillingCode><Name>Monolith Corpectomy System</Name><Description>Vertebral Body Replacement System</Description><Size>Diameter 12-14mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108587</GroupID><ARTGs><ARTG>209197</ARTG></ARTGs><MinimumBenefit>3529</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ023</BillingCode><Name>VerteLoc Spine System</Name><Description>Locking Nut</Description><Size>one size only</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108587</GroupID><ARTGs><ARTG>217033</ARTG></ARTGs><MinimumBenefit>3529</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW752</BillingCode><PriorBillingCodes><PriorBillingCode>ER175</PriorBillingCode></PriorBillingCodes><Name>Santorini Stackable Corpectomy Cage-Small</Name><Description>Corpectomy Cage, Peek  </Description><Size>(12x17)mm footprint x (2-62)mm height</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108587</GroupID><ARTGs><ARTG>204117</ARTG></ARTGs><MinimumBenefit>3529</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW753</BillingCode><PriorBillingCodes><PriorBillingCode>ER176</PriorBillingCode></PriorBillingCodes><Name>Santorini Stackable Corpectomy Cage-Medium/Large</Name><Description>Corpectomy Cage, Peek </Description><Size>(16x20) or (21x25)mm footprint x (2-98)mm height</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108587</GroupID><ARTGs><ARTG>204117</ARTG></ARTGs><MinimumBenefit>3529</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER165</BillingCode><Name>Signus Athlet VBR System - End Body</Name><Description>Peek Vertebral Body Replacement System (End body)</Description><Size>4, 6, 8mm heights</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108587</GroupID><ARTGs><ARTG>216750</ARTG></ARTGs><MinimumBenefit>3529</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER164</BillingCode><Name>Signus Athlet VBR System - Main Body</Name><Description>Peek Vertebral Body Replacement System (Main body)</Description><Size>12, 18, 24, 30, 36 and 42mm lengths</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108587</GroupID><ARTGs><ARTG>216750</ARTG></ARTGs><MinimumBenefit>3529</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ022</BillingCode><Name>VerteLoc Spine System</Name><Description>Stackable Cage</Description><Size>Extra Small- Extra large</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108587</GroupID><ARTGs><ARTG>217031</ARTG></ARTGs><MinimumBenefit>3529</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ021</BillingCode><Name>VerteLoc Spine System</Name><Description>Locking Screw</Description><Size>20mm - 150mm</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108587</GroupID><ARTGs><ARTG>217033</ARTG></ARTGs><MinimumBenefit>3529</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY293</BillingCode><Name>Synmesh</Name><Description>Mesh, Oblong</Description><Size>6mm - 88mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108588</GroupID><ARTGs><ARTG>133398</ARTG></ARTGs><MinimumBenefit>2616</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB054</BillingCode><Name>Titanium Spinal Mesh</Name><Description>Mesh, Round</Description><Size>18 - 90 mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108588</GroupID><ARTGs><ARTG>215887</ARTG></ARTGs><MinimumBenefit>2616</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV017</BillingCode><Name>Titanium Mesh</Name><Description>Oval/Flat/Long/Round</Description><Size>20mm + Diameter, 30mm - 90mm Length</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108588</GroupID><ARTGs><ARTG>132467</ARTG></ARTGs><MinimumBenefit>2616</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC451</BillingCode><Name>Pyramesh</Name><Description>Ovoid</Description><Size>8 - 130mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108588</GroupID><ARTGs><ARTG>169501</ARTG></ARTGs><MinimumBenefit>2616</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH657</BillingCode><Name>HTS Leander Cervical Vertebral Body Replacement</Name><Description>Titanium alloy implant base bodies available in different heights for different defect heights</Description><Size>Diameter 11.5mm; Height 16mm - 55mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108588</GroupID><ARTGs><ARTG>372782</ARTG></ARTGs><MinimumBenefit>2616</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC378</BillingCode><Name>Pyramesh</Name><Description>Titanium Surgical Mesh</Description><Size>51 - 500mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108588</GroupID><ARTGs><ARTG>169501</ARTG></ARTGs><MinimumBenefit>2616</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC450</BillingCode><Name>Pyramesh</Name><Description>Curved / Round</Description><Size>20 - 150mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108588</GroupID><ARTGs><ARTG>169501</ARTG></ARTGs><MinimumBenefit>2616</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB196</BillingCode><Name>COLOSSEUM Mesh Corpectomy Spacer</Name><Description>Titanium mesh corpectomy spacer</Description><Size>12-25mm X 14-30mm, 8-120mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108588</GroupID><ARTGs><ARTG>325140</ARTG></ARTGs><MinimumBenefit>2616</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC379</BillingCode><Name>Pyramesh</Name><Description>Titanium Surgical Mesh</Description><Size>5 - 50mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108588</GroupID><ARTGs><ARTG>169501</ARTG></ARTGs><MinimumBenefit>2616</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY294</BillingCode><Name>Synmesh</Name><Description>Mesh, Round</Description><Size>6mm - 88mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108588</GroupID><ARTGs><ARTG>133398</ARTG></ARTGs><MinimumBenefit>2616</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC449</BillingCode><Name>Pyramesh</Name><Description>Angled</Description><Size>25 - 150mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108588</GroupID><ARTGs><ARTG>169501</ARTG></ARTGs><MinimumBenefit>2616</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK338</BillingCode><Name>VBOSS/VLIFT</Name><Description>Cage Body</Description><Size>Available from 10 to 25mm in Diameter and from 8 to 120mm in Length</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108588</GroupID><ARTGs><ARTG>315419</ARTG></ARTGs><MinimumBenefit>2616</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BF002</BillingCode><Name>A-Mesh Spinal Titanium Mesh Spacer</Name><Description>A-Mesh® Spinal Titanium Mesh is designed to restore biomechanical integrity throughout the thoracic and lumbar spine following vertebrectomy or corpectomy for patients with spine tumors or fractures.</Description><Size>Diameter: 10mm, Length: 20mm, 50mm 70mm
Diameter: 12mm, Length: 20mm, 50mm, 70mm
Diameter: 14mm, Length: 20mm, 50mm, 70mm
Diameter: 16mm, Length: 20mm, 50mm, 70mm, 90mm
Diameter: 20mm, Length: 20mm, 50mm, 70mm, 90mm
Diameter: 25mm, Length: 20mm, 50mm, 70mm, 90mm
Diameter: 30mm, Length: 20mm, 50mm, 70mm, 90mm
Diameter: 35mm, Length: 20mm, 50mm, 70mm, 90mm</Size><SupplierCode>40171</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108588</GroupID><ARTGs><ARTG>187179</ARTG></ARTGs><MinimumBenefit>2616</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BF020</BillingCode><Name>A-Mesh Spinal Titanium Mesh Plate and Set Screw</Name><Description>A-Mesh Spinal Titanium Mesh is designed to restore biomechanical integrity throughout the thoracic and lumbar spine following vertebrectomy or corpectomy for patients with spine tumors or fractures</Description><Size>Diameter 10m 12, 14, 16, 20, 15, 30 or 35mm</Size><SupplierCode>40171</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108589</GroupID><ARTGs><ARTG>187179</ARTG></ARTGs><MinimumBenefit>1030</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC539</BillingCode><Name>Pyramesh</Name><Description>End ring/cap</Description><Size>10 - 25mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108589</GroupID><ARTGs><ARTG>169501</ARTG></ARTGs><MinimumBenefit>1030</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY295</BillingCode><Name>Synmesh</Name><Description>End rings</Description><Size>round/oblong</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108589</GroupID><ARTGs><ARTG>133398</ARTG></ARTGs><MinimumBenefit>1030</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB197</BillingCode><Name>COLLOSSEUM Mesh Endcap</Name><Description>Endcap</Description><Size>12-25mm X 14-30mm, 2-8mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108589</GroupID><ARTGs><ARTG>325140</ARTG></ARTGs><MinimumBenefit>1030</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC821</BillingCode><Name>T2</Name><Description>End Cap</Description><Size>13-31 mm, 0, 4, 8, 15 degree lordosis</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108589</GroupID><ARTGs><ARTG>169501</ARTG></ARTGs><MinimumBenefit>1030</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH658</BillingCode><Name>HTS Leander VBR Endplates</Name><Description>Titanium alloy Endplates available in different widths and angles for adaption to different vertebral body structures</Description><Size>Length 12-14mm; Width 14-16mm; Angle 2.5, 5, 7.5 degrees</Size><SupplierCode>40113</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108589</GroupID><ARTGs><ARTG>372782</ARTG></ARTGs><MinimumBenefit>1030</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB055</BillingCode><Name>Titanium Spinal Mesh</Name><Description>End rings</Description><Size>10 - 24 mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108589</GroupID><ARTGs><ARTG>215887</ARTG></ARTGs><MinimumBenefit>1030</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK424</BillingCode><Name>VBOSS / VLIFT</Name><Description>End cap</Description><Size>Sizes 10 to 25mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108589</GroupID><ARTGs><ARTG>315105</ARTG></ARTGs><MinimumBenefit>1030</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW768</BillingCode><PriorBillingCodes><PriorBillingCode>ER409</PriorBillingCode></PriorBillingCodes><Name>Capri Small Solid Corpectomy Cage System</Name><Description>Non Stackable vertebral body replacement</Description><Size>(12 x14)mm or (13x16)mm footprint</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108591</GroupID><ARTGs><ARTG>291618</ARTG></ARTGs><MinimumBenefit>3340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE758</BillingCode><Name>KONG-C</Name><Description>KONG-C VBR Body</Description><Size>13mm Diameter  16-66mm, Height</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108591</GroupID><ARTGs><ARTG>345871</ARTG></ARTGs><MinimumBenefit>3340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB131</BillingCode><Name>Niko Corpectomy Spacer</Name><Description>PEEK Thoracolumbar pre-assembled corpectomy cage</Description><Size>Width 12 and 14mm, Length 14mm and 16mm, Height 15-33mm in 2mm increments</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108591</GroupID><ARTGs><ARTG>190055</ARTG></ARTGs><MinimumBenefit>3340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB140</BillingCode><Name>Fortify® I-R Static Corpectomy Spacer System -Spacer</Name><Description>PEEK spacer with integrated titanium plates</Description><Size>Footprint - 12 X14mm   Heights 15-33mm (2mm increments)</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108591</GroupID><ARTGs><ARTG>190055</ARTG></ARTGs><MinimumBenefit>3340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW748</BillingCode><PriorBillingCodes><PriorBillingCode>ER138</PriorBillingCode></PriorBillingCodes><Name>Santorini Solid Corpectomy Cage System</Name><Description>Cage, fixed height, Peek</Description><Size>(12x14) or (16x20) mm footprint x (18-62) mm height</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108591</GroupID><ARTGs><ARTG>204117</ARTG></ARTGs><MinimumBenefit>3340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE759</BillingCode><Name>KONG-C</Name><Description>KONG-C VBR Endplates</Description><Size>14x13mm, 16x13mm, 18x14mm  5.5mm Height  0,3 &amp; 6 Degree Angles</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108591</GroupID><ARTGs><ARTG>345871</ARTG></ARTGs><MinimumBenefit>3340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ302</BillingCode><Name>3DFusion VCL Core </Name><Description>3DFusion VCLCore is part of the 3DFusion VCL System, a patient-specific thoraco-lumbar vertebrectomy system intended to immobilize, stabilize and maintain the space between instrumented spinal segments in order to allow bone fusion in the thoraco-lumbar, lumbar or lumbo-sacral spine. </Description><Size>22mm-92mm </Size><SupplierCode>40226</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108591</GroupID><ARTGs><ARTG>406173</ARTG></ARTGs><MinimumBenefit>3340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH763</BillingCode><PriorBillingCodes><PriorBillingCode>LM410</PriorBillingCode></PriorBillingCodes><Name>Axle Interspinous fusion System</Name><Description>Interspinous fusion plate system</Description><Size>Plates: 28mm to 55mm  Inserts: 8-18mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107675</SubCategoryID><GroupID>108592</GroupID><ARTGs><ARTG>160750</ARTG></ARTGs><MinimumBenefit>1321</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV064</BillingCode><Name>Affix Plate</Name><Description>Spinous process plate with an integrated canted-coil locking mechanism.</Description><Size>25mm - 55mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107675</SubCategoryID><GroupID>108592</GroupID><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>1321</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC637</BillingCode><Name>CD Horizon</Name><Description>Spire Plate</Description><Size>35-41mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107675</SubCategoryID><GroupID>108592</GroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>1321</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU032</BillingCode><Name>Romeo 2 PAD System</Name><Description>Interspinous fusion device</Description><Size>8mm to 18mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107675</SubCategoryID><GroupID>108592</GroupID><ARTGs><ARTG>198720</ARTG></ARTGs><MinimumBenefit>1321</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB113</BillingCode><Name>SP-Fix™ Spinous Process Fixation</Name><Description>Posterior non-pedicle supplemental fixation device</Description><Size>35-55mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107675</SubCategoryID><GroupID>108592</GroupID><ARTGs><ARTG>237299</ARTG></ARTGs><MinimumBenefit>1321</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB062</BillingCode><Name>SI-LOK Stabilization System</Name><Description>Fusion Screw</Description><Size>8.0-12.0mm diameter x 25-60mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107676</SubCategoryID><GroupID>108593</GroupID><Suffix>No Suffix</Suffix><ARTGs><ARTG>199414</ARTG></ARTGs><MinimumBenefit>1853</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH759</BillingCode><PriorBillingCodes><PriorBillingCode>LM422</PriorBillingCode></PriorBillingCodes><Name>Silex Joint Fixation Device</Name><Description>Single-Thread Sacroiliac Anchor Implant or Dual-Thread Sacroiliac Anchor Implant</Description><Size>12.5mm x 30-70mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107676</SubCategoryID><GroupID>108593</GroupID><Suffix>No Suffix</Suffix><ARTGs><ARTG>228758</ARTG></ARTGs><MinimumBenefit>1853</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI197</BillingCode><Name>Rialto</Name><Description>SI Fusion System</Description><Size>12mm Dia. 40mm to 60mm Length</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107676</SubCategoryID><GroupID>108593</GroupID><Suffix>No Suffix</Suffix><ARTGs><ARTG>281942</ARTG></ARTGs><MinimumBenefit>1853</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU164</BillingCode><Name>M.U.S.T. Sacro-Iliac Joint Screws and Washers</Name><Description>Headless and Standard Sacro-Iliac Joint Screws and Washers</Description><Size>Headless SI screws: Ø 7.5-11 mm, Lenght 30-100 mm.   Standard SI screws: Ø 8-10 mm, Lenght 25-80 mm.   Washers: Standard version Ø 13-20 mm; Favored angle version Ø 15-20 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107676</SubCategoryID><GroupID>108593</GroupID><Suffix>No Suffix</Suffix><ARTGs><ARTG>301842</ARTG></ARTGs><MinimumBenefit>1853</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE608</BillingCode><Name>iFuse Implant System-Implant</Name><Description>iFuse Implant System-Implant</Description><Size>4-10.75 mm; length 30-90 mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107676</SubCategoryID><GroupID>108593</GroupID><Suffix>No Suffix</Suffix><ARTGs><ARTG>212886</ARTG></ARTGs><MinimumBenefit>1853</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER678</BillingCode><Name>Orthofix Firebird SI Fusion System</Name><Description>Firebird SI Fusion System, cannulated, fenestrated, Ti, sterile</Description><Size>Diameter: 9-12 mm, Length 25-70 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107676</SubCategoryID><GroupID>108593</GroupID><Suffix>No Suffix</Suffix><ARTGs><ARTG>405334</ARTG><ARTG>405333</ARTG></ARTGs><MinimumBenefit>1853</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER345</BillingCode><Name>Signus Diana SI Joint Fusion Device</Name><Description>The DIANA® sacroiliac fusion device is a titanium alloy, tapered hollow cylindrical implant with radial fenestrations to encourage bony in-growth and a threaded outer surface for fixation and stabilisation of the sacroiliac joint.</Description><Size>Tapered design: dia at wide point (13-21 mm) x dia at narrow point (12-20mm) x length 30mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107676</SubCategoryID><GroupID>108593</GroupID><Suffix>No Suffix</Suffix><ARTGs><ARTG>216752</ARTG></ARTGs><MinimumBenefit>1853</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER305</BillingCode><Name>Barricaid</Name><Description>Annular replacement prosthesis</Description><Size>Height: 14mm; Width 8mm, 10mm, 12mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107677</SubCategoryID><GroupID>108594</GroupID><ARTGs><ARTG>273822</ARTG></ARTGs><MinimumBenefit>4954</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK196</BillingCode><Name>Exeter Hip System - ETS (endoprosthesis trauma stem)</Name><Description>Orthinox Stainless Steel Endoprosthesis unipolar monoblock</Description><Size>40mm Offset body with monoblock head sizes 38mm, 40mm, 41mm, 42mm, 43mm, 44mm, 45mm, 46mm, 47mm, 48mm, 49mm, 50mm, 52mm, 54mm, 56mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108607</GroupID><ARTGs><ARTG>255313</ARTG></ARTGs><MinimumBenefit>517</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV041</BillingCode><Name>Profemur Modular Neck</Name><Description>CoCr Femoral Necks</Description><Size>Straight Short &amp; Long, Ante/Retro Varus/ Valgus 1,2 Short &amp; Long, Ante/Retro Short &amp; Long - 8 &amp; 15 degrees</Size><SupplierCode>40177</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108608</GroupID><ARTGs><ARTG>234443</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Description, Size</ChangeExplanation><MinimumBenefit>1029</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT003</BillingCode><PriorBillingCodes><PriorBillingCode>TZ014</PriorBillingCode></PriorBillingCodes><Name>S.F Modula Neck</Name><Description>S.F Modula Neck. Titanium for use with Adler Modular Hip Stems</Description><Size>OX, OY, OZ, OA, OB, OC, 9X, 9Y, 9Z, 9A, 9B, 9C, 9AA, 9BB, 9CC</Size><SupplierCode>40232</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108608</GroupID><ARTGs><ARTG>289075</ARTG></ARTGs><MinimumBenefit>1029</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC029</BillingCode><Name>Modular Neck</Name><Description>Modular Neck Segment - CoCrMo</Description><Size>Size 1-6, Sm &amp; Lg in STD, LAT, AVR/RVL, AVL/RVR</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108608</GroupID><ARTGs><ARTG>210671</ARTG></ARTGs><MinimumBenefit>1029</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI052</BillingCode><Name>Modular Neck for Acor &amp; Integrale Femoral Stems</Name><Description>Titanium neck, with varying alignments &amp; tapers</Description><Size>4 sizes</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108608</GroupID><ARTGs><ARTG>210537</ARTG></ARTGs><MinimumBenefit>1029</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB296</BillingCode><Name>Metha - Modular neck adaptors</Name><Description>Modular neck adaptors made from CoCr</Description><Size>CCD - 130°, 135 °, 140°; Offset  - 0mm, -5mm ,+5mm; Version - 7.5° left ante/right retro, 0 °, 7.5 ° left retro/right ante</Size><SupplierCode>40020</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108608</GroupID><ARTGs><ARTG>126457</ARTG></ARTGs><MinimumBenefit>1029</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI553</BillingCode><Name>M/L Taper Kinectiv Neck</Name><Description>Neck component for M/L taper stem</Description><Size>size K, S, A, E, P, X, B, G, R, C, J, D, K1, S1, AA, E1, P1, X1, K2, E2, BB, G1, R1 ,S2, P2, G2, CC, J1, X2, R2, J2, DD</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108608</GroupID><ARTGs><ARTG>208721</ARTG></ARTGs><MinimumBenefit>1029</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH658</BillingCode><PriorBillingCodes><PriorBillingCode>OO118</PriorBillingCode></PriorBillingCodes><Name>Mutars RS revision system - Proximal component</Name><Description>RS proximal component</Description><Size>127 degrees, 32/42mm, 135 degrees, 32/42mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108608</GroupID><Suffix>Complex (Neck)</Suffix><ARTGs><ARTG>238834</ARTG><ARTG>284587</ARTG></ARTGs><MinimumBenefit>1449</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI271</BillingCode><Name>Trabecular Metal acetabular Medial wall augment</Name><Description>Tantalum disc</Description><Size>26mm, 32mm and 38mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108624</GroupID><ARTGs><ARTG>115915</ARTG></ARTGs><MinimumBenefit>1175</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC025</BillingCode><Name>Delta Hemispheric Acetabular Cup</Name><Description>Delta Hemispheric Acetabular Cup Ti6AI4V</Description><Size>50 - 62mm &amp; Eccentricity 12-18mm</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108624</GroupID><ARTGs><ARTG>210763</ARTG></ARTGs><MinimumBenefit>1175</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI276</BillingCode><Name>Trabecular Metal Acetabular Augment</Name><Description>Tantalum acetabular augment</Description><Size>40 - 70mm x 10, 15, 20 &amp;30mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108624</GroupID><Suffix>Bone Reconstruction</Suffix><ARTGs><ARTG>115915</ARTG></ARTGs><MinimumBenefit>2769</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW473</BillingCode><Name>Restoration Acetabular Wedge Augment System</Name><Description>The Restoration Acetabular Wedge Augment System is designed for hip surgeries requiring additional acetabular component support in cases where host bone is insuficient. 

The Wedge Augments provide the intraoperative flexibility to optimize screw placement.</Description><Size>Outer Diameter 46mm, Inner Diameter 48, Thickness 15mm Screw Holes 3
Outer Diameter 46mm, Inner Diameter 48, Thickness 20mm Screw Holes 4
Outer Diameter 46mm, Inner Diameter 48, Thickness 25mm Screw Holes 4
Outer Diameter 50mm, Inner Diameter 52, Thickness 15mm Screw Holes 3
Outer Diameter 50mm, Inner Diameter 52, Thickness 20mm Screw Holes 4
Outer Diameter 50mm, Inner Diameter 52, Thickness 25mm Screw Holes 4
Outer Diameter 54mm, Inner Diameter 56, Thickness 15mm Screw Holes 4
Outer Diameter 54mm, Inner Diameter 56, Thickness 20mm Screw Holes 6
Outer Diameter 54mm, Inner Diameter 56, Thickness 25mm Screw Holes 6
Outer Diameter 58mm, Inner Diameter 60, Thickness 15mm Screw Holes 6
Outer Diameter 58mm, Inner Diameter 60, Thickness 20mm Screw Holes 6
Outer Diameter 58mm, Inner Diameter 60, Thickness 25mm Screw Holes 6
Outer Diameter 62mm, Inner Diameter 64, Thickness 15mm Screw Holes 6
Outer Diameter 62mm, Inner Diameter 64, Thickness 20mm Screw Holes 8
Outer Diameter 62mm, Inner Diameter 64, Thickness 25mm Screw Holes 8
Outer Diameter 66mm, Inner Diameter 68, Thickness 15mm Screw Holes 6
Outer Diameter 66mm, Inner Diameter 68, Thickness 20mm Screw Holes 8</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108624</GroupID><Suffix>Bone Reconstruction</Suffix><ARTGs><ARTG>192159</ARTG></ARTGs><MinimumBenefit>2769</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN150</BillingCode><Name>Pinnacle Acetabular System</Name><Description>Gripton Ti-Foam Augments</Description><Size>Wedges 52-72, buttress 56-68 or shim 5 to 15 degrees</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108624</GroupID><Suffix>Bone Reconstruction</Suffix><ARTGs><ARTG>248252</ARTG></ARTGs><MinimumBenefit>2769</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL163</BillingCode><Name>REDAPT Acetabular Augment</Name><Description>Titanium Alloy Acetabular Augment</Description><Size>50 to 74mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108624</GroupID><Suffix>Bone Reconstruction</Suffix><ARTGs><ARTG>292977</ARTG></ARTGs><MinimumBenefit>2769</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU165</BillingCode><Name>Mpact Acetabular System</Name><Description>3D Metal Augments</Description><Size>50-80 mm.  Thickness 10 ÷ 30 mm.</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108624</GroupID><Suffix>Bone Reconstruction</Suffix><ARTGs><ARTG>307500</ARTG></ARTGs><MinimumBenefit>2769</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QG005</BillingCode><Name>MRP Titan Locking Bolt</Name><Description>Bolt used to lock together the proximal femoral component to the femoral stem of a modular revision hip system</Description><Size>Short &amp; Long</Size><SupplierCode>39928</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108625</GroupID><ARTGs><ARTG>311586</ARTG></ARTGs><MinimumBenefit>336</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH617</BillingCode><PriorBillingCodes><PriorBillingCode>OO030</PriorBillingCode></PriorBillingCodes><Name>Mutars RS revision system - bolt</Name><Description>RS bolt</Description><Size>40,50,65,75,90,100,115,125mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108625</GroupID><ARTGs><ARTG>250156</ARTG></ARTGs><MinimumBenefit>336</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH696</BillingCode><PriorBillingCodes><PriorBillingCode>OO148</PriorBillingCode></PriorBillingCodes><Name>MUTARS LUMiC Screw, M6</Name><Description>M6 Screw used to bolt the LUMiC Cup and LUMiC Stem together</Description><Size>28mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108625</GroupID><ARTGs><ARTG>250195</ARTG></ARTGs><MinimumBenefit>336</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH691</BillingCode><PriorBillingCodes><PriorBillingCode>OO142</PriorBillingCode></PriorBillingCodes><Name>MUTARS RS screw for coupling device</Name><Description>RS coupling device screw</Description><Size>60-140mm length M8</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108625</GroupID><ARTGs><ARTG>250353</ARTG></ARTGs><MinimumBenefit>336</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH692</BillingCode><PriorBillingCodes><PriorBillingCode>OO144</PriorBillingCode></PriorBillingCodes><Name>MUTARS - M10 Screw</Name><Description>M10 Screw - Tumour System and Arthrodesis Interlocking System</Description><Size>25mm - 245mm Length</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108625</GroupID><ARTGs><ARTG>250194</ARTG></ARTGs><MinimumBenefit>336</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TG006</BillingCode><Name>Securus Modular Revision Hip System</Name><Description>Modular Locking Bolt</Description><Size>One Size</Size><SupplierCode>40373</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108625</GroupID><ARTGs><ARTG>132478</ARTG></ARTGs><MinimumBenefit>336</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO188</BillingCode><Name>Link MP Reconstruction Expansion Bolt</Name><Description>MP Reconstruction Expansion Bolt</Description><Size>41mm, 61mm</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108625</GroupID><ARTGs><ARTG>257495</ARTG></ARTGs><MinimumBenefit>336</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ844</BillingCode><Name>Reclaim Revision Hip System - Bolt</Name><Description>Locking Bolt</Description><Size>75-105mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108625</GroupID><ARTGs><ARTG>242912</ARTG></ARTGs><MinimumBenefit>336</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI860</BillingCode><Name>Segmental Trabecular Proximal Femoral Component - Bolt</Name><Description>4mm Bolt
7mm Bolt
Set Screw</Description><Size>4mm and 7mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108625</GroupID><ARTGs><ARTG>95938</ARTG></ARTGs><MinimumBenefit>336</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC024</BillingCode><Name>Lima Bone Screw</Name><Description>Titanium  Bone Screw</Description><Size>Dia. 4.5mm to 6.5mm
Length 15mm - 90mm</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>168711</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI048</BillingCode><Name>Amplitude Orthopaedic Bone Screw</Name><Description>Titanium cancellous bone screw</Description><Size>Diam 6.5mm, lengths 15 - 55 mm</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>242000</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST545</BillingCode><Name>Osteonics hip prostheses </Name><Description>Cancellous bone screw, Titanium</Description><Size>6.5mm &amp; 5.5mm dia</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>242312</ARTG><ARTG>242299</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI036</BillingCode><Name>Acetabular Cup</Name><Description>Trilogy Bone Screw - Titanium</Description><Size>15 - 60</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW603</BillingCode><Name>METS Trochanter Screw</Name><Description>Titanium</Description><Size>Short, Medium, Long</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>246513</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR070</BillingCode><Name>Titanium Counter Sunk Screw</Name><Description>Titanium Counter Sunk Screw</Description><Size>Lengths 15-70mm</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>106747</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EX006</BillingCode><Name>Novation Crown Cup Screws</Name><Description>Titanium cortical bone screws</Description><Size>Full radius tip: 6.5mm x 15mm, 6.5mm x 20mm, 6.5mm x 25mm, 6.5mm x 30mm, 6.5mm x 35mm, 6.5mm x 40mm, 6.5mm x 45mm, 6.5mm x 50mm, 6.5mm x 55mm, 6.5mm x 60mm, 6.5mm x 70mm; Peripheral Rim screw: 4.5mm x 25mm, 4.5mm x 30mm, 4.5mm x 35mm, 4.5mm x 40mm, 4.5mm x 45mm, 4.5mm x 50mm, 4.5mm x 55mm, 4.5mm x 60mm, 4.5mm x 65mm, 4.5mm x 70mm; Pointed tip: MBA 6.5mm x 15mm, MBA 6.5mm x 20mm, MBA 6.5mm x 25mm, MBA 6.5mm x 30mm, MBA 6.5mm x 35mm, MBA 6.5mm x 40mm, MBA 6.5mm x 45mm, MBA 6.5mm x 50mm, MBA 6.5mm x 55mm, MBA 6.5mm x 60mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>250113</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM041</BillingCode><Name>Universal Cancellous Bone Screws</Name><Description>Cancellous bone screw titanium</Description><Size>15-60mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>181252</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP944</BillingCode><Name>DePuy Hip Bone Screws</Name><Description>Titanium, cancellous screws</Description><Size>Size 3.5-6.5 diameter 5-120mm length</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>99196</ARTG><ARTG>171784</ARTG><ARTG>98086</ARTG><ARTG>150913</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT009</BillingCode><PriorBillingCodes><PriorBillingCode>TZ006</PriorBillingCode></PriorBillingCodes><Name>Adler Bone Screw</Name><Description>Bone Screw for Acetabular Cup</Description><Size>6.5 and 8.5mm Diameter.  15-65mm Length.</Size><SupplierCode>40232</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>237073</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF034</BillingCode><Name>Bone Screw</Name><Description>Titanium, cancellous screw</Description><Size>15mm - 90mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>246581</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM137</BillingCode><Name>Polar Cup Acetabular Screws</Name><Description>Stainless Steel Cortical Screws</Description><Size>4.5mm by 40-60mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>181252</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB238</BillingCode><Name>Acetabular Fixation Screws</Name><Description>Isotan</Description><Size>16mm-68mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>98978</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV036</BillingCode><Name>Bone Screw</Name><Description>Cancellous Bone Screw Titanium</Description><Size>6.5mm x 1.5 – 6 cm in 0.5cm increments</Size><SupplierCode>40177</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>247558</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH438</BillingCode><Name>Samo Acetabular Cup bone screw</Name><Description>Bone screw</Description><Size>20 - 40 mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>165470</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WN007</BillingCode><PriorBillingCodes><PriorBillingCode>RL006</PriorBillingCode></PriorBillingCodes><Name>Orthopaedic bone screw, non-biodegradable</Name><Description>Acetabular shell cancellous bone screw</Description><Size>8 x sized from 20mm - 60mm</Size><SupplierCode>40384</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>237105</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UK027</BillingCode><PriorBillingCodes><PriorBillingCode>GO261</PriorBillingCode></PriorBillingCodes><Name>Novae Double Cup Cortical Bone Screw</Name><Description>Cortical Bone Screw</Description><Size>5mm diameter, 30 to 65mm length in 5mm increments</Size><SupplierCode>40267</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>246511</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TG001</BillingCode><Name>JRI CSF Hip System</Name><Description>CSF Bone Screws, Titanium Alloy</Description><Size>15mm - 50mm</Size><SupplierCode>40373</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>132409</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU127</BillingCode><Name>Medacta Cortical Bone Screws</Name><Description>Titanium cortical bone screws</Description><Size>25 - 70 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>219907</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU014</BillingCode><Name>Medacta Acetabular Screws</Name><Description>Titanium, cancellous screws</Description><Size>6.5 L 15-70mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>219907</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT026</BillingCode><PriorBillingCodes><PriorBillingCode>TZ030</PriorBillingCode></PriorBillingCodes><Name>Pantheon Flat Plate Compression Screw</Name><Description>Ti6Al4V Screw </Description><Size>Short, Medium, Long</Size><SupplierCode>40232</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>237073</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH618</BillingCode><Name>Mutars RS revision system - bone screws</Name><Description>RS bone screw</Description><Size>25mm, 30mm, 35mm, 40mm, 45mm, 50mm, 55mm, 60mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>237075</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI047</BillingCode><Name>Femoral Shaft Locking Screw</Name><Description>Titanium femoral locking screw</Description><Size>6.2 diameter, 13 lengths 20-80 in 5mm increments</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>135326</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW011</BillingCode><Name>ABG Hip System</Name><Description>Bone screw - Titanium, used with ABG11 Cups</Description><Size>12,15,20,25,30,35,40,45 and 50mm lengths</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>242299</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF012</BillingCode><Name>Atlas Acetabular Cup System</Name><Description>Screw</Description><Size>Atlas Screw Dia 6.5mm 15-50mm L</Size><SupplierCode>40106</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>141168</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI109</BillingCode><Name>G7 Acetabular Low Profile Dome Screw and Biomet Low Profile Self Tapping Bone Screw</Name><Description>Screw, Acetabular</Description><Size>6.5mm dia x (15 - 70)mm length</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>210290</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW047</BillingCode><Name>Exeter Hip System</Name><Description>X-Change Bone Screws -  Stainless Steel</Description><Size>3.5mm X 10, 15, 20, 25, 30, 35mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>128022</ARTG><ARTG>16232</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA514</BillingCode><Name>Acetabular Screws</Name><Description>Titanium cancellous bone screws</Description><Size>varying lengths and sizes</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108626</GroupID><ARTGs><ARTG>241996</ARTG></ARTGs><MinimumBenefit>111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI024</BillingCode><Name>Zimmer 'VerSys CRC Hip Systems</Name><Description>Modular Calcar Block</Description><Size>13/15 x 10-30mm &amp; 17/19 x 10-30mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108627</GroupID><ARTGs><ARTG>246833</ARTG></ARTGs><MinimumBenefit>480</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU183</BillingCode><Name>MectaPlug PE II</Name><Description>Cement restrictor</Description><Size>5 sizes  from Ø8 to Ø30</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108628</GroupID><ARTGs><ARTG>229714</ARTG></ARTGs><MinimumBenefit>100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO106</BillingCode><Name>LINK Intramedullary Plug</Name><Description>P/E Intramedullary Plug</Description><Size>12 to 20 mm</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108628</GroupID><ARTGs><ARTG>157547</ARTG></ARTGs><MinimumBenefit>100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN263</BillingCode><Name>Buck</Name><Description>Cement Restrictor</Description><Size>13 - 35mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108628</GroupID><ARTGs><ARTG>140410</ARTG></ARTGs><MinimumBenefit>100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF036</BillingCode><Name>Cement Pug</Name><Description>UHMWPE Cement Plug</Description><Size>14 - 35mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108628</GroupID><ARTGs><ARTG>246579</ARTG></ARTGs><MinimumBenefit>100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP233</BillingCode><Name>Hardinge Cement Restrictor</Name><Description>Hardinge cement Restrictor (ea)</Description><Size>One size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108628</GroupID><ARTGs><ARTG>137671</ARTG></ARTGs><MinimumBenefit>100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ754</BillingCode><Name>DePuy Femoral Cement Restrictor</Name><Description>UHMWPE cement restrictor</Description><Size>Size 0 to 10</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108628</GroupID><ARTGs><ARTG>138869</ARTG><ARTG>97695</ARTG></ARTGs><MinimumBenefit>100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI356</BillingCode><Name>Medullary Plug, MS 30</Name><Description>Centring Plug, cement restrictor, hip - PE</Description><Size>2 to 7</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108628</GroupID><ARTGs><ARTG>100394</ARTG></ARTGs><MinimumBenefit>100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI226</BillingCode><Name>Zimmer Bone Plug</Name><Description>Allen Medullary Plug</Description><Size>8 - 23mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108628</GroupID><ARTGs><ARTG>115913</ARTG></ARTGs><MinimumBenefit>100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW001</BillingCode><Name>Hardinge Cement Restrictor</Name><Description>PMMA</Description><Size>6,9 and 12 Leaf</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108628</GroupID><ARTGs><ARTG>289666</ARTG></ARTGs><MinimumBenefit>100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA018</BillingCode><Name>Intramedullary Plug</Name><Description>Cement Restricter</Description><Size>Small to Extra Large</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108628</GroupID><ARTGs><ARTG>241997</ARTG></ARTGs><MinimumBenefit>100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR041</BillingCode><Name>Canal Occluder</Name><Description>Cement plug, UHMWPE, multi-layered</Description><Size>08/10mm, 12/14mm, 16/18mm,20/22mm and universal.</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108628</GroupID><ARTGs><ARTG>106747</ARTG></ARTGs><MinimumBenefit>100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH643</BillingCode><PriorBillingCodes><PriorBillingCode>OO102</PriorBillingCode></PriorBillingCodes><Name>IC Intramedullary Plug</Name><Description>Intramedullary Plug</Description><Size>9mm, 14mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108628</GroupID><ARTGs><ARTG>208322</ARTG></ARTGs><MinimumBenefit>100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK505</BillingCode><Name>BioPrep Bone Preparation System</Name><Description>Femoral Preparation Kit with cement restrictor</Description><Size>18.5 - 25mm O.D.</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108628</GroupID><ARTGs><ARTG>139937</ARTG></ARTGs><MinimumBenefit>100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST582</BillingCode><Name>Osteonics hip prostheses </Name><Description>Cement restrictor Polyethylene</Description><Size>Universal and sizes 1-8</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108628</GroupID><ARTGs><ARTG>289666</ARTG></ARTGs><MinimumBenefit>100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU111</BillingCode><Name>MectaPlug PE</Name><Description>Cement Restrictor</Description><Size>12 - 30 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108628</GroupID><ARTGs><ARTG>229714</ARTG></ARTGs><MinimumBenefit>100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI131</BillingCode><Name>Mallory Head Hip System</Name><Description>Femoral Centraliser, UHMWPE</Description><Size>9-17mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108629</GroupID><ARTGs><ARTG>98097</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI092</BillingCode><Name>E2 PMMA Centraliser</Name><Description>PMMA distal Centraliser</Description><Size>20mm</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108629</GroupID><ARTGs><ARTG>260435</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK315</BillingCode><Name>Exeter Hip System</Name><Description>Exeter Distal Centraliser -PMMA</Description><Size>One Size Only</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108629</GroupID><ARTGs><ARTG>289666</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV039</BillingCode><Name>Cement Centraliser</Name><Description>Profemur XM Cement Centraliser</Description><Size>N/A</Size><SupplierCode>40177</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108629</GroupID><ARTGs><ARTG>247578</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU002</BillingCode><Name>Medacta Femoral Stem Distal centraliser</Name><Description>PMMA</Description><Size>Distal centraliser, various sizes</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108629</GroupID><ARTGs><ARTG>233996</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF030</BillingCode><Name>PMMA Centraliser</Name><Description>PMMA centraliser used for cemented total hip arthroplasty</Description><Size>Size 10mm, 11mm, 12mm, 13mm, 14mm, 15mm, 17mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108629</GroupID><ARTGs><ARTG>246578</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ963</BillingCode><Name>DePuy Hip Systems</Name><Description>Distal femoral centralisers</Description><Size>8 to 20mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108629</GroupID><ARTGs><ARTG>137671</ARTG><ARTG>97695</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU187</BillingCode><Name>Medacta Femoral Stem Proximal Centraliser</Name><Description>PMMA Proximal centraliser</Description><Size>Proximal Centraliser, various sizes</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108629</GroupID><ARTGs><ARTG>233996</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC150</BillingCode><Name>Proximal Centraliser PMMA</Name><Description>Proximal Centraliser PMMA</Description><Size>Left &amp; Right Size 0-3</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108629</GroupID><ARTGs><ARTG>186627</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN269</BillingCode><Name>CPCS</Name><Description>Polished Cemented Stem Distal Centraliser</Description><Size>8 - 18</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108629</GroupID><ARTGs><ARTG>230144</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN359</BillingCode><Name>Invis</Name><Description>Distal Centraliser PMMA</Description><Size>size 1-5, 7 - 21mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108629</GroupID><ARTGs><ARTG>230144</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST581</BillingCode><Name>Osteonics hip prostheses</Name><Description>Distal spacer  PMMA</Description><Size>8-15mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108629</GroupID><ARTGs><ARTG>141275</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI374</BillingCode><Name>MS-30 Hip prosthesis </Name><Description>Centralizer for Cemented Stems </Description><Size>8 to 20</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108629</GroupID><ARTGs><ARTG>242597</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB245</BillingCode><Name>Distal centraliser</Name><Description>PMMA</Description><Size>7mm - 18mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108629</GroupID><ARTGs><ARTG>123313</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI013</BillingCode><Name>Zimmer distal centralisers CPT, VerSys, Natural and MS30</Name><Description> PMMA Centraliser  </Description><Size>Size 1</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108629</GroupID><ARTGs><ARTG>95938</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI021</BillingCode><Name>Zimmer Hip Systems Femoral Stem</Name><Description>VerSys Distal Centraliser - PMMA</Description><Size>10 - 18</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108629</GroupID><ARTGs><ARTG>95938</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI124</BillingCode><Name>ARCOS Modular Femoral Revision System</Name><Description>Trochanteric Claw, Titanium</Description><Size>Large, Small</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108630</GroupID><ARTGs><ARTG>145218</ARTG></ARTGs><MinimumBenefit>387</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI125</BillingCode><Name>ARCOS Modular Femoral Revision System</Name><Description>Trochanteric Connector (includes bolt and button)</Description><Size>Sizes 24-54mm Bolt  Size 25mm Button</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108631</GroupID><ARTGs><ARTG>246835</ARTG><ARTG>145218</ARTG></ARTGs><MinimumBenefit>387</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN295</BillingCode><Name>Reflection</Name><Description>Threaded hole cover (Reflection)</Description><Size>One size only</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108632</GroupID><ARTGs><ARTG>238632</ARTG></ARTGs><MinimumBenefit>131</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF141</BillingCode><Name>C2 Hole Eliminator</Name><Description>Titanium Screw Hole Plug</Description><Size>6.3 x 3.2mm, 11.3 x 4.2mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108632</GroupID><ARTGs><ARTG>246580</ARTG></ARTGs><MinimumBenefit>131</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY077</BillingCode><Name>Apex Hole eliminator </Name><Description>Hole eliminator screw Titanium</Description><Size>48 - 66 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108632</GroupID><ARTGs><ARTG>238812</ARTG></ARTGs><MinimumBenefit>131</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI102</BillingCode><Name>C2 Hole Eliminator</Name><Description>Titanium Screw Hole Plug</Description><Size>6.3 x 3.2mm, 11.3 x 4.2mm</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108632</GroupID><ARTGs><ARTG>260435</ARTG></ARTGs><MinimumBenefit>131</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST551</BillingCode><Name>Osteonics Hip Prostheses</Name><Description>Dome hole plug titanium</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108632</GroupID><ARTGs><ARTG>300154</ARTG></ARTGs><MinimumBenefit>131</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI622</BillingCode><Name>Continuum Acetabular System</Name><Description>Continuum Hole Plugs</Description><Size>One Size - Dome Hole Plug  One Size - Screw Hole Plug</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108632</GroupID><ARTGs><ARTG>243774</ARTG></ARTGs><MinimumBenefit>131</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TG016</BillingCode><Name>Securus Modular Revision Hip System</Name><Description>Modular Body Cap</Description><Size>One size</Size><SupplierCode>40373</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108632</GroupID><ARTGs><ARTG>132478</ARTG></ARTGs><MinimumBenefit>131</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST569</BillingCode><Name>Head Taper Insert</Name><Description>Neck extention, vitallium alloy</Description><Size>-4 TO +12mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108633</GroupID><ARTGs><ARTG>255353</ARTG></ARTGs><MinimumBenefit>266</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH037</BillingCode><Name>Biolox Delta Option Taper</Name><Description>Taper Sleeve, Titanium</Description><Size>-6mm, -3mm, Std, +3mm and +6mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108633</GroupID><ARTGs><ARTG>117715</ARTG></ARTGs><MinimumBenefit>266</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY403</BillingCode><Name>Cathcart Taper Insert</Name><Description>CoCr head taper insert for use with Unipolar Head (DY402)</Description><Size>-3 to +10mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108633</GroupID><ARTGs><ARTG>255314</ARTG></ARTGs><MinimumBenefit>266</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT008</BillingCode><PriorBillingCodes><PriorBillingCode>TZ017</PriorBillingCode></PriorBillingCodes><Name>Adler Revision Sleeve</Name><Description>Adler revision femoral head titanium sleeve</Description><Size>Short, Medium, Long, X-Long</Size><SupplierCode>40232</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108633</GroupID><ARTGs><ARTG>296609</ARTG></ARTGs><MinimumBenefit>266</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN307</BillingCode><Name>Unipolar</Name><Description>Taper Sleeve Co Cr</Description><Size>12/14 and 14/16 tapers, +0,-3,+4,+8,+12mm.</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108633</GroupID><ARTGs><ARTG>229993</ARTG><ARTG>242995</ARTG></ARTGs><MinimumBenefit>266</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI567</BillingCode><Name>Zimmer Hip System</Name><Description>VerSys Endo Adaptors</Description><Size>+7.0mm; +10.5mm; +14.0mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108634</GroupID><ARTGs><ARTG>95938</ARTG></ARTGs><MinimumBenefit>436</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK482</BillingCode><Name>Stryker Neck Taper Adaptor</Name><Description>Adaptor Sleeve for Stryker stems</Description><Size>Offset -2.5mm to +4mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108634</GroupID><ARTGs><ARTG>224747</ARTG><ARTG>236777</ARTG></ARTGs><MinimumBenefit>436</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR300</BillingCode><PriorBillingCodes><PriorBillingCode>GO292</PriorBillingCode></PriorBillingCodes><Name>BioBall - Revision Neck Adaptor</Name><Description>Titanium, varying tapers &amp; lengths, for ceramic &amp; metal heads</Description><Size>Types: 12/14, 14/16, V40, PCA, ABG, 11/13, SROM, 10/12, 8/10  Sizes:  S, M, L, XL, 2XL, 3XL, 4XL, 5XL  Options: Standard, Offset</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108634</GroupID><ARTGs><ARTG>276306</ARTG></ARTGs><MinimumBenefit>436</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC190</BillingCode><Name>BioBall - Revision Neck Adaptor</Name><Description>Titanium, varying tapers &amp; lengths, for ceramic &amp; metal heads</Description><Size>8/10 standard, 8/10 offset
10/12 standard, 10/12 offset
12/14 standard, 12/14 offset
14/16 standard,14/16 offset
V40 standard, V40 offset,
PCA standard, PCA offset
Type 1 standard 
11/13 standard, 11/13 offset
S - 5XL standard
M-5XL offset</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108634</GroupID><ARTGs><ARTG>227099</ARTG></ARTGs><MinimumBenefit>436</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI902</BillingCode><Name>ZMR Compression Nut</Name><Description>Compression Nut</Description><Size>One Size</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108635</GroupID><ARTGs><ARTG>259942</ARTG></ARTGs><MinimumBenefit>172</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN292</BillingCode><Name>Reflection</Name><Description>Fixation peg Titanium Alloy</Description><Size>15mm, 25mm, 35mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108636</GroupID><ARTGs><ARTG>238633</ARTG></ARTGs><MinimumBenefit>159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW588</BillingCode><Name>Steinmann Pins</Name><Description>Titanium Steinmann Pins</Description><Size>Ø5mm x 300mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108636</GroupID><ARTGs><ARTG>246513</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WN008</BillingCode><PriorBillingCodes><PriorBillingCode>RL005</PriorBillingCode></PriorBillingCodes><Name>Acetabulum prosthesis apical hole plug</Name><Description>This is a screw hole plug intended to close the screw holes of a two-piece acetabular prosthesis.  It is screwed into place after implantation of the acetabular component at the discretion of the surgeon.</Description><Size>One size M10 screw hole plug</Size><SupplierCode>40384</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108637</GroupID><ARTGs><ARTG>237111</ARTG></ARTGs><MinimumBenefit>135</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI130</BillingCode><Name>Bio-Plug Cement Restrictor</Name><Description>Canal Plug, UHMWPE</Description><Size>7-20mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108637</GroupID><ARTGs><ARTG>98097</ARTG></ARTGs><MinimumBenefit>135</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU017</BillingCode><Name>Medacta Acetabular Plug</Name><Description>Titanium Plug</Description><Size>no sizes</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108637</GroupID><ARTGs><ARTG>237072</ARTG></ARTGs><MinimumBenefit>135</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI122</BillingCode><Name>Amplitude C2 Acetabular Cup Base Hole Cover</Name><Description>Titanium Base Hole Cover</Description><Size>One size only</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108637</GroupID><ARTGs><ARTG>368571</ARTG></ARTGs><MinimumBenefit>135</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB277</BillingCode><Name>Excia Hip System</Name><Description>Cement plug</Description><Size>8mm-18mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108637</GroupID><ARTGs><ARTG>123313</ARTG></ARTGs><MinimumBenefit>135</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC149</BillingCode><Name>Lima Plug and hood </Name><Description>UHMWPE Cement Plug with distal femoral stem hood</Description><Size>10mm - 20mm</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108638</GroupID><ARTGs><ARTG>186627</ARTG></ARTGs><MinimumBenefit>236</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC151</BillingCode><Name>Cement Plug UHMWPE</Name><Description>UHMWPE Cement Restrictor / Plug</Description><Size>Size 1 - 3</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108638</GroupID><ARTGs><ARTG>186627</ARTG></ARTGs><MinimumBenefit>236</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI140</BillingCode><Name>Mallory Head Hip System</Name><Description>Acetabular Shell, Ringloc.  Replacement Ring, Titanium alloy</Description><Size>Size 1</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108640</GroupID><ARTGs><ARTG>98098</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP250</BillingCode><Name>Duraloc Dynamic Locking Ring</Name><Description>Titanium locking Ring for Duraloc insert, seperately listed, only for revision</Description><Size>Size 36-76mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108640</GroupID><ARTGs><ARTG>138292</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN701</BillingCode><Name>Reflection</Name><Description>Constrained acetabular liner - adaptor ring</Description><Size>42 - 76mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108640</GroupID><ARTGs><ARTG>218153</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN284</BillingCode><Name>Screws</Name><Description>Cancellous, Peripheral, Spherical Head, REDAPT Locking</Description><Size>15mm - 70mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108641</GroupID><ARTGs><ARTG>230143</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO031</BillingCode><Name>LINK Endo-Model Partial Pelvis Replacement</Name><Description>Fixation Screws, for Obturator Foramen, including screw lock</Description><Size>20mm - 35mm; four (4) sizes</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108641</GroupID><ARTGs><ARTG>140660</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TG010</BillingCode><Name>Securus Modular Revision Hip System</Name><Description>Distal locking screws</Description><Size>30-70mm</Size><SupplierCode>40373</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108641</GroupID><ARTGs><ARTG>132409</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH629</BillingCode><PriorBillingCodes><PriorBillingCode>OO043</PriorBillingCode></PriorBillingCodes><Name>IC bone screw</Name><Description>Cancellous bone screw</Description><Size>6.5mm x 15/20/25/30/35/40/45/50/55/60/65/70/75/80/85mm length.</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108641</GroupID><ARTGs><ARTG>237075</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GG013</BillingCode><PriorBillingCodes><PriorBillingCode>CR221</PriorBillingCode></PriorBillingCodes><Name>SMR Locking Screw</Name><Description>Locking Screw for Proximal Body to Stem</Description><Size>40 to 70mm</Size><SupplierCode>40371</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108641</GroupID><ARTGs><ARTG>246519</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW587</BillingCode><Name>Bone Screws</Name><Description>Titanium Bone Screws</Description><Size>Ø4.5mm 50mm &amp; 80mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108641</GroupID><ARTGs><ARTG>246513</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI399</BillingCode><Name>Cancellous Screws</Name><Description>Screws- Cancell - Ti alloy</Description><Size>6.5/15 to 6.5/70mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108641</GroupID><ARTGs><ARTG>100337</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA090</BillingCode><Name>Arcos Modular Femoral Revision System</Name><Description>Distal Interlocking Stem Screws</Description><Size>25-60mm length</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108641</GroupID><ARTGs><ARTG>145406</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI117</BillingCode><Name>Ceramic Head Revision Sleeve</Name><Description>Titanium Sleeve</Description><Size>10/12 and 12/14 Taper  Short, Medium, Long and Extra-Long</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108642</GroupID><ARTGs><ARTG>281067</ARTG></ARTGs><MinimumBenefit>218</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF024</BillingCode><Name>Taper Sleeve</Name><Description>Taper Sleeve for femoral head</Description><Size>taper sleeve: 12/14 -3.5mm, 12/14 +0mm, 12/14 +3.5mm, 12/14 +7mm, 12/14 +10mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108642</GroupID><ARTGs><ARTG>298300</ARTG></ARTGs><MinimumBenefit>218</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST821</BillingCode><Name>Titanium Adapter Sleeve</Name><Description>For use with new ceramic heads</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108642</GroupID><ARTGs><ARTG>288040</ARTG></ARTGs><MinimumBenefit>218</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF013</BillingCode><Name>Pharo</Name><Description>Intermediate Sleeve</Description><Size>-5 to +10 (six sizes)</Size><SupplierCode>40106</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108642</GroupID><ARTGs><ARTG>141168</ARTG></ARTGs><MinimumBenefit>218</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM166</BillingCode><Name>Biolox Option Sleeves</Name><Description>Biolox Option Titianium Sleeves</Description><Size>S to XL - 12/14</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108642</GroupID><ARTGs><ARTG>430154</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Description, Size</ChangeExplanation><MinimumBenefit>218</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM168</BillingCode><Name>Revision Delta Ceramic Femoral Head Sleeve</Name><Description>Biolox Option Sleeve</Description><Size>&gt;32mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108642</GroupID><ARTGs><ARTG>236061</ARTG></ARTGs><MinimumBenefit>218</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU116</BillingCode><Name>Mectacer Biolox Option Sleeves</Name><Description>Biolox Option Titanium Sleeve</Description><Size>S, M, L, XL</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108642</GroupID><ARTGs><ARTG>206685</ARTG></ARTGs><MinimumBenefit>218</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI953</BillingCode><Name>Stage One Select Hip Mould</Name><Description>Modular Spacer Mould, Stainless Steel, Silicon.</Description><Size>Stem 9 - 17mm  Head 43 - 64 Head</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108643</GroupID><ARTGs><ARTG>232624</ARTG></ARTGs><MinimumBenefit>1309</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UK003</BillingCode><PriorBillingCodes><PriorBillingCode>ER295</PriorBillingCode></PriorBillingCodes><Name>Spacer-G</Name><Description>Temporary implantable device for the treatment of infected total hip replacement, Composition - stainless steel core surrounded by PMMA impregnated with Gentamicin</Description><Size>Short Stems,  Head size 46mm, 54mm, 60mm</Size><SupplierCode>40267</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108643</GroupID><ARTGs><ARTG>155142</ARTG></ARTGs><MinimumBenefit>1309</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC203</BillingCode><Name>SpaceFlex Hip</Name><Description>Modular Hip Spacer Mold</Description><Size>10mm  13mm  15mm</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108643</GroupID><ARTGs><ARTG>329464</ARTG></ARTGs><MinimumBenefit>1309</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UK031</BillingCode><Name>Spacer-G Flat Stem</Name><Description>Temporary implantable device for the treatment of infected total hip replacement, Composition - stainless steel core surrounded by PMMA impregnated with Gentamicin.</Description><Size>46 mm head - 96mm flat stem  54 mm head - 94 mm flat stem  60 mm head - 96mm flat stem  46 mm head - 211mm flat stem  54 mm head - 209mm flat stem  60 mm head - 211mm flat stem</Size><SupplierCode>40267</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108643</GroupID><ARTGs><ARTG>387273</ARTG></ARTGs><MinimumBenefit>1309</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UK004</BillingCode><PriorBillingCodes><PriorBillingCode>ER296</PriorBillingCode></PriorBillingCodes><Name>Spacer-G</Name><Description>Temporary implantable device for the treatment of infected total hip replacement, Composition - stainless steel core surrounded by PMMA impregnated with Gentamicin</Description><Size>Long Stems, Head size 46mm, 54mm, 60mm</Size><SupplierCode>40267</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108643</GroupID><ARTGs><ARTG>155142</ARTG></ARTGs><MinimumBenefit>1309</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW602</BillingCode><Name>METS Trochanter plate</Name><Description>Titanium with plasma spray of titanium and HA</Description><Size>One size</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108645</GroupID><ARTGs><ARTG>246512</ARTG></ARTGs><MinimumBenefit>387</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT024</BillingCode><PriorBillingCodes><PriorBillingCode>TZ028</PriorBillingCode></PriorBillingCodes><Name>Pantheon Flat Plate with Spikes</Name><Description>Ti6Ai4V Plate with spikes on inner surface, screw and cable compatibility for Trochanter</Description><Size>L50, L70</Size><SupplierCode>40232</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108645</GroupID><ARTGs><ARTG>340794</ARTG></ARTGs><MinimumBenefit>387</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT027</BillingCode><PriorBillingCodes><PriorBillingCode>TZ031</PriorBillingCode></PriorBillingCodes><Name>Cortical Plate </Name><Description>Titanium plate either rough with HA or porous Ti-Por used as a flange for femoral or tibial prosthesis</Description><Size>30 to 70mm</Size><SupplierCode>40232</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108645</GroupID><ARTGs><ARTG>340794</ARTG></ARTGs><MinimumBenefit>387</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI861</BillingCode><Name>Segmental Trabeculer Metal Proximal Femoral Component - Washer</Name><Description>4mm Flat Washer
&amp;mm Flat Washer
4mm Curved Washer</Description><Size>4mm and 7mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108647</GroupID><ARTGs><ARTG>95938</ARTG></ARTGs><MinimumBenefit>484</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW642</BillingCode><Name>METS Trochanter Reattachment Wire</Name><Description>CoCr</Description><Size>0.6m</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108648</GroupID><ARTGs><ARTG>246517</ARTG></ARTGs><MinimumBenefit>67</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP224</BillingCode><Name>Charnley &amp; Wroblewski Trochanteric Spring Wire</Name><Description>Stainless steel wire for trochanteric attachment</Description><Size>0.5-3.00mm, 18 to 20g</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108649</GroupID><ARTGs><ARTG>99178</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC023</BillingCode><Name>DELTA Coupling / Spacer / Liner</Name><Description>DELTA Coupling / Spacer / Adaptor / Liner</Description><Size>Size Small to Extra Large  Angle (In degrees) 0 to 20  Offset +5</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108650</GroupID><ARTGs><ARTG>210771</ARTG></ARTGs><MinimumBenefit>1309</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH695</BillingCode><PriorBillingCodes><PriorBillingCode>OO147</PriorBillingCode></PriorBillingCodes><Name>MUTARS LUMiC Stem</Name><Description>Stems for use with a modular partial pelvic replacement and acetabula reconstruction device in case of large bone defects</Description><Size>10mm x 65, 75, 85mm, 8mm x 65, 75, 85mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107681</SubCategoryID><GroupID>108651</GroupID><ARTGs><ARTG>236007</ARTG><ARTG>236018</ARTG></ARTGs><MinimumBenefit>5833</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI031</BillingCode><Name>Oxford Meniscal Knee System Uni Femoral Component </Name><Description>Uni Femoral Component, CoCr, Cemented (Phase III)</Description><Size>Extra Small, Small, Medium, Large, Extra Large.</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107683</SubCategoryID><GroupID>108657</GroupID><ARTGs><ARTG>206918</ARTG><ARTG>206172</ARTG></ARTGs><MinimumBenefit>2007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA451</BillingCode><Name>BalanSys UNI femoral component </Name><Description>Uni Femoral component, cemented CoCr</Description><Size>A, B,C,D,E</Size><SupplierCode>40172</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107683</SubCategoryID><GroupID>108657</GroupID><ARTGs><ARTG>212827</ARTG></ARTGs><MinimumBenefit>2007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK585</BillingCode><Name>Restoris MCK Knee - Femeral Component</Name><Description>Femeral Component</Description><Size>LM/RL sizes 1 to 8  RM/LL sizes 1 to 8</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107683</SubCategoryID><GroupID>108657</GroupID><ARTGs><ARTG>242176</ARTG></ARTGs><MinimumBenefit>2007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA075</BillingCode><Name>Persona Partial Knee System</Name><Description>Femoral component</Description><Size>Sizes 1-8</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107683</SubCategoryID><GroupID>108657</GroupID><ARTGs><ARTG>336793</ARTG></ARTGs><MinimumBenefit>2007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR083</BillingCode><Name>Triathlon PKR - Cemented Femoral Component</Name><Description>Triathlon PKR - Uni Femoral Component, CoCR, Cemented</Description><Size>12 -Femurs in total: 1 through to 6, Left Media/Right lateral + 1 through to 6, Right Media/Left Lateral</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107683</SubCategoryID><GroupID>108657</GroupID><ARTGs><ARTG>224840</ARTG></ARTGs><MinimumBenefit>2007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT012</BillingCode><PriorBillingCodes><PriorBillingCode>TZ023</PriorBillingCode></PriorBillingCodes><Name>Genus Uni Cemented Femoral Component</Name><Description>Genus Uni - unicompartmental Knee Femoral Component - Cemented</Description><Size>RM/LL and LM/RL Sizes 1-6</Size><SupplierCode>40232</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107683</SubCategoryID><GroupID>108657</GroupID><ARTGs><ARTG>287896</ARTG></ARTGs><MinimumBenefit>2007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ781</BillingCode><Name>Sigma HP Unicompartmental Knee - Unicondylar femoral component</Name><Description>Unicompartmental femoral component, cemented, CoCr</Description><Size>Size 1-6, LM/RL &amp; RM/LL</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107683</SubCategoryID><GroupID>108657</GroupID><ARTGs><ARTG>223246</ARTG></ARTGs><MinimumBenefit>2007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU060</BillingCode><Name>Unicompartmental femoral component</Name><Description>cemented unicompartmental femoral component</Description><Size>1 to 4</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107683</SubCategoryID><GroupID>108657</GroupID><ARTGs><ARTG>223021</ARTG></ARTGs><MinimumBenefit>2007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO059</BillingCode><Name>LINK Endo-Model SLED Uni femoral componet</Name><Description>Uni Femoral Component, cemented, CoCr</Description><Size>Short, medium-short, medium &amp; large</Size><SupplierCode>40190</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107683</SubCategoryID><GroupID>108657</GroupID><ARTGs><ARTG>271932</ARTG></ARTGs><MinimumBenefit>2007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM156</BillingCode><Name>Journey Uni Femur-Oxinium</Name><Description>Uni Femur - Oxinium - It is UniCondylar Femur</Description><Size>Size 1 to Size 7 Please refer to the pocket guide</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107683</SubCategoryID><GroupID>108658</GroupID><Suffix>Ceramic Surface</Suffix><ARTGs><ARTG>206258</ARTG></ARTGs><MinimumBenefit>2464</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI127</BillingCode><Name>NexGen Knee Tibial Baseplate</Name><Description>Baseplate All Poly, cemented, UHMWPE</Description><Size>1 - 10</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108660</GroupID><ARTGs><ARTG>222316</ARTG><ARTG>226648</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW663</BillingCode><Name>Triathlon All Polyethylene Tibial Component - CS</Name><Description>All poly monoblock tibial baseplate.</Description><Size>1-8</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108660</GroupID><ARTGs><ARTG>220722</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN869</BillingCode><Name>Genesis II Knee System Tibial Baseplate</Name><Description>Tibial Baseplate, all poly, cemented</Description><Size>Left / Right 1 - 8</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108660</GroupID><ARTGs><ARTG>242033</ARTG><ARTG>242853</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR289</BillingCode><PriorBillingCodes><PriorBillingCode>GO256</PriorBillingCode></PriorBillingCodes><Name>Apex Revision Knee System</Name><Description>A modular tibial baseplate</Description><Size>sizes 1-6</Size><SupplierCode>39996</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><Suffix>Revision</Suffix><ARTGs><ARTG>311061</ARTG></ARTGs><MinimumBenefit>2647</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA093</BillingCode><Name>Persona Revision Tibia Fixed Non-Porous</Name><Description>Fixed Tibial component made of Tivanium® for cemented use.</Description><Size>A, B, C, D, E, F, G, H, J in Left and Right configurations</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><Suffix>Revision</Suffix><ARTGs><ARTG>374551</ARTG></ARTGs><MinimumBenefit>2647</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA509</BillingCode><Name>Balansys Revision Knee, Tibial Plateau</Name><Description>Revision Tibial Baseplate, modular</Description><Size>64 to 85</Size><SupplierCode>40172</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><Suffix>Revision</Suffix><ARTGs><ARTG>209537</ARTG></ARTGs><MinimumBenefit>2647</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR034</BillingCode><Name>Triathlon TS Knee System Tibial Baseplate </Name><Description>Tibial baseplate, stemmed revision, cemented, CoCr</Description><Size>1 to 8</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>218001</ARTG></ARTGs><MinimumBenefit>2647</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI867</BillingCode><Name>NexGen Stemmed Tibial Component - cemented</Name><Description>Stemmed tibial baseplate, cemented,for fixed insert, titanium PMMA coated, with capacity for augment and stem attachment</Description><Size>1-10</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>227159</ARTG></ARTGs><MinimumBenefit>2647</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA020</BillingCode><Name>Optetrak Logic Tibial Tray</Name><Description>Tibial Baseplate, titanium, fixed insert, cemented, fit and trapezoid. The tibial tray accepts augments and stem extensions with offset couplers (if needed).</Description><Size>0F/0T - 6F/6T</Size><SupplierCode>40074</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>285505</ARTG><ARTG>285441</ARTG></ARTGs><MinimumBenefit>2647</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY467</BillingCode><Name>PFC Sigma Knee System tibial baseplate</Name><Description>Tibial baseplate, cemented, keeled, Titanium, standard and offset keels with capacity for augment and stem attachment </Description><Size>Size 1.5 - 5</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><Suffix>Revision</Suffix><ARTGs><ARTG>221774</ARTG></ARTGs><MinimumBenefit>2647</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW141</BillingCode><Name>MRH (Modular Rotating Hinge) Tibial Baseplate</Name><Description>MRH Tibial baseplate, CoCr (Vitallium), fixed insert with central hole for hinged insertion, w/attachable stem</Description><Size>Small, Medium, Large</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><Suffix>Revision, Hinged</Suffix><ARTGs><ARTG>224539</ARTG></ARTGs><MinimumBenefit>3619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST034</BillingCode><Name>Scorpio Knee System Tibial Baseplate </Name><Description>Tibial baseplate, cemented, ability to attach stems, CoCr  </Description><Size>3,5,7,9,11,13</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><Suffix>Revision</Suffix><ARTGs><ARTG>211459</ARTG></ARTGs><MinimumBenefit>2647</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI126</BillingCode><Name>NexGen Knee Tibial Baseplate </Name><Description>Stemmed AP wedged tibial baseplate, cemented, for fixed insert, titanium, PMMA coated, with capacity for augment and stem attachment</Description><Size>1 - 10</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><Suffix>Revision</Suffix><ARTGs><ARTG>217359</ARTG></ARTGs><MinimumBenefit>2647</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH612</BillingCode><PriorBillingCodes><PriorBillingCode>OO020</PriorBillingCode></PriorBillingCodes><Name>ACS Knee System</Name><Description>Revision base plate, cemented, for use with augments and straight or offset stems</Description><Size>Left and Right, Sizes 2-6</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>265611</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Size</ChangeExplanation><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB391</BillingCode><Name>AS Columbus Revision Tibial Component Cemented</Name><Description>Revision Tibial Component AS (Advanced Surface)</Description><Size>T0+ - T5</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><Suffix>Revision</Suffix><ARTGs><ARTG>312586</ARTG></ARTGs><MinimumBenefit>2647</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH417</BillingCode><Name>Trekking Knee System - TCK Tibial Component Revision</Name><Description>Revision Tibial Component</Description><Size>Size: T1-T5
Width (mm) Depth: 42 - 57
Width (mm) 64 - 86</Size><SupplierCode>40113</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><Suffix>Revision</Suffix><ARTGs><ARTG>287508</ARTG></ARTGs><MinimumBenefit>2647</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU138</BillingCode><Name>GMK Revision Cemented fixed Tibia Tray</Name><Description>Asymmetric polished cemented fixed tibial component</Description><Size>1 to 6, left to right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><Suffix>Revision</Suffix><ARTGs><ARTG>210966</ARTG></ARTGs><MinimumBenefit>2647</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ510</BillingCode><Name>PFC Sigma Knee System tibial baseplate</Name><Description>Tibial baseplate, cemented, keeled, forged CoCr, polished tibial insert surface </Description><Size>Size 1-6</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><Suffix>Revision</Suffix><ARTGs><ARTG>227175</ARTG></ARTGs><MinimumBenefit>2647</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU030</BillingCode><Name>Evolis Knee System Tibial baseplate  </Name><Description>Tibial baseplate, cemented, titanium for fixed insert </Description><Size>1 - 6</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>204203</ARTG></ARTGs><MinimumBenefit>2647</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI811</BillingCode><Name>Vanguard 360 Tibial Tray</Name><Description>Tibial baseplate, Chrome cobalt alloy</Description><Size>59-91mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><Suffix>Revision</Suffix><ARTGs><ARTG>275614</ARTG></ARTGs><MinimumBenefit>2647</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU100</BillingCode><Name>GMK Hinge fixed tibial tray</Name><Description>Tibial Component cemented CoCr</Description><Size>1 to 6 Left and Right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><Suffix>Revision, Hinged</Suffix><ARTGs><ARTG>211409</ARTG></ARTGs><MinimumBenefit>3619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN207</BillingCode><Name>Attune Knee System</Name><Description>Revision fixed bearing tibial tray.</Description><Size>1 to 10</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><Suffix>Revision</Suffix><ARTGs><ARTG>289595</ARTG></ARTGs><MinimumBenefit>2647</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN824</BillingCode><Name>Legion Knee System Tibial Baseplate</Name><Description>Tibial baseplate, cemented, Titanium, for fixed insert,</Description><Size>1-8</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><Suffix>Revision</Suffix><ARTGs><ARTG>208089</ARTG></ARTGs><MinimumBenefit>2647</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN848</BillingCode><Name>Journey Knee System Tibial Baseplate</Name><Description>Tibial baseplate, cemented, Titanium, for fixed insert</Description><Size>Sizes 1-8, Left and Right</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>370844</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ662</BillingCode><Name>PFC Sigma Knee System Tibial Baseplate</Name><Description>Tibial baseplate, cemented, keeled, titanium, with capacity for stem attachment</Description><Size>Size 1.5-6</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>227176</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WQ006</BillingCode><Name>Origin PS Fixed Tibia Monobloc Cemented</Name><Description>Patient-Matched cemented tibial component</Description><Size>Patient Specific - Left and Right Knee</Size><SupplierCode>40394</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>382629</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV054</BillingCode><Name>Evolution Medial Pivot Knee System</Name><Description>Revision Tibial Base Implant</Description><Size>Sizes 1 - 8  Left, Right  Standard, Plus</Size><SupplierCode>40177</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>317407</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV002</BillingCode><Name>Evolution Medial Pivot Knee System</Name><Description>Tibial component, CoCr, cemented</Description><Size>1-8
Standard, Plus
Left, Right</Size><SupplierCode>40177</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>234319</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU114</BillingCode><Name>GMK Cemented FIXED Tibial Tray -TiNbN coated</Name><Description>Asymmetric polished cemented fixed tibial component, with TiNbN surface coating</Description><Size>1 to 6, left to right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>254614</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH425</BillingCode><Name>Trekking Knee System, Tibial Component</Name><Description>Tibial Component Cemented</Description><Size>Size: T1 - T5
Width (mm): Depth 42-57
Width (mm): 64 - 86</Size><SupplierCode>40113</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>287520</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD019</BillingCode><Name>3D Knee System Tibial Baseplate </Name><Description>Tibial Baseplate, cemented, CoCr</Description><Size>Size 1 to 12</Size><SupplierCode>39986</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>161909</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF142</BillingCode><Name>Active Knee Tibial Baseplate</Name><Description>Tibial baseplate, Cemented, CoCr</Description><Size>Sizes 1-5 </Size><SupplierCode>40413</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>276957</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FL008</BillingCode><Name>iTotal Cruciate-Retaining (CR) Total Knee Replacement System – iTotal G2+ Tibial Tray</Name><Description>Tibial baseplate, cemented, CoCrMo</Description><Size>Left Knee, Right Knee, patient-specific</Size><SupplierCode>40018</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>377131</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ957</BillingCode><Name>Attune Knee System</Name><Description>Fixed Bearing Cemented Tibial Tray</Description><Size>1-10</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>220503</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU137</BillingCode><Name>GMK Cemented fixed Tibia Tray</Name><Description>Asymmetric polished cemented fixed tibial component</Description><Size>1 to 6, left to right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>210966</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB400</BillingCode><Name>Columbus AS CR PS Tibial Plateau</Name><Description>Tibial baseplate, cemented, for fixed insert</Description><Size>T0 - T5</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>279473</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AE040</BillingCode><Name>Active Knee Tibial Baseplate</Name><Description>Tibial baseplate, Cemented, CoCr</Description><Size>Sizes 1-5</Size><SupplierCode>40045</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>276957</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI112</BillingCode><Name>Anatomic Cemented Tibial Baseplate</Name><Description>Cemented fixed bearing tibial baseplate with the ability to attach stem extensions</Description><Size>Size 0 to 8</Size><SupplierCode>40041</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>222531</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB396</BillingCode><Name>Columbus Tibial Baseplate</Name><Description>Tibial baseplate CRA/PSA, cemented, for fixed insert</Description><Size>T0+ - T4+ and T0 - T5</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>298186</ARTG><ARTG>298272</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB204</BillingCode><Name>Columbus Total Knee System (TKS) Tibial Baseplate </Name><Description>Tibial baseplate, cemented, CoCr for fixed insert</Description><Size>T0 to T5    T0+ to T4+</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>298271</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR251</BillingCode><Name>Unity Knee – Tibial Tray</Name><Description>Tibial Tray Cemented</Description><Size>Sizes 1 – 9</Size><SupplierCode>39996</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>223558</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA013</BillingCode><Name>Optetrak Logic Total Knee System, Tibial Baseplate</Name><Description>Tibial Baseplate, titanium, fixed insert, cemented</Description><Size>Size 0 - 6</Size><SupplierCode>40074</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>285441</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA515</BillingCode><Name>Balansys Tibial Baseplate</Name><Description>Tibial Baseplate cemented, CoCr</Description><Size>59mm to 85mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>211082</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR286</BillingCode><PriorBillingCodes><PriorBillingCode>GO194</PriorBillingCode></PriorBillingCodes><Name>Apex Knee, Tibial Base Plate - Cemented</Name><Description>Tibial Baseplate, Cemented, Non-Porous, Size 1 - 7 Left &amp; Right</Description><Size>Size 1 Left &amp; Right, size 2 Left &amp; Right, size 3 Left &amp; Right, size 4 Left &amp; Right, size 5 Left &amp; Right, size 6 Left &amp; Right, size 7 Left &amp; Right.</Size><SupplierCode>39996</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>278528</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI182</BillingCode><Name>Biomet Universal Tibial Baseplate </Name><Description>Tibial baseplate, Cemented, one piece, Ti or CoCr</Description><Size>59-91mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>98451</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MJ008</BillingCode><Name>MRK (Medial Rotation Knee) Total Knee System Tibial Baseplate </Name><Description>Tibial Baseplate, cemented, Titanium for fixed insert </Description><Size>1-5</Size><SupplierCode>40173</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>117769</ARTG><ARTG>192371</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA518</BillingCode><Name>Balansys Tibial Baseplate</Name><Description>Tibial Baseplate cemented, CoCr, TiNbN coated</Description><Size>59mm to 85mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>211083</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MJ009</BillingCode><Name>Saiph Knee System Tibial Component Cemented</Name><Description>CoCr Tibial Component, Cemented</Description><Size>A - F, Standard and Long Stem</Size><SupplierCode>40173</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>192371</ARTG><ARTG>117769</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI935</BillingCode><Name>Persona Knee System</Name><Description>Persona Tibial Tray, Stemmed</Description><Size>9 sizes, left and right</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>261273</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST066</BillingCode><Name>Scorpio Knee System Tibial Baseplate </Name><Description>Tibial baseplate, cemented, CoCr </Description><Size>3, 5, 7, 9, 11, 13</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><ARTGs><ARTG>217949</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO158</BillingCode><Name>Link Modular Knee ProsthesisSystem</Name><Description>Tibial Components</Description><Size>Extra Small - Extra Large</Size><SupplierCode>40190</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><Suffix>Hinged</Suffix><ARTGs><ARTG>221853</ARTG><ARTG>225784</ARTG><ARTG>226252</ARTG><ARTG>225001</ARTG></ARTGs><MinimumBenefit>3619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN857</BillingCode><Name>Genesis II Knee System Tibial Baseplate</Name><Description>Tibial Baseplate, cemented, Titanium, grit blasted</Description><Size>1 - 9</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><Suffix>SCP</Suffix><ARTGs><ARTG>207027</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK327</BillingCode><Name>Triathlon Knee System Tibial Baseplate</Name><Description>Tibial baseplate, cemented, CoCr</Description><Size>Sizes 0 to 8</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108661</GroupID><Suffix>SCP</Suffix><ARTGs><ARTG>217832</ARTG></ARTGs><MinimumBenefit>1836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ804</BillingCode><Name>MBT Revision Thick Tibial Tray</Name><Description>Tibial Tray</Description><Size>Size range 2 to 5.  Tray Thickness of 25mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108663</GroupID><Suffix>Revision, Extra Thick</Suffix><ARTGs><ARTG>230630</ARTG></ARTGs><MinimumBenefit>6497</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ634</BillingCode><Name>LCS Complete Knee System - MBT Revision Thick Tray</Name><Description>Thick Tibial Tray</Description><Size>1 to 6</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108663</GroupID><Suffix>Revision, Extra Thick</Suffix><ARTGs><ARTG>230630</ARTG></ARTGs><MinimumBenefit>6497</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI068</BillingCode><Name>Score Knee System Tibial Baseplate </Name><Description>Tibial Baseplate, Cemented, CoCr, polished insert surface for mobile insert </Description><Size>9 Sizes</Size><SupplierCode>40041</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108663</GroupID><ARTGs><ARTG>210578</ARTG></ARTGs><ChangeExplanation>Change to Group benefit</ChangeExplanation><MinimumBenefit>3402</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH611</BillingCode><PriorBillingCodes><PriorBillingCode>OO019</PriorBillingCode></PriorBillingCodes><Name>ACS Knee System - ACS SC Revision Tibial component, Cemented</Name><Description>Revision MB base plate for use with augments and straight or offset stems</Description><Size>Sizes 2,3,4,5,6</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108663</GroupID><Suffix>Revision</Suffix><ARTGs><ARTG>265619</ARTG></ARTGs><MinimumBenefit>3402</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ958</BillingCode><Name>Attune Knee System</Name><Description>Mobile Bearing Cemented Tibial Tray</Description><Size>1-10</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108663</GroupID><ARTGs><ARTG>226651</ARTG></ARTGs><MinimumBenefit>2005</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP032</BillingCode><Name>MBT Knee System tibial baseplate </Name><Description>Tibial baseplate, cemented, CoCr, for rotating platform, (keeled and non keeled) </Description><Size>Sizes 1 - 7</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108663</GroupID><ARTGs><ARTG>226233</ARTG><ARTG>226234</ARTG></ARTGs><MinimumBenefit>2005</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM160</BillingCode><Name>Legion Hinge Tibial Baseplate</Name><Description>A tibial baseplate used for the Legion Hinge system.</Description><Size>Size 2 to 7 Left, Right</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108663</GroupID><Suffix>Revision, Hinged</Suffix><ARTGs><ARTG>232074</ARTG></ARTGs><MinimumBenefit>3838</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN270</BillingCode><Name>Attune Knee System</Name><Description>Revision mobile bearing tibial tray, also usable with specific hinged insert </Description><Size>2-10</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108663</GroupID><Suffix>Revision, Hinged</Suffix><ARTGs><ARTG>298539</ARTG></ARTGs><MinimumBenefit>3838</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY151</BillingCode><Name>MBT Knee System Revision Tibial base Plate </Name><Description>Tibial baseplate, cemented, CoCr, for rotating platform, also usable with specific hinged insert </Description><Size>Sizes: 1-6 ; Tray Thickness: 4.8</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108663</GroupID><Suffix>Revision, Hinged</Suffix><ARTGs><ARTG>230630</ARTG></ARTGs><MinimumBenefit>3838</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT014</BillingCode><PriorBillingCodes><PriorBillingCode>TZ011</PriorBillingCode></PriorBillingCodes><Name>Genus Knee System - Genus Cemented Tibial Tray</Name><Description>Cemented Mobile Bearing Tibial Tray</Description><Size>1-7</Size><SupplierCode>40232</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108663</GroupID><ARTGs><ARTG>232058</ARTG></ARTGs><MinimumBenefit>2005</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB201</BillingCode><Name>e.MOTION Total Knee</Name><Description>Tibial baseplate, cemented, CoCr with polished surface for mobile insert</Description><Size>T1-T8, left and right</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108663</GroupID><ARTGs><ARTG>293935</ARTG><ARTG>296715</ARTG></ARTGs><MinimumBenefit>2005</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH687</BillingCode><PriorBillingCodes><PriorBillingCode>OO179</PriorBillingCode></PriorBillingCodes><Name>ACS Mobile Tibial Component Cemented</Name><Description>Tibia Base Plate Cemented for use with a Mobile Bearing insert - TiN Coated</Description><Size>2-7</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108663</GroupID><ARTGs><ARTG>265622</ARTG><ARTG>265672</ARTG></ARTGs><MinimumBenefit>2005</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA015</BillingCode><Name>Optetrak Logic Total Knee System, RBK Tibial Baseplate</Name><Description>Tibial Baseplate, titanium with polished insert surface, cemented, for a mobile insert</Description><Size>Size 1F/1T - 5F/5T</Size><SupplierCode>40074</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108663</GroupID><ARTGs><ARTG>285906</ARTG></ARTGs><MinimumBenefit>2005</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA312</BillingCode><Name>balanSys Tibial Baseplate</Name><Description>Tibial Baseplate for Mobile Bearing Insert, cemented, CoCr</Description><Size>59mm to 85mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108663</GroupID><ARTGs><ARTG>211085</ARTG></ARTGs><MinimumBenefit>2005</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU115</BillingCode><Name>GMK Mobile Cemented Tibial Tray  - TiNbN coated</Name><Description>Asymmetric mobile cemented tibial component, with TiNbN surface coating.</Description><Size>1 to 6, left to right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108663</GroupID><ARTGs><ARTG>254615</ARTG></ARTGs><MinimumBenefit>2005</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH422</BillingCode><Name>Trekking Knee System, Tibial Component MB Cemented</Name><Description>Tibial Component MB Cemented</Description><Size>Size: T1 - T5
Width (mm): 64 - 86
Width (mm): Depth 42 - 57</Size><SupplierCode>40113</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108663</GroupID><ARTGs><ARTG>287519</ARTG></ARTGs><MinimumBenefit>2005</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF136</BillingCode><Name>SHiVA Modular Knee Prosthesis - Tibial Tray</Name><Description>Tibial Tray</Description><Size>Size 2,3 and 4</Size><SupplierCode>40413</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108663</GroupID><Suffix>Revision, Hinged</Suffix><ARTGs><ARTG>192962</ARTG></ARTGs><MinimumBenefit>3838</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI308</BillingCode><Name>Nexgen Rotating Hinge Tibial Baseplate </Name><Description>Stemmed Tibial Baseplate with polished tibial insert surface, cemented, PMMA coated for Nexgen rotating hinged femoral component </Description><Size>1-6</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108663</GroupID><Suffix>Revision, Hinged</Suffix><ARTGs><ARTG>220389</ARTG><ARTG>226691</ARTG></ARTGs><MinimumBenefit>3838</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB354</BillingCode><Name>EnduRo Rotating Hinge Knee Tibial Component</Name><Description>The EnduRo is a Rotating Hinge Knee prosthesis that enables the Orthopaedic Surgeon to  treat complex revision knee arthoplasty as well as unstable knees</Description><Size>1-3</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108663</GroupID><Suffix>Revision, Hinged</Suffix><ARTGs><ARTG>303700</ARTG></ARTGs><MinimumBenefit>3838</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB388</BillingCode><Name>AS EnduRo Tibial Component Cemented</Name><Description>EnduRo Rotating Hinge Knee Tibial Component AS (Advanced Surface)</Description><Size>1-3</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108663</GroupID><Suffix>Revision, Hinged</Suffix><ARTGs><ARTG>312501</ARTG></ARTGs><MinimumBenefit>3838</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH700</BillingCode><PriorBillingCodes><PriorBillingCode>OO157</PriorBillingCode></PriorBillingCodes><Name>MUTARS GenuX MK Tibial Component, cemented</Name><Description>MUTARS GenuX MK Tibial Component, cemented</Description><Size>2-6</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108663</GroupID><Suffix>Revision, Hinged</Suffix><ARTGs><ARTG>238837</ARTG></ARTGs><MinimumBenefit>3838</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU077</BillingCode><Name>GMK Mobile Cemented Tibia Tray</Name><Description>Asymmetric mobile cemented tibial component</Description><Size>1 to 6, left to right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108663</GroupID><ARTGs><ARTG>210965</ARTG></ARTGs><MinimumBenefit>2005</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO171</BillingCode><Name>Link Endo Model Rotational and Hinge Knee Prostheses</Name><Description>Tibial Components</Description><Size>Extra small - extra large</Size><SupplierCode>40190</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108663</GroupID><ARTGs><ARTG>157545</ARTG></ARTGs><MinimumBenefit>2005</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD020</BillingCode><Name>3D Knee System Tibial Baseplate </Name><Description>Tibial Baseplate, uncemented,  beaded, CoCr and Titanium</Description><Size>Size 1 to 12</Size><SupplierCode>39986</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108664</GroupID><ARTGs><ARTG>161909</ARTG></ARTGs><MinimumBenefit>2007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI989</BillingCode><Name>Persona Knee System</Name><Description>Persona TM tibial base plate</Description><Size>A-J, left and right</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108664</GroupID><ARTGs><ARTG>222393</ARTG></ARTGs><MinimumBenefit>2007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW656</BillingCode><Name>Triathlon Tritanium Baseplate</Name><Description>Triathlon Tritanium BP</Description><Size>0-8</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108664</GroupID><ARTGs><ARTG>281719</ARTG></ARTGs><MinimumBenefit>2007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU040</BillingCode><Name>Evolis Knee System Tibial baseplate  </Name><Description>Tibial baseplate, uncemented, titanium with titanium plasma spray, for fixed insert </Description><Size>1 -6</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108664</GroupID><ARTGs><ARTG>205559</ARTG></ARTGs><ChangeExplanation>Change to Group benefit</ChangeExplanation><MinimumBenefit>3314</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH613</BillingCode><PriorBillingCodes><PriorBillingCode>OO021</PriorBillingCode></PriorBillingCodes><Name>ACS Knee System</Name><Description>Revision tibial component, cementless porous coated, for use with augments and straight or offset stems.</Description><Size>Left and Right, Sizes 2- 6</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108664</GroupID><ARTGs><ARTG>265612</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Size</ChangeExplanation><MinimumBenefit>2007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP031</BillingCode><Name>MBT Knee System tibial baseplate </Name><Description>Tibial baseplate, uncemented, CoCr, beaded (Porocoat) for rotating platform, (keeled and non keeled) </Description><Size>Sizes 1 - 7</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108666</GroupID><ARTGs><ARTG>226682</ARTG></ARTGs><MinimumBenefit>2493</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN274</BillingCode><Name>Attune Knee System</Name><Description>Rotating Platform Cementless Components</Description><Size>Size 1-10</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108666</GroupID><ARTGs><ARTG>290324</ARTG></ARTGs><MinimumBenefit>2493</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY377</BillingCode><Name>MBT knee system tibial baseplate </Name><Description>Tibial baseplate, uncemented, Titanium, TiN, beaded (Porocoat) for rotating platform, (non keeled only) </Description><Size>Sizes 1 - 7</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108666</GroupID><ARTGs><ARTG>217367</ARTG></ARTGs><MinimumBenefit>2493</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH686</BillingCode><PriorBillingCodes><PriorBillingCode>OO178</PriorBillingCode></PriorBillingCodes><Name>ACS Knee Porous Coated Tibia Component Cementless</Name><Description>Tibial base plate porous coated for use with mobile bearing insert - TiN Coated</Description><Size>2-7</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108666</GroupID><ARTGs><ARTG>265617</ARTG><ARTG>265623</ARTG></ARTGs><MinimumBenefit>2493</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU070</BillingCode><Name>GMK Unicompartmental Full - PE Tibia Component</Name><Description>cemented unicompartmental all polyethylene fixed component</Description><Size>1 to 5, left and right, 8/9/10/11/12/14mm  thicknesses</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107685</SubCategoryID><GroupID>108667</GroupID><ARTGs><ARTG>211419</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN337</BillingCode><Name>Genesis Uni Tibial Baseplate</Name><Description>Uni Tibial baseplate, all poly, cemented</Description><Size>size 1-6</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107685</SubCategoryID><GroupID>108667</GroupID><ARTGs><ARTG>208340</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT016</BillingCode><PriorBillingCodes><PriorBillingCode>TZ021</PriorBillingCode></PriorBillingCodes><Name>Genus Uni All Poly tibial Component</Name><Description>Genus Uni All Poly cemented Tibial Component</Description><Size>Sizes 1-6, RM/LL and LM/RL Heights 9-14mm</Size><SupplierCode>40232</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107685</SubCategoryID><GroupID>108667</GroupID><ARTGs><ARTG>287901</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK586</BillingCode><Name>Restoris MCK Knee - Tibial Baseplate</Name><Description>Tibial Baseplate</Description><Size>LM/RL and RM/LL, sizes 1 to 8</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107685</SubCategoryID><GroupID>108668</GroupID><ARTGs><ARTG>242174</ARTG></ARTGs><MinimumBenefit>1352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA078</BillingCode><Name>Persona Partial Knee System</Name><Description>Tibial baseplate</Description><Size>C-J</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107685</SubCategoryID><GroupID>108668</GroupID><ARTGs><ARTG>336795</ARTG></ARTGs><MinimumBenefit>1352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA452</BillingCode><Name>BalanSys UNI tibial baseplate </Name><Description>Uni tibial baseplate for fixed bearing insert, cemented, CoCr</Description><Size>1,2,3,4,5</Size><SupplierCode>40172</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107685</SubCategoryID><GroupID>108668</GroupID><ARTGs><ARTG>212824</ARTG></ARTGs><MinimumBenefit>1352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK497</BillingCode><Name>Triathlon PKR - Cemented Tibial component</Name><Description>Uni tibial baseplate, cemented, CoCR</Description><Size>Size 1 to 6</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107685</SubCategoryID><GroupID>108668</GroupID><ARTGs><ARTG>224797</ARTG></ARTGs><MinimumBenefit>1352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI107</BillingCode><Name>Unicompartmental Tibial Plate</Name><Description>Uni 'Tibial baseplate, cemented, Titanium </Description><Size>1 to 6</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107685</SubCategoryID><GroupID>108668</GroupID><ARTGs><ARTG>220169</ARTG></ARTGs><MinimumBenefit>1352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU065</BillingCode><Name>GMK Unicompartmental fixed tibial baseplate</Name><Description>cemented unicompartmental fixed tibial component with peg and fixation keel</Description><Size>1 to 5, left and right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107685</SubCategoryID><GroupID>108668</GroupID><ARTGs><ARTG>223022</ARTG></ARTGs><MinimumBenefit>1352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT017</BillingCode><PriorBillingCodes><PriorBillingCode>TZ024</PriorBillingCode></PriorBillingCodes><Name>Genus Uni Tibial Tray Cemented</Name><Description>Genus Uni Tibial Component Cemented is part of the Genus Uni Unicompartmental system.</Description><Size>Sizes 1-6 RM/LL and LM/RL</Size><SupplierCode>40232</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107685</SubCategoryID><GroupID>108668</GroupID><ARTGs><ARTG>287898</ARTG></ARTGs><MinimumBenefit>1352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL070</BillingCode><Name>Journey Knee System Tibial Uni Baseplate</Name><Description>Uni Tibial Baseplate, Titanium, cemented, for fixed insert</Description><Size>1-6</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107685</SubCategoryID><GroupID>108668</GroupID><ARTGs><ARTG>207003</ARTG></ARTGs><MinimumBenefit>1352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ780</BillingCode><Name>Sigma HP Unicompartmental Knee - Fixed bearing tibial tray</Name><Description>Unicompartmental tibial base plate, cemented, CoCr for fixed bearing insert</Description><Size>Size 1-6, LM/RL &amp; RM/LL</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107685</SubCategoryID><GroupID>108668</GroupID><ARTGs><ARTG>224039</ARTG></ARTGs><MinimumBenefit>1352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO060</BillingCode><Name>LINK Endo-Model SLED Uni Tibial Tray </Name><Description>Uni tibial tray including UHMWPE insert, cemented, CoCr tray</Description><Size>7mm-13mm in 45, 50, 55 diameter</Size><SupplierCode>40190</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107685</SubCategoryID><GroupID>108669</GroupID><ARTGs><ARTG>140653</ARTG></ARTGs><MinimumBenefit>1744</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA083</BillingCode><Name>Oxford Meniscal Knee System Uni Tibial Baseplate   </Name><Description>tibial baseplate</Description><Size>AA-F</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107685</SubCategoryID><GroupID>108670</GroupID><ARTGs><ARTG>205937</ARTG><ARTG>206061</ARTG><ARTG>206976</ARTG></ARTGs><MinimumBenefit>1527</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA058</BillingCode><Name>Persona Knee System</Name><Description>Medial Congruent tibial insert</Description><Size>10-20mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>290973</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA516</BillingCode><Name>BalanSys Tibial Insert</Name><Description>Tibial Insert, ultra congruent and minimally stabilised, UHMWPE</Description><Size>59/8mm to 85/20.5mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>211087</ARTG><ARTG>211081</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR031</BillingCode><Name>Triathlon Knee System Tibial Insert </Name><Description>Minimally stabilised, mobile bearing tibial insert, UHMWPE (N2VAC)</Description><Size>1 to 8, 9mm to 19mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>141151</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA010</BillingCode><Name>Optetrak Logic Total Knee System, Tibial Insert, CR</Name><Description>Tibial Insert, UHMWPE, Fixed (Cruciate retained), Neutral, Slope +, Slope ++</Description><Size>Size 0 - 6, 9 - 15mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>284907</ARTG><ARTG>285442</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR250</BillingCode><Name>Unity Knee - Cruciate Retaining Insert</Name><Description>Tibial Insert Cruciate Retaining</Description><Size>Size 1 – 9, Thickness 9-20MM</Size><SupplierCode>39996</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>223556</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR077</BillingCode><Name>Scorpio NRG X3 CR Tibial Insert</Name><Description>Intended use as part of a total knee system in primary cemented and primary uncemented total knee arthroplasty.</Description><Size>Sizes 3,5,7,9,11 in thicknesses: 8,10,12,15,18,21,24mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>211473</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AE251</BillingCode><Name>Active Knee Tibial Insert</Name><Description>Tibial Insert, UHMWPE</Description><Size>Sizes 1 - 5 Thickness 6 - 17.5mm</Size><SupplierCode>40045</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>276961</ARTG><ARTG>276964</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB198</BillingCode><Name>Emotion Total Knee System (TKS) Tibial Insert </Name><Description>Tibial Insert, UHMWPE, mobile</Description><Size>T1 to T8 Size: 10 to 24mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>96482</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH644</BillingCode><PriorBillingCodes><PriorBillingCode>OO103</PriorBillingCode></PriorBillingCodes><Name>ACS Knee Minimmaly Stabilised Tibial Insert</Name><Description>ACS PE Insert</Description><Size>10, 12.5, 15, 17.5, 20mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>265632</ARTG><ARTG>265641</ARTG><ARTG>265643</ARTG><ARTG>265624</ARTG><ARTG>265640</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB207</BillingCode><Name>Columbus Total Knee System (TKS) Tibial Insert  </Name><Description>Tibial Insert, UHMWPE, fixed </Description><Size>T0/0+ - T4/4+, T5  10mm -20mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>279900</ARTG><ARTG>298115</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI070</BillingCode><Name>Score Knee System Tibial Insert  </Name><Description>Tibial Insert, mobile bearing, UHMWPE</Description><Size>7 sizes, 5 thicknesses</Size><SupplierCode>40041</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>271353</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI962</BillingCode><Name>Persona Knee System</Name><Description>CR and UC tibial insert</Description><Size>10-18  mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>261276</ARTG><ARTG>261275</ARTG><ARTG>261282</ARTG><ARTG>261284</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST912</BillingCode><Name>Duracon ISA Knee System Tibial Insert</Name><Description>Minimally stabilised, mobile bearing tibial insert, UHMWPE (Duration)</Description><Size>Small, medium, large, X-large - left, right</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>141151</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK333</BillingCode><Name>Scorpio NRG Knee System Tibial Insert </Name><Description>Minimally stabilised tibial insert, UHMPWE (N2VAC)</Description><Size>Sizes 3,4,5,6,7,9,11,13, x (8/10/12/15/18/21/24mm thickness)</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>211472</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU092</BillingCode><Name>UC fixed insert for Evolis tibial revision</Name><Description>Polyethylene ultra-congruent fixed insert for Evolis tibial revision (using a GMK tibia)</Description><Size>Size 1 to 6, each one available in 5 thicknesses: 10, 12, 14, 17 20mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>211448</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU197</BillingCode><Name>GMK Sphere CR Insert</Name><Description>Fixed polyethylene insert</Description><Size>1 to 6. 10 to 14 mm. Left and Right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>211413</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU071</BillingCode><Name>GMK Standard Fixed Tibial Insert</Name><Description>Fixed polyethylene insert</Description><Size>1 to 6, left to right, 10/11/12/13/14/17/20mm thickness</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>132459</ARTG><ARTG>211413</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU068</BillingCode><Name>GMK Standard mobile tibial insert</Name><Description>posterior cruciate retaining mobile polyethylene insert</Description><Size>size 1 to 7, 10/12/14/17/20mm thickness</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>210968</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FL011</BillingCode><Name>iTotal Cruciate-Retaining (CR) Total Knee Replacement System – Tibial Insert iPoly G2+</Name><Description>UHMWPE polyethylene (iPoly) minimally stabilised tibial insert.</Description><Size>Shape - Medial and Lateral; Thickness (Medial) - 6mm-16mm, patient-specific; Size (Lateral) - A-K, patient-specific</Size><SupplierCode>40018</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>377134</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP166</BillingCode><Name>PFC Sigma Knee System  tibial insert </Name><Description>Tibial Insert, rotating platform UHMWPE</Description><Size>Sizes  2 - 6.  10-17.5mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>226935</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI197</BillingCode><Name>Rotating Platform Knee System</Name><Description>Tibial Bearing, UHMWPE</Description><Size>60-75mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>109966</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW232</BillingCode><Name>HMRS (Howmedica Modular Replacement System) Rotating Hinge Tibial Insert</Name><Description>HMRS Rotating Hinge Tibial insert, UHMWPE (Duration), Fixed </Description><Size>6, 10, 14mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>247553</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR284</BillingCode><PriorBillingCodes><PriorBillingCode>GO191</PriorBillingCode></PriorBillingCodes><Name>Apex Knee, Tibial Insert</Name><Description>Tibial Insert, Standard, Ultra &amp; Congruent, UHMWPE &amp; ECiMa, Size 1-6, 10mm to 20mm</Description><Size>Size 1, 10mm to 20mm, size 2, 10mm to 20mm, size 3, 10mm to 20mm, size 4, 10mm to 20mm, size 5, 10mm to 20mm, size 6, 10mm to 20mm.</Size><SupplierCode>39996</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>278615</ARTG><ARTG>388575</ARTG><ARTG>388574</ARTG><ARTG>271614</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW102</BillingCode><Name>Duracon Knee System Tibial Insert </Name><Description>Minimally stabilised, tibial insert to match PCA femur with Duracon baseplate, UHMWPE (Duration)</Description><Size>Small, Medium, Large, Extra-Large in each thickness 9mm, 11mm, 13mm, 16mm, 19mm, 22mm, 25mm, 28mm, 31mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>141151</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW248</BillingCode><Name>MRH (Modular Rotating Hinge) &amp; GMRS (Global Modular Replacement System) Tibial Inserts</Name><Description>MRH &amp; GMRS Tibial insert, (Duration) UHMWPE, for MRH and GMRS Tibial baseplate, CoCr (Vitallium), Fixed with central hole for Hinge</Description><Size>xsmall - xlarge</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>223659</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW160</BillingCode><Name>Kinemax Knee System Tibial Insert</Name><Description>Minimally stabilised, tibial insert, Low Stress, UHMWPE (Duration)</Description><Size>8, 10, 12, 15, 18, 21, 25mm per size</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>141151</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA311</BillingCode><Name>balanSys Tibial Mobile Insert</Name><Description>Tibial Insert, Mobile bearing, UHMWPE,</Description><Size>XS/8mm to F/20.5mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>211084</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR079</BillingCode><Name>Triathlon X3 CS Lipped Tibial Insert</Name><Description>Intended use as part of a total knee system in primary cemented and primary uncemented total knee arthroplasty.</Description><Size>Sizes 0-8</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>218019</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI134</BillingCode><Name>NexGen Tibial Insert</Name><Description>Tibial Insert, fixed, standard and anterior lipped, UHMWPE</Description><Size>10 - 20 mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>236459</ARTG><ARTG>241872</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK091</BillingCode><Name>Duracon Knee System CS Lipped Tibial Insert</Name><Description>Minimally stabilised, CS Lipped tibial insert, deep dish, UHMWPE, (Duration)</Description><Size>XS,S,M,L,XL Thickness 9,11,13,16,19,22,25mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>216478</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI976</BillingCode><Name>Vanguard E-Poly CR Tibial bearing</Name><Description>Vitamin E infused Highly Cross linked Polyethylene /cruciate Retaining Tibial bearing.</Description><Size>63 to 83 x (10-18mm)</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>219196</ARTG><ARTG>222271</ARTG><ARTG>267171</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA550</BillingCode><Name>balanSys vitamys Inlay</Name><Description>Tibial insert - cruciate retaining, ultra congruent and rotating platform, minimally stabilised, vitamys</Description><Size>59/8mm to 85/20.5mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>312504</ARTG><ARTG>312507</ARTG><ARTG>312503</ARTG><ARTG>312505</ARTG><ARTG>312506</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR076</BillingCode><Name>Triathlon X3 CR Tibial Insert</Name><Description>Intended use as part of a total knee system in primary cemented and primary uncemented total knee arthroplasty.</Description><Size>Sizes 0-8</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>216480</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI888</BillingCode><Name>Vanguard Total Knee System</Name><Description>Tibial Bearing, CR, curved or lipped, UHMWPE</Description><Size>59, 63/67, 71/75, 79/83, 87/91 widths, 10, 12, 14, 16, 18, 20, 22, 24mm thicknesses</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>246654</ARTG><ARTG>219841</ARTG><ARTG>223027</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI135</BillingCode><Name>NexGen Tibial Insert </Name><Description>Ant. Constr. - UHMWPE</Description><Size>9 - 23mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>220921</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW091</BillingCode><Name>Duracon Knee System Tibial Insert </Name><Description>Minimally stabilised, AP Lipped tibial insert, UHMWPE, (Duration)</Description><Size>Small, Medium, Large, Extra-Large in each thickness 9mm, 11mm, 13mm, 16mm, 19mm, 22mm, 25mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>213154</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST032</BillingCode><Name>Scorpio Knee System Tibial Insert</Name><Description>Minimally stabilised, mobile bearing tibial insert, UHMWPE (N2VAC)</Description><Size>8-24mm for all tibia sizes</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>128031</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MJ012</BillingCode><Name>MRK (Medial Rotation Knee) Total Knee System Tibial Insert</Name><Description>Tibial Insert, UHMWPE, Fixed</Description><Size>1/2/3, 8-18mm thickness</Size><SupplierCode>40173</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>117769</ARTG><ARTG>192415</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW662</BillingCode><Name>Scorpio FLEX CR insert</Name><Description>CR Knee poly insert for Scorpio CR minor revisions</Description><Size>3-11 in thicknesses 8, 10, 12, 15, 18, 21 &amp; 24</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>293035</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK431</BillingCode><Name>Triathlon Knee System CS Lipped Insert</Name><Description>Minimally stabilised, CS Lipped tibial insert deep dish, UHMWPE (N2VAC) </Description><Size>Sizes 1-8 _small - large) size increments, 9mm, 11mm, 13mm, 16mm, 19mm, 22mm, 25mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>128028</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST608</BillingCode><Name>Scorpio Knee System Tibial Insert</Name><Description>Minimally stabilised tibial insert, UHMWPE (N2VAC)</Description><Size>Size: 3-11  Thickness: 8-24mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>211471</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN320</BillingCode><Name>Genesis II Knee System Tibial Insert</Name><Description>Tibial Insert for mobile insert, UHMWPE</Description><Size>Left &amp; Right, Size 1-8, 9-15mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>242032</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK328</BillingCode><Name>Triathlon Knee System Tibial Insert</Name><Description>Minimally stabilised, tibial insert, UHMWPE, (N2VAC)</Description><Size>Sizes 0 to 8 (9/11/13/16/19/22/25mm thickness)</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><Suffix>SCP</Suffix><ARTGs><ARTG>218000</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI450</BillingCode><Name>Natural Knee Tibial Insert</Name><Description>Tibial Insert, UHMWPE, Highly crossed linked (Durasul PE), congruent and ultra congruent</Description><Size>00 to 5, 9 to 22mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><Suffix>SCP</Suffix><ARTGs><ARTG>228017</ARTG><ARTG>220172</ARTG><ARTG>222216</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI584</BillingCode><Name>NexGen Prolong Flex Articulating Surface</Name><Description>Highly Crosslinked - Ultra High Molecular Weight Polyethylene - Fixed Bearing - CR</Description><Size>Height 10-20mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><Suffix>SCP</Suffix><ARTGs><ARTG>215512</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP026</BillingCode><Name>LCS Complete Knee System rotating platform tibial Insert </Name><Description>Tibial insert, for rotating platform, UHMWPE </Description><Size>Sizes small to large+</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>217376</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL002</BillingCode><Name>Genesis II Knee System Tibial Insert</Name><Description>Tibial Insert, UHMWPE, fixed, without peg</Description><Size>1-8; 9-25mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>207346</ARTG><ARTG>207043</ARTG><ARTG>207045</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL003</BillingCode><Name>Profix Knee System Tibial Insert</Name><Description>Tibial Insert, UHMWPE, Fixed</Description><Size>Left / Right 1 - 6</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>224641</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT022</BillingCode><PriorBillingCodes><PriorBillingCode>TZ001</PriorBillingCode></PriorBillingCodes><Name>Genus Knee System - Genus PE Tibial Insert</Name><Description>Genus PE Insert</Description><Size>1-7 in thickness; 10mm, 12mm, 14mm, 17mm, 20mm, 24mm</Size><SupplierCode>40232</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>232062</ARTG><ARTG>232063</ARTG><ARTG>232064</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF143</BillingCode><Name>Active Knee Tibial Insert</Name><Description>Tibial Insert, UHMWPE</Description><Size>Sizes 1 - 5 Thickness 6 - 17.5mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>276960</ARTG><ARTG>276961</ARTG><ARTG>276964</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ955</BillingCode><Name>Attune Knee System</Name><Description>Cruciate Retaining Insert</Description><Size>1-10</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>220506</ARTG><ARTG>226662</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV004</BillingCode><Name>Evolution Medial Pivot Knee System</Name><Description>Minimally stabilised, fixed, tibial insert, UHMWPE</Description><Size>1-8
Standard, Plus
Left, Right
10-24mm</Size><SupplierCode>40177</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>234318</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV020</BillingCode><Name>Advance Medial Pivot Knee System</Name><Description>Minimally stabilised, fixed, tibial insert, UHMWPE</Description><Size>0-6  Left, Right  10-25mm</Size><SupplierCode>40177</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>278297</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH548</BillingCode><Name>Trekking Knee System - Tibial Insert - CR</Name><Description>Tibial Insert - CR</Description><Size>Size: T1 - T5
Thickness: -0 - +13</Size><SupplierCode>40113</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>287503</ARTG><ARTG>287505</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FL012</BillingCode><Name>iTotal Cruciate-Retaining (CR) Total Knee Replacement System – Tibial Insert iPoly XE</Name><Description>UHMWPE Vitmain E infused polyethylene (iPoly XE) minimally stabilised tibial insert.</Description><Size>Shape - Medial and Lateral; Thickness (Medial) - 6mm-16mm, patient-specific; Size (Lateral) - A-K, patient-specific </Size><SupplierCode>40018</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>377135</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY481</BillingCode><Name>PFC Sigma Knee System  tibial insert </Name><Description>Curved GVF Insert </Description><Size>Sizes  1.5 - 6.  8-20mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>224761</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ509</BillingCode><Name>PFC Sigma Knee System  tibial insert </Name><Description>Tibial insert, UHMWPE, moderately cross linked</Description><Size>Sizes  1.5 - 6.  8-20mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>224759</ARTG><ARTG>219401</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM174</BillingCode><Name>Smith &amp; Nephew CR XLPE Insert</Name><Description>Highly Cross-linked UHMWPE Cruciate Retaining Tibial Insert</Description><Size>1-8, 9-21mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>208014</ARTG><ARTG>280113</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO172</BillingCode><Name>Link Endo Model Rotational and Hinge Knee Prostheses</Name><Description>Plastic insert</Description><Size>Extra small - Extra large</Size><SupplierCode>40190</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>157545</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU074</BillingCode><Name>GMK ultracongruent Fixed tibial Insert</Name><Description>Ultracongruent fixed polyethylene insert</Description><Size>1 to 6, left to right, 10/12/14/17/20mm thickness</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>210969</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD021</BillingCode><Name>3D Knee System Tibial Insert </Name><Description>Tibial insert, UHMWPE, fixed with lateral pivot with locking screw</Description><Size>Size 1 to 12, 9mm to 19mm</Size><SupplierCode>39986</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>161909</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU146</BillingCode><Name>GMK Sphere Flex Insert</Name><Description>Fixed polyethylene insert</Description><Size>1 to 6, 10-11-12-13-14-17-20 mm
Left &amp; Right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>211413</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU034</BillingCode><Name>Evolis Knee System Tibial Insert   </Name><Description>Tibial Insert, UHMWPE, fixed  </Description><Size>1 - 6, 9/11/13/16/19mm thickness</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108673</GroupID><ARTGs><ARTG>204596</ARTG><ARTG>205623</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI071</BillingCode><Name>Score Knee System Tibial Insert  </Name><Description>Tibial Insert, mobile bearing, posterior stabilised with reinforcement post</Description><Size>20 sizes</Size><SupplierCode>40041</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>210526</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ306</BillingCode><Name>Vanguard Total Knee System</Name><Description>Vanguard PS Bearing</Description><Size>Size (mm) 10-24 Size (mm) 59-91</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>219825</ARTG><ARTG>223028</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ214</BillingCode><Name>Vanguard SSK Knee System</Name><Description>Tibial Bearing Insert, PS non-constrained UHMWPE
</Description><Size>Size (mm) 10-24 Size (mm) 59-91</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>221507</ARTG><ARTG>225307</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU090</BillingCode><Name>PS fixed insert for Evolis tibial revision</Name><Description>Polyethylene posterior-stabilised fixed insert for Evolis tibial revision (using a GMK tibia)</Description><Size>Size 1 to 6, each one available in 5 thicknesses: 10, 12, 14, 17 20mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>211449</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU059</BillingCode><Name>GMK Posterior Stabilised fixed tibial insert</Name><Description>Posterior Stabilised fixed polyethylene insert</Description><Size>size 1 to 6, 10/12/14/17/20mm thickness</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>140176</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH549</BillingCode><Name>Trekking Knee System, Tibial Insert - PS</Name><Description>Tibial Insert - PS</Description><Size>Size: T1 - T5
Thickness: +0 - +13</Size><SupplierCode>40113</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>287511</ARTG><ARTG>287509</ARTG><ARTG>287504</ARTG><ARTG>287510</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GO257</BillingCode><Name>Apex Posterior Stabilized Tibial Insert</Name><Description>Apex Posterior Stabilized Tibial Insert</Description><Size>size 1 to 6mm x 10 to 28mm UHMWPE &amp; ECiMa</Size><SupplierCode>40360</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>282757</ARTG><ARTG>311062</ARTG><ARTG>388576</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WQ007</BillingCode><Name>Origin PS Fixed Tibial Insert</Name><Description>Patient-Matched posterior stabilised tibial fixed insert UHMWPE</Description><Size>Patient Specific - Left and Right Knee, 6 and 8mm thickness.</Size><SupplierCode>40394</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>382627</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU091</BillingCode><Name>GMK Revision semi-constrained fixed tibial insert</Name><Description>Semi-constrained Posterior Stabilised fixed Tibial Insert</Description><Size>Size 1 to 6, each one available in 8 thicknesses: 10, 12, 14, 17, 20, 23, 26, 29mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>211428</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU032</BillingCode><Name>Evolis Knee System Tibial Insert   </Name><Description>Tibial Insert, UHMWPE, fixed, posterior stabilised </Description><Size>1 - 6, 9/11/13/16/19mm thickness</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>205560</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI586</BillingCode><Name>NexGen Prolong Flex Articulating Surface</Name><Description>Highly Crosslinked - Ultra high Molecular Weight Polyethylene - Fixed Bearing - LPS</Description><Size>Sizes 1 to 10, 9mm to 23mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>222148</ARTG><ARTG>230873</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI057</BillingCode><Name>NexGen Flex Tibial Insert </Name><Description>Tibial Insert, fixed, posterior stabilised, high flex, UHMWPE</Description><Size>Sizes 9 - 23mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>230875</ARTG><ARTG>230874</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR074</BillingCode><Name>Triathlon X3 PS Tibial Insert</Name><Description>Intended use as part of a total knee system in primary cemented and primary uncemented total knee arthroplasty. Intended to be used in situation where the posterior cruciate ligament is absent, or cannot be preserved.</Description><Size>Sizes 0-8</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>218200</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI058</BillingCode><Name>NexGen LPS Tibial Insert </Name><Description>Tibial Insert, posterior stabilised, UHMWPE, mobile </Description><Size>Sizes 9 - 23mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>222625</ARTG><ARTG>230874</ARTG><ARTG>222233</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR002</BillingCode><Name>Triathlon Knee System Tibial Insert </Name><Description>Posterior stabilised insert, UHMWPE,(N2VAC) </Description><Size>Sizes 0 to 8 (9/11/13/16/19/22/25mm thickness)</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>219399</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR261</BillingCode><Name>Unity Knee – Posterior Stabilised Insert</Name><Description>Tibial Insert Posterior Stabilised</Description><Size>Size 1 – 9, Thickness 9-20MM</Size><SupplierCode>39996</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>223557</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA014</BillingCode><Name>Optetrak Logic Total Knee System, RBK Tibial Insert</Name><Description>Tibial Insert, UHMWPE, mobile, posterior stabilised</Description><Size>Size 1 - 5, 9 - 15mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>285911</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MJ013</BillingCode><Name>Saiph Knee System APS Tibial Insert</Name><Description>Compression Moulded Anterior Posterior Stablilised Tibial Bearing</Description><Size>A - F, Left &amp; Right 10 - 20mm</Size><SupplierCode>40173</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>192415</ARTG><ARTG>117769</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH420</BillingCode><Name>Trekking Knee System, Tibial Insert</Name><Description>Tibial Insert</Description><Size>Size: T1 - T5
Thickness: +0 - +7</Size><SupplierCode>40113</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>287506</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM175</BillingCode><Name>Smith &amp; Nephew PS XLPE Inserts</Name><Description>Highly Cross-linked UHMWPE Posterior Stabilized Tibial Insert</Description><Size>1-8; 9-25mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>208015</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL005</BillingCode><Name>Genesis II Knee System Tibial Insert</Name><Description>Tibial Insert, UHMWPE, Posterior Stabalised with peg, Fixed</Description><Size>SZ 1-8; 9-25mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>207042</ARTG><ARTG>207044</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ956</BillingCode><Name>Attune Knee System</Name><Description>Posterior Stabilised Insert</Description><Size>1-10</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>213019</ARTG><ARTG>220507</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN876</BillingCode><Name>Profix Knee System Tibial Insert</Name><Description>Tibial Insert, UHMWPE, posterior stabilised with peg, fixed</Description><Size>1-8</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>224649</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY405</BillingCode><Name>PFC Sigma Knee System RPF tibial insert</Name><Description>Tibial insert, UHMWPE, rotating platform for high flex with post </Description><Size>Size 1 - 6.  10-17.5mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>209459</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ508</BillingCode><Name>PFC Sigma Knee System  tibial insert </Name><Description>Tibial insert, UHMWPE, moderately cross linked, with peg </Description><Size>Sizes  1 - 6.  8-30mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>97700</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ665</BillingCode><Name>PFC Sigma Knee System Tibial Insert</Name><Description>Tibial insert, posterior stabilised, UHMWPE, with post</Description><Size>Sizes 1.5-6.  8-25mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>224770</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL168</BillingCode><Name>Journey II BCS XLPE Insert</Name><Description>Highly cross-linked UHMWPE tibial insert</Description><Size>1-8 Left/Right</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>370845</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN780</BillingCode><Name>Journey Knee System Tibial Insert</Name><Description>Tibial Insert, UHMWPE, Fixed posterior stabilised with peg</Description><Size>8-30mm, 1-10</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>278110</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY457</BillingCode><Name>PFC Sigma Knee System  tibial insert </Name><Description>Tibial insert, posterior stabilised, rotating platform UHMWPE</Description><Size>Sizes  2 - 6.  10-20mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>223651</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW092</BillingCode><Name>Duracon Knee System Tibial Insert </Name><Description>Posterior stabilised tibial insert, with reinforcing pin, UHMWPE, (Duration) </Description><Size>Small, Medium, Large, Extra-Large in each thickness 9mm, 11mm, 13mm, 16mm, 19mm, 22mm, 25mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>128028</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR078</BillingCode><Name>Scorpio NRG X3 PS tibial Insert</Name><Description>intended to be used in situations where the posterior cruciate ligament is absent, or cannot be preserved.</Description><Size>3,5,7,9,11 in thickness: 8,10,12,15,18,21,24mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>211474</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST925</BillingCode><Name>Scorpio Knee System SuperFlex Tibial Insert </Name><Description>Posterior stabilised tibial insert, SuperFlex, UHMWPE (N2VAC)</Description><Size>3, 5, 7, 9 , 11, 13 in thickness 8, 10, 12, 15, 18, 21, 24mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>211482</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH645</BillingCode><PriorBillingCodes><PriorBillingCode>OO104</PriorBillingCode></PriorBillingCodes><Name>ACS Knee System</Name><Description>ACS Posterior Stabilised Tibial PE Insert</Description><Size>Sizes 2-6 x 10-20mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>265625</ARTG><ARTG>265639</ARTG><ARTG>265626</ARTG><ARTG>265642</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Size</ChangeExplanation><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB199</BillingCode><Name>Emotion Total Knee System (TKS) Tibial Insert </Name><Description>Tibial Insert, UHMWPE, mobile, posterior stabilised with peg</Description><Size>T1 to T8 Sizes: 10 to 24mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>96482</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB209</BillingCode><Name>Columbus Total Knee System (TKS) Tibial Insert  </Name><Description>Tibial Insert, UHMWPE, fixed, posterior stabilised with included screw for fixation to baseplate</Description><Size>T0/0+ - T4/4+, T5  10mm - 20mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>279901</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI113</BillingCode><Name>Anatomic Fixed Bearing Insert</Name><Description>Posterior stabilised, fixed bearing polyethylene insert</Description><Size>Size 0 to 8  Heights 10 to 20</Size><SupplierCode>40041</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>222532</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR012</BillingCode><Name>Scorpio NRG Knee System Tibial Insert </Name><Description>Posterior stabilised tibial insert, UHMWPE, (N2VAC)</Description><Size>Sizes 3,4,5,6,7,9,11,13, x (8/10/12/15/18/21/24mm thickness)</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>211460</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI885</BillingCode><Name>ROCC Tibial Insert</Name><Description>Tibial Insert, mobile bearing, rotating platform, UHMWPE</Description><Size>Thickness 10-20MM, Size 55 to 75</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>226211</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA549</BillingCode><Name>balanSys vitamys Inlay</Name><Description>Tibial insert, posterior stabilised, vitamys</Description><Size>59/8 to 85/20.5</Size><SupplierCode>40172</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>312507</ARTG><ARTG>312506</ARTG><ARTG>312503</ARTG><ARTG>312504</ARTG><ARTG>312505</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR020</BillingCode><Name>S7000 Tibial Insert </Name><Description>Posterior stabilised tibial insert, UHMWPE, (N2VAC), used for series 7000 revisions </Description><Size>3, 5, 7, 9, 11, 13 in 8, 10, 12, 15, 18, 21,24mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>128028</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU073</BillingCode><Name>GMK Ultracongruent Mobile Tibial Insert</Name><Description>Ultracongruent Mobile Polyethylene  Insert</Description><Size>size 1 to 7, 10/12/14/17/20mm thickness</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>210980</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR008</BillingCode><Name>Scorpio Knee System Tibial Insert</Name><Description>Posterior stabilised tibial insert, UHMWPE (N2VAC)</Description><Size>8-18mm in 2mm increments</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>211470</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA012</BillingCode><Name>Optetrak Logic Total Knee System, Tibial Insert, PS</Name><Description>Tibial Insert, UHMWPE, Fixed (Posterior Stabilised)</Description><Size>Size 0 - 6, 9-15mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>285503</ARTG><ARTG>285502</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR032</BillingCode><Name>Triathlon Knee System Tibial Insert</Name><Description>Posterior stabilised mobile bearing insert, UHMWPE (N2VAC)</Description><Size>1 to 8, 9mm to 22mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>141151</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI934</BillingCode><Name>Persona Knee System</Name><Description>Persona PS Articular Surface</Description><Size>10-20 mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>261277</ARTG><ARTG>261280</ARTG><ARTG>261281</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR013</BillingCode><Name>Scorpio Knee System Tibial Insert</Name><Description>Posterior stabilised mobile bearing insert,  UHMWPE (N2VAC)</Description><Size>10,12,15,18, 21mm thickness; sizews 3,5,7,9,11,13</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>141151</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA489</BillingCode><Name>balanSys Tibial Insert</Name><Description>Tibial insert, posterior stabilised UHMWPE</Description><Size>59/8mm to 85/23mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>211054</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI587</BillingCode><Name>NexGen Prolong Flex Articulating Surface</Name><Description>Highly Crosslinked - Ultra high Molecular Weight Polyethylene - Mobile Bearing - LPS</Description><Size>Sizes 1 to 10, 9mm to 23mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>222990</ARTG><ARTG>223747</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA510</BillingCode><Name>Balansys Revision Knee, Tibial Insert</Name><Description>Tibial insert, contrained, with stabilising screw for reinforcement</Description><Size>64/10.5 to 85/23</Size><SupplierCode>40172</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108674</GroupID><ARTGs><ARTG>210625</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY367</BillingCode><Name>PFC Sigma TC3 Knee System  Tibial Insert </Name><Description>Tibial Insert, totally constrained, mobile bearing, UHMWPE, with post</Description><Size>Size 1.5 to 5 thickness of 10mm to 30mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108675</GroupID><ARTGs><ARTG>270732</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB406</BillingCode><PriorBillingCodes><PriorBillingCode>BB352</PriorBillingCode><PriorBillingCode>BB389</PriorBillingCode></PriorBillingCodes><Name>EnduRo Meniscal Component</Name><Description>EnduRo Rotating Hinge Knee Meniscal Component</Description><Size>Sizes 1-3 10mm-24mm includes rotation axle, PEEK bushing and Tibial locking nut</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108675</GroupID><Suffix>Axle included</Suffix><ARTGs><ARTG>312502</ARTG><ARTG>303702</ARTG></ARTGs><MinimumBenefit>1726</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ532</BillingCode><Name>LCS Complete Knee System tibial insert </Name><Description>Tibial insert, UHMWPE, rotating platform, totally constrained, with reinforcing post  </Description><Size>Sizes small to large+. 10-25mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108675</GroupID><ARTGs><ARTG>259354</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN863</BillingCode><Name>Genesis II Knee System Tibial Insert</Name><Description>Tibial insert, UHMWPE, fixed, totally constrained</Description><Size>Left / Right 1 - 8</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108675</GroupID><ARTGs><ARTG>207342</ARTG><ARTG>231595</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV056</BillingCode><Name>Evolution Medial Pivot Knee System</Name><Description>Revision CCK Tibial Insert</Description><Size>Sizes 3-8  10mm - 24mm  Standard, Plus</Size><SupplierCode>40177</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108675</GroupID><ARTGs><ARTG>317613</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU101</BillingCode><Name>GMK Hinge fixed tibial insert</Name><Description>Tibial Insert for GMK Hinge prosthesis, UHMWPE, fixed, includes hinge locking post</Description><Size>1 to 6 10-26mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108675</GroupID><ARTGs><ARTG>211410</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF135</BillingCode><Name>SHiVA Modular Knee Prosthesis - Rotating Bearing</Name><Description>Rotating Bearing</Description><Size>Sizes 2,3 and 4 x 10mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108675</GroupID><ARTGs><ARTG>192962</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP257</BillingCode><Name>SROM Noiles Knee System tibial insert</Name><Description>Tibial insert, rotating platform, hinged, with metal axis ring incorporated and polyethylene axis bearings</Description><Size>Sizes: XS, S, M; Thickness: 12mm - 31mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108675</GroupID><ARTGs><ARTG>219089</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK438</BillingCode><Name>Triathlon TS Knee System Tibial Insert</Name><Description>Totally constrained, TS (Total Stabilizer) Insert, with metal post, UHMWPE (X3)</Description><Size>Tibial Insert Sizes: Left &amp; right 9-31mm sizes 1-8
Reinforced Post Sizes 9-31mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108675</GroupID><ARTGs><ARTG>219400</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EX028</BillingCode><Name>Optetrak Total Knee System Tibial Insert</Name><Description>Tibial Insert, UHMWPE, fixed and totally stabilised with peg and reinforced with screw/post fixation (Spine stiffening screw)</Description><Size>Size 1 - 5, 1 Delta</Size><SupplierCode>40074</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108675</GroupID><ARTGs><ARTG>277743</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST601</BillingCode><Name>Duracon TS Knee System Tibial Insert</Name><Description>Totally constrained tibial insert, with metal post, UHMWPE (Duration)</Description><Size>Extra Small, Small, Medium, Medium Large, Large, Extra Large</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108675</GroupID><ARTGs><ARTG>218199</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST024</BillingCode><Name>Scorpio Knee System Tibial Insert</Name><Description>Totally constrained tibial insert, with metal post, UHMWPE (X3)</Description><Size>8-24mm for all tibia sizes</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108675</GroupID><ARTGs><ARTG>211475</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI939</BillingCode><Name>Vanguard SSK Knee System</Name><Description>Tibial Bearing Insert, PSC, UHMWPE</Description><Size>10-24mm x 59-91mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108675</GroupID><ARTGs><ARTG>226020</ARTG><ARTG>271192</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH415</BillingCode><Name>Samo TCK Revision Knee System</Name><Description>TCK poly insert</Description><Size>1-5,6-19mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108675</GroupID><ARTGs><ARTG>165471</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA092</BillingCode><Name>Persona Revision CCK Vivacit-E Articular Surface</Name><Description>Vitamin E blended polyethylene (Vivacit- E®) with a Tivanium® Ti- 6Al-4V insert and lockdown screw</Description><Size>AB, CD, EF, GH, and J in left and right confugrations</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108675</GroupID><ARTGs><ARTG>374552</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI137</BillingCode><Name>NexGen LCCK Tibial Insert</Name><Description>Tibial Insert, totally constrained, UHMWPE, fixed, with post</Description><Size>10 - 35mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108675</GroupID><ARTGs><ARTG>214760</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH701</BillingCode><Name>MUTARS GenuX PE Insert</Name><Description>MUTARS GenuX PE Insert</Description><Size>Size: 2 - 6  Height : 12.5, 15, 17.5 mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108675</GroupID><ARTGs><ARTG>250453</ARTG><ARTG>238794</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN223</BillingCode><Name>Attune Knee System</Name><Description>Revision totally constrained tibial insert, fixed and mobile bearing</Description><Size>Size 1 - 10</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108675</GroupID><ARTGs><ARTG>298541</ARTG><ARTG>298540</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ664</BillingCode><Name>PFC Sigma Knee System TC3 Tibial Insert</Name><Description>Tibial insert, totally constrained, UHMWPE, with post</Description><Size>Sizes 1.5-5.  10-30mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108675</GroupID><ARTGs><ARTG>227166</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL169</BillingCode><Name>Journey II BCS Constrained Insert</Name><Description>Tibial insert, UHMWPE, totally constrained</Description><Size>1-8; Left/Right</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108675</GroupID><ARTGs><ARTG>370846</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM161</BillingCode><Name>Legion Hinge Guided Motion Tibial Insert</Name><Description>This tibial insert is used for the construction of the Legion hinge.</Description><Size>Sizes 2-7 11,13,15,18,21mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108675</GroupID><ARTGs><ARTG>232075</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB392</BillingCode><Name>Columbus Revision Tibial Insert</Name><Description>Columbus Revision Gliding Surface</Description><Size>10mm - 32mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108675</GroupID><ARTGs><ARTG>312588</ARTG><ARTG>312587</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI307</BillingCode><Name>Nexgen Rotating Hinge Tibial Insert</Name><Description>Tibial insert for NexGen Rotating Hinge prosthesis, UHMWPE, mobile. Includes hinge locking post.</Description><Size>12-26mm, sizes B-F</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108675</GroupID><ARTGs><ARTG>220053</ARTG></ARTGs><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI904</BillingCode><Name>Vanguard Total Knee System</Name><Description>Vanguard SSK 360 Tibial Bearing</Description><Size>59mm width x (10 to 24)mm thickness</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107686</SubCategoryID><GroupID>108675</GroupID><ARTGs><ARTG>275613</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Description, Size</ChangeExplanation><MinimumBenefit>1090</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA454</BillingCode><Name>BalanSys UNI tibial Insert </Name><Description>Uni tibial insert, UHMWPE, fixed </Description><Size>5,6,7,9</Size><SupplierCode>40172</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107687</SubCategoryID><GroupID>108676</GroupID><ARTGs><ARTG>212830</ARTG></ARTGs><MinimumBenefit>689</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW657</BillingCode><Name>Restoris MCK System, X3® Uni Tibial Onlay Insert</Name><Description>Uni Tibial Onlay Insert, Highly Crosslinked Polyethylene, fixed bearing</Description><Size>sizes 1 - 8 &amp; thickness 8mm - 12mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107687</SubCategoryID><GroupID>108676</GroupID><ARTGs><ARTG>283846</ARTG></ARTGs><MinimumBenefit>689</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA548</BillingCode><Name>balanSys Uni vitamys Inlay</Name><Description>Uni tibial insert, vitamys</Description><Size>5,6,7,9</Size><SupplierCode>40172</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107687</SubCategoryID><GroupID>108676</GroupID><ARTGs><ARTG>312503</ARTG></ARTGs><MinimumBenefit>689</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI105</BillingCode><Name>Unicompartmental Tibial Insert</Name><Description>Uni Tibial Insert, UHMWPE, fixed </Description><Size>8 - 14 mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107687</SubCategoryID><GroupID>108676</GroupID><ARTGs><ARTG>220168</ARTG></ARTGs><MinimumBenefit>689</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK587</BillingCode><Name>Restoris MCK Knee - Tibial Onlay Insert</Name><Description>Tibial Onlay Insert</Description><Size>Tibial Onlay Insert come in sizes 1 to 8, each size with 8, 9, 10 and 12mm thickness options</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107687</SubCategoryID><GroupID>108676</GroupID><ARTGs><ARTG>242173</ARTG></ARTGs><MinimumBenefit>689</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN837</BillingCode><Name>Journey Knee System Uni Tibial Insert</Name><Description>Uni Tibial Insert, for fixed bearing, UHMWPE</Description><Size>size 1-6, 8-11mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107687</SubCategoryID><GroupID>108676</GroupID><ARTGs><ARTG>207002</ARTG></ARTGs><MinimumBenefit>689</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT019</BillingCode><PriorBillingCodes><PriorBillingCode>TZ020</PriorBillingCode></PriorBillingCodes><Name>Genus Uni Tibial Insert</Name><Description>Genus Uni Tibial Insert for use with Genus Uni Tibial Tray</Description><Size>Heights 9-14, Size 1-6, RM/LL, LM/RL</Size><SupplierCode>40232</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107687</SubCategoryID><GroupID>108676</GroupID><ARTGs><ARTG>287900</ARTG></ARTGs><MinimumBenefit>689</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ779</BillingCode><Name>Sigma HP Unicompartmental Knee - Fixed bearing insert</Name><Description>Unicompartmental tibial insert, fixed bearing UHMWPE</Description><Size>Size 1-6, 7-11mm LM/RL &amp; RM/LL</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107687</SubCategoryID><GroupID>108676</GroupID><ARTGs><ARTG>233187</ARTG></ARTGs><MinimumBenefit>689</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI861</BillingCode><Name>Oxford Meniscal Knee System Uni Tibial Insert </Name><Description>Uni Tibial Insert conforming surface, mobile bearing, UHMWPE (Phase III)</Description><Size>(Small - Extra Large) x (3-9)</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107687</SubCategoryID><GroupID>108676</GroupID><ARTGs><ARTG>126863</ARTG></ARTGs><MinimumBenefit>689</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA076</BillingCode><Name>Persona Partial Knee System</Name><Description>Tibial insert</Description><Size>8-14mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107687</SubCategoryID><GroupID>108676</GroupID><ARTGs><ARTG>336794</ARTG></ARTGs><MinimumBenefit>689</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK498</BillingCode><Name>Triathlon PKR - X3 Polyethylene Tibial insert</Name><Description>Uni tibial insert, X3 polyethylene, fixed</Description><Size>Size 1 to 6, thicknesses from 8mm to 12mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107687</SubCategoryID><GroupID>108676</GroupID><ARTGs><ARTG>224841</ARTG></ARTGs><MinimumBenefit>689</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST656</BillingCode><Name>UNIX Unicompartmental Knee System Tibial Insert</Name><Description>Uni tibial insert, UHMWPE, Fixed</Description><Size>1, 2, 3, 4 in 8, 10, 12, 15mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107687</SubCategoryID><GroupID>108676</GroupID><ARTGs><ARTG>216613</ARTG></ARTGs><MinimumBenefit>689</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU062</BillingCode><Name>GMK Unicompartmental fixed tibia insert</Name><Description>cemented unicompartmental polyethylene fixed tibial insert</Description><Size>1 to 5, left and right, 8/9/10/11/12/14mm thiknesses</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107687</SubCategoryID><GroupID>108676</GroupID><ARTGs><ARTG>223023</ARTG></ARTGs><MinimumBenefit>689</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI563</BillingCode><Name>Zimmer Gender Solutions Patellofemoral Joint System</Name><Description>Patellofemoral joint fem implant PMMA precoat</Description><Size>Sizes 1 - 5 - Left &amp; Right</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107688</SubCategoryID><GroupID>108677</GroupID><ARTGs><ARTG>212228</ARTG></ARTGs><MinimumBenefit>2399</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST600</BillingCode><Name>Avon Patello Femoral System Femoral Component</Name><Description>Trochlear component, CoCr (Vitallium), cemented</Description><Size>Extra Small, Small, Medium, Large</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107688</SubCategoryID><GroupID>108677</GroupID><ARTGs><ARTG>217761</ARTG></ARTGs><MinimumBenefit>2399</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW988</BillingCode><Name>RESTORIS MCK Patellofemoral (PF) Knee System - Patellofemoral component</Name><Description>Trochlear component, CoCr, cemented</Description><Size>sizes 2-8, Left &amp; Right</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107688</SubCategoryID><GroupID>108677</GroupID><ARTGs><ARTG>242175</ARTG></ARTGs><MinimumBenefit>2399</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN834</BillingCode><Name>Journey Knee System Patella Femoral Replacement Trochlear Component</Name><Description>Trochlear Component,cemented, Oxinium</Description><Size>Sm, Med Lg, XLg</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107688</SubCategoryID><GroupID>108678</GroupID><Suffix>Ceramic Surface</Suffix><ARTGs><ARTG>242492</ARTG></ARTGs><MinimumBenefit>2616</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MJ014</BillingCode><Name>MRK (Medial Rotation Knee) Total Knee System Patellar Component</Name><Description>All Poly Patellar, UHMWPE, 1 central peg, This is a uncemented poly button</Description><Size>20-30mm</Size><SupplierCode>40173</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>192372</ARTG><ARTG>117770</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI176</BillingCode><Name>Biomet Universal Patellar component</Name><Description>All poly Patella, cemented, UHMWPE, domed  </Description><Size>size 25 to 40mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>219842</ARTG><ARTG>219858</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR252</BillingCode><Name>Unity Knee – Patella</Name><Description>Patella Cemented</Description><Size>Sizes 1 – 5</Size><SupplierCode>39996</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>223558</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST636</BillingCode><Name>Scorpio Knee System &amp; S7000 Knee System Patella Component</Name><Description>Patella component, Inlay, UHMWPE (N2VAC), cemented</Description><Size>3, 5, 7, 9, 11, 13</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>211462</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI148</BillingCode><Name>NexGen/Persona Patella</Name><Description>All poly, cemented, patella, UHMWPE</Description><Size>26 - 41</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>225311</ARTG><ARTG>261274</ARTG><ARTG>261283</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA111</BillingCode><Name>Balansys Patella Component</Name><Description>All Polyethylene, UHMWPE, cemented </Description><Size>Dia 25, 26, 28, 31, 34, 37mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>211443</ARTG><ARTG>211442</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR282</BillingCode><PriorBillingCodes><PriorBillingCode>GO189</PriorBillingCode></PriorBillingCodes><Name>Apex Knee, All-Poly Patella</Name><Description>All-Poly Dome 3 Peg Patella, ECiMa or UHMWPE</Description><Size>26mm x 10mm &amp; 8mm, 29mm x 10mm &amp; 8mm, 32mm x 10mm &amp; 8mm, 35mm x 10mm &amp; 8mm, 38mm x 10mm &amp; 8mm, 41mm x 10mm</Size><SupplierCode>39996</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>278529</ARTG><ARTG>388573</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MJ015</BillingCode><Name>Saiph Knee System Patella Component</Name><Description>Polyethylene Patella Component</Description><Size>Diameter 23mm - 42mm</Size><SupplierCode>40173</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>209578</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW105</BillingCode><Name>Duracon Knee System Patella Component</Name><Description>Patella component, UHMWPE (Duration), cemented</Description><Size>Small, Medium, Large, Xlarge</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>212696</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW140</BillingCode><Name>Kinemax Knee System Patella Component</Name><Description>Patella component Symmetric &amp; Asymmetric, UHMWPE (Duration), cemented</Description><Size>Small, Medium, Large</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>224198</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW989</BillingCode><Name>RESTORIS MCK Patellofemoral (PF) Knee System - Patella component</Name><Description>Patella component, UHMWPE, cemented</Description><Size>Size 26 - 41</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>242172</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP524</BillingCode><Name>LCS Complete Knee System patella component </Name><Description>All Poly patella, UHMWPE, cemented</Description><Size>Sizes small to large+</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>217375</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL246</BillingCode><PriorBillingCodes><PriorBillingCode>SN323</PriorBillingCode></PriorBillingCodes><Name>Genesis II Patella</Name><Description>Patella, cemented, UHMWPE, can be used for multiple systems (Genesis II, Journey, Legion)</Description><Size>23-41mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>220595</ARTG><ARTG>242034</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN382</BillingCode><Name>Profix Knee System Patella Component</Name><Description>Patella Component, UHMWPE, Inset, cemented</Description><Size>23-29mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>223619</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP152</BillingCode><Name>PFC Sigma Knee System</Name><Description>Cemented, all poly, patella</Description><Size>32-41mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>271408</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP264</BillingCode><Name>SROM Noiles Knee System patella</Name><Description>All poly, cemented patella </Description><Size>Sizes 30 - 38mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>219087</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT020</BillingCode><Name>Genus Knee System - Genus PE Patella</Name><Description>Polyethylene Patella</Description><Size>20 to 39mm</Size><SupplierCode>40232</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>232066</ARTG><ARTG>232065</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WQ008</BillingCode><Name>Origin Patella Cemented</Name><Description>Cemented patella component with medialised dome UHMWPE</Description><Size>XS to XL</Size><SupplierCode>40394</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>382628</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO042</BillingCode><Name>LINK Knee Patella Component</Name><Description>Patella Component, UHMWPE, cemented</Description><Size>Diameter: 25, 28, 30, 31, 34, 35 and 40mm
Height: 7, 8, 9 and 10mm</Size><SupplierCode>40190</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>223374</ARTG><ARTG>231794</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU061</BillingCode><Name>GMK  Inset Patella</Name><Description>Inset cemented polyethylene patella</Description><Size>sizes 1-2; 3-4; 5-6 (20/24/28/32mm diameter)</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>210970</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH423</BillingCode><Name>Trekking Knee System, Patella Component</Name><Description>Patella Component</Description><Size>Size: 1, 2, 3
Diam (mm): 30, 35, 40</Size><SupplierCode>40113</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>287502</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV011</BillingCode><Name>Advance Medial Pivot Knee System</Name><Description>All Poly Patella, Recessed, Onlay, Tri-Peg, Low-Dome, High-Dome</Description><Size>25-41mm</Size><SupplierCode>40177</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>278304</ARTG><ARTG>278303</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FL010</BillingCode><Name>iTotal Cruciate-Retaining (CR) Total Knee Replacement System – iTotal Patella Implant, iPoly</Name><Description>Highly cross-linked ultra high molecular weight polyethylene (iPoly) patella component, cemented.</Description><Size>29x6mm, 32x6mm, 35x7mm, 38x8.5mm, 41x10mm, 44x12mm </Size><SupplierCode>40018</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>377133</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU031</BillingCode><Name>Evolis Knee System Patella Component </Name><Description>All poly patella, cemented, UHMWPE</Description><Size>20, 24,28, 30, 33, 36, 39mm diam</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>205561</ARTG><ARTG>204598</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD022</BillingCode><Name>3D Knee System Patellar component </Name><Description>All poly, cemented patella, 3 pegs </Description><Size>Size 26 to 38mm</Size><SupplierCode>39986</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>161909</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF145</BillingCode><Name>Active Knee Patella</Name><Description>Patella, cemented, UHMWPE </Description><Size>Sizes 1 - 5</Size><SupplierCode>40413</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>276965</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FL009</BillingCode><Name>iTotal Cruciate-Retaining (CR) Total Knee Replacement System – iTotal Patella Implant, iPoly XE</Name><Description>Highly cross-linked ultra high molecular weight Vitamin-E enriched polyethylene (iPoly XE) patella component, cemented.</Description><Size>29x6mm, 32x6mm, 35x7mm, 38x8.5mm, 41x10mm, 44x12mm </Size><SupplierCode>40018</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>377132</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF138</BillingCode><Name>SHiVA Modular Knee Hinge Prosthesis - Patella Button</Name><Description>Patella Button</Description><Size>Sizes 2,3 and 4</Size><SupplierCode>40413</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>192962</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ959</BillingCode><Name>Attune Knee System</Name><Description>All Poly Cemented Patella</Description><Size>29-41mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>220505</ARTG><ARTG>208794</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL245</BillingCode><PriorBillingCodes><PriorBillingCode>SN323</PriorBillingCode></PriorBillingCodes><Name>Journey Patella</Name><Description>Patella, cemented, UHMWPE </Description><Size>23-41mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>278111</ARTG><ARTG>206505</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU072</BillingCode><Name>GMK Resurfacing Patella</Name><Description>resurfacing three pegged cemented polyethylene patella</Description><Size>sizes 1, 2, 3, 4</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>222424</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AE050</BillingCode><Name>Active Knee Patella</Name><Description>Patella, cemented, UHMWPE</Description><Size>Sizes 1 - 5</Size><SupplierCode>40045</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>276965</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI072</BillingCode><Name>Score Knee System Patella Component </Name><Description>All poly patella UHMWPE, cemented   Resurfacing and Inset</Description><Size>7 Diameters</Size><SupplierCode>40041</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>210604</ARTG><ARTG>216375</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH633</BillingCode><PriorBillingCodes><PriorBillingCode>OO057</PriorBillingCode></PriorBillingCodes><Name>MUTARS - Patella</Name><Description>Mutars PE Patella</Description><Size>Standard Large</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>227773</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB375</BillingCode><Name>Aesculap Patella 3-Pegs</Name><Description>All poly patellar, UHMWPE cemented, 3 pegs</Description><Size>P1 - P5</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>293939</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH605</BillingCode><PriorBillingCodes><PriorBillingCode>OO012</PriorBillingCode></PriorBillingCodes><Name>ACS Knee System - PE patella implant</Name><Description>ACS PE patella</Description><Size>26mm, 29mm, 32mm, 35mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>265637</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK419</BillingCode><Name>Triathlon Knee System Patella Component</Name><Description>Patella Component, Cemented,  Asymmetric &amp; Symmetric , (X3) UHMWPE</Description><Size>Asymmetric - Width: M/L 33-44mm &amp; S/I 29-40mm Thickness: 9mm - 11mm  Symmetric - Width: 27-39mm Thickness: 8mm - 11mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>212701</ARTG><ARTG>212702</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK323</BillingCode><Name>Triathlon Knee System Patella Component</Name><Description>Patella Component, Cemented,  Asymmetric &amp; Symmetric, (X3) UHMWPE</Description><Size>Symmetric: 27mm x 8mm, 29mm x 8mm, 31mm x 9mm, 33mm x 9mm, 36mm x 10mm, 39mm x 11mm; Assymetric: 29mm x 9mm, 32mm x 10mm, 35mm x 10mm, 38mm x 11mm, 40mm x 11mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>212699</ARTG><ARTG>212700</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EX038</BillingCode><Name>Optetrak Total Knee System</Name><Description>Patellar</Description><Size>26-41mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>279041</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK415</BillingCode><Name>Scorpio Knee System Patella Component</Name><Description>Patella Component, Inset, Recessed, Medialized dome, Universal Dome, Concentric Dome, UHMWPE (X3), Fixed, Cemented</Description><Size>Concentric &amp; Medialized Dome patella sizes: 5, 7, 9 &amp; 11; Universal Dome patella sizes: 3, 5, 7, 9 &amp; 11; Inset &amp; Recessed patella sizes: 26, 28, 30 and 32mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>211481</ARTG><ARTG>211463</ARTG><ARTG>309143</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW182</BillingCode><Name>PCA Modular Knee System Patella Component</Name><Description>Patella component, UHMWPE, (Duration), cemented</Description><Size>Small, Medium, Large, Extra Large</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>139146</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK314</BillingCode><Name>Avon Patello Femoral System Patella Component</Name><Description>Patella component, UHMWPE (Duration), Fixed, cemented</Description><Size>Small, Medium, Large</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>216641</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI454</BillingCode><Name>Natural Knee Patella CSTi</Name><Description>All Poly, Cemented, Patella</Description><Size>0-3</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108679</GroupID><ARTGs><ARTG>228016</ARTG></ARTGs><MinimumBenefit>337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI576</BillingCode><Name>Zimmer segmental system - segments - femoral/ tibial</Name><Description>fem/tib segment male-female</Description><Size>Male/female x 30 - 220mm. Male/Male x 80- 90mm.</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108686</GroupID><ARTGs><ARTG>275845</ARTG></ARTGs><MinimumBenefit>3845</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH689</BillingCode><Name>MUTARS intrameduallary connecting module</Name><Description>MUTARS intramedullary connecting module</Description><Size>100-440mm Length</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108686</GroupID><ARTGs><ARTG>244052</ARTG><ARTG>244656</ARTG></ARTGs><MinimumBenefit>3845</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH649</BillingCode><PriorBillingCodes><PriorBillingCode>OO108</PriorBillingCode></PriorBillingCodes><Name>Mutars Tumour System</Name><Description>Mutars diaphyseal implant</Description><Size>100mm length x 11-19mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108686</GroupID><ARTGs><ARTG>221740</ARTG><ARTG>284222</ARTG></ARTGs><MinimumBenefit>3845</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI868</BillingCode><Name>Orthopaedic Salvage System</Name><Description>Diaphyseal Segment or Diaphyseal Coupler, Stacking Adapter and Locking Screws, Ti</Description><Size>Diaphyseal Segment 1-23cm, Diaphyseal coupler 10-30cm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108686</GroupID><ARTGs><ARTG>204613</ARTG><ARTG>246837</ARTG></ARTGs><MinimumBenefit>3845</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK162</BillingCode><Name>GMRS (Global Modular Replacement System) Connection Piece </Name><Description>GMRS Connection Piece, uncemented Titanium, to replace varying lengths of diaphyseal bone loss</Description><Size>Left 80, 90mm; Right 80, 90mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108686</GroupID><ARTGs><ARTG>242293</ARTG></ARTGs><MinimumBenefit>3845</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW615</BillingCode><Name>METS Tibial Shaft</Name><Description>Titanium shaft</Description><Size>45-115mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108686</GroupID><ARTGs><ARTG>246516</ARTG></ARTGs><MinimumBenefit>3845</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI566</BillingCode><Name>Zimmer segmental system - articulating surfaces</Name><Description>Segmental articulating surface</Description><Size>B, C, D, E &amp; F - 12, 14, 17, 20, 23 &amp; 26mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108688</GroupID><ARTGs><ARTG>284864</ARTG></ARTGs><MinimumBenefit>2007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW629</BillingCode><Name>METS Tibial Rotating Hinge Polyethylene</Name><Description>UHMWPE tibial bearing component</Description><Size>N/A</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108688</GroupID><ARTGs><ARTG>278136</ARTG></ARTGs><MinimumBenefit>2007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH137</BillingCode><Name>Orthopaedic Salvage System</Name><Description>Tibial bearing Insert UHMWPE</Description><Size>12-22mm Thick</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108688</GroupID><ARTGs><ARTG>238434</ARTG><ARTG>238432</ARTG><ARTG>238433</ARTG></ARTGs><MinimumBenefit>2007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW251</BillingCode><Name>MRS (Modular Replacement System) Tibial Insert </Name><Description>Tibial insert UHMWPE (Duration) for MRS Metal Encapsulated Rotating Hinge Tibial component, Mobile.</Description><Size>Small and Medium in 11, 13, 16, 21mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108688</GroupID><ARTGs><ARTG>141151</ARTG></ARTGs><MinimumBenefit>2007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH632</BillingCode><PriorBillingCodes><PriorBillingCode>OO056</PriorBillingCode></PriorBillingCodes><Name>MUTARS - PE Inlay</Name><Description>MUTARS - PE Inlay</Description><Size>xsmall, Small, Standard, Large</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108688</GroupID><ARTGs><ARTG>227770</ARTG></ARTGs><MinimumBenefit>2007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI866</BillingCode><Name>Orthopaedic Salvage System</Name><Description>Femoral or Tibial Augment, Ti</Description><Size>Femoral Sleeve - One Size; or Femoral Flange - One Size; or Tibial Block Augment 10-20mm;  or Tibial Augment Sleeve - Small/Large or Tibial Sleeve 3-7cm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108689</GroupID><ARTGs><ARTG>169733</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>1864</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW607</BillingCode><Name>METS Tibial Plateau Plate</Name><Description>CoCr</Description><Size>Small and standard in 4 thicknesses</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108689</GroupID><ARTGs><ARTG>246518</ARTG></ARTGs><MinimumBenefit>1864</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW618</BillingCode><Name>METS Femoral Plateau Plate</Name><Description>Titanium</Description><Size>Small &amp; Standard, 4 thicknesses</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108689</GroupID><ARTGs><ARTG>246518</ARTG></ARTGs><MinimumBenefit>1864</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH653</BillingCode><PriorBillingCodes><PriorBillingCode>OO112</PriorBillingCode></PriorBillingCodes><Name>Mutars – Metaphyseal component</Name><Description>Mutars – Genux metaphyseal tibial spacer</Description><Size>Right/Left 25mm, 35mm, 45mm, 50mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108689</GroupID><ARTGs><ARTG>284267</ARTG><ARTG>284269</ARTG><ARTG>221737</ARTG></ARTGs><MinimumBenefit>1864</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH652</BillingCode><PriorBillingCodes><PriorBillingCode>OO111</PriorBillingCode></PriorBillingCodes><Name>Mutars – Genux Augments</Name><Description>Mutars – Genux Augments</Description><Size>Size, small, 3,4,5, 5mm, 10mm, 15mm, 20mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108689</GroupID><ARTGs><ARTG>284269</ARTG><ARTG>221737</ARTG></ARTGs><MinimumBenefit>1864</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO166</BillingCode><Name>Link Modular Knee ProsthesisSystem</Name><Description>Augments</Description><Size>X-Small, Small, Medium and Large</Size><SupplierCode>40190</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108689</GroupID><ARTGs><ARTG>224949</ARTG><ARTG>245854</ARTG></ARTGs><MinimumBenefit>1864</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI574</BillingCode><Name>Zimmer segmental system - cemented stem</Name><Description>Segmental cemented stem</Description><Size>9-19mm x 130mm; 190mm, 250mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108690</GroupID><ARTGs><ARTG>223825</ARTG></ARTGs><MinimumBenefit>2648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW247</BillingCode><Name>Howmedica Modular Resection System</Name><Description>Oncology Femoral Stem -  Vitallium</Description><Size>127mm and 203mm length 11, 13, 15, 17mm diameter</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108690</GroupID><ARTGs><ARTG>267613</ARTG><ARTG>267612</ARTG></ARTGs><MinimumBenefit>2648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW613</BillingCode><Name>METS Tibial Stem</Name><Description>Titanium</Description><Size>5 diameters 9-13mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108690</GroupID><ARTGs><ARTG>276635</ARTG></ARTGs><MinimumBenefit>2648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW612</BillingCode><Name>METS Stem</Name><Description>Titanium, curved and straight</Description><Size>6 diameters, 10-15mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108690</GroupID><ARTGs><ARTG>279902</ARTG></ARTGs><MinimumBenefit>2648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK168</BillingCode><Name>GMRS (Global Modular Replacement System) Straight Fluted Stem</Name><Description>GMRS Straight Fluted Stem,Titanium, with Ti plasma coating, uncemented, proximal 3cm Hydroxyapatite coated (Purefix) </Description><Size>125mm length in 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108690</GroupID><ARTGs><ARTG>152389</ARTG></ARTGs><MinimumBenefit>2648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI864</BillingCode><Name>Orthopaedic Salvage System</Name><Description>Stem, Cemented or Porous, Ti</Description><Size>(9-22.5)mm diameter x (80-300)mm length</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108690</GroupID><ARTGs><ARTG>250653</ARTG><ARTG>250654</ARTG><ARTG>250655</ARTG><ARTG>250656</ARTG><ARTG>250657</ARTG><ARTG>251373</ARTG><ARTG>250652</ARTG><ARTG>273724</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>2648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK167</BillingCode><Name>GMRS (Global Modular Replacement System) Short Bowed Pressfit Stem</Name><Description>GMRS Short Bowed Stem,Titanium, with Ti plasma coating, uncemented, proximal 3cm Hydroxyapatite coated (Purefix) </Description><Size>150mm in: 11, 12, 13, 14, 15, 16, 17, 18, 19mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108690</GroupID><ARTGs><ARTG>152389</ARTG></ARTGs><MinimumBenefit>2648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK166</BillingCode><Name>GMRS (Global Modular Replacement System) Long Bowed Stem</Name><Description>GMRS Long Bowed Stem,Titanium, with Ti plasma coating, uncemented, proximal 3cm Hydroxyapatite coated (Purefix) </Description><Size>200mm stem length in 11, 12, 13, 14, 15, 16, 17, 18, 19mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108690</GroupID><ARTGs><ARTG>152389</ARTG></ARTGs><MinimumBenefit>2648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY194</BillingCode><Name>Limb Preservation System</Name><Description>LPS Diaphyseal Porous Straight Stem, with 2cm porous collar</Description><Size>Porocoat 10.5mm - 18.5mm diameter x 100mm - 125mm length</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108690</GroupID><ARTGs><ARTG>227900</ARTG></ARTGs><MinimumBenefit>2648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY193</BillingCode><Name>Limb Preservation System</Name><Description>LPS Cemented Straight Stem with 2cm porous Collar</Description><Size>9mm - 17mm diameter, 100 - 125mm length</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108690</GroupID><ARTGs><ARTG>228694</ARTG></ARTGs><MinimumBenefit>2648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY189</BillingCode><Name>Limb Preservation System</Name><Description>LPS Cemented Bowed Stem with 2cm porous Collar</Description><Size>11mm - 17mm diameter x 150 - 200mm length</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108690</GroupID><ARTGs><ARTG>225059</ARTG></ARTGs><MinimumBenefit>2648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY190</BillingCode><Name>Limb Preservation System</Name><Description>LPS Diaphyseal Porous Bowed Stem, with 2cm porous collar</Description><Size>Porocoat 12.5mm - 18.5mm diameter x 150mm - 200mm length</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108690</GroupID><ARTGs><ARTG>225060</ARTG></ARTGs><MinimumBenefit>2648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO167</BillingCode><Name>Link Modular Knee ProsthesisSystem</Name><Description>Stems</Description><Size>100, 120, 130, 160, 200, 240, 280, 320 and 360</Size><SupplierCode>40190</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108690</GroupID><ARTGs><ARTG>245852</ARTG><ARTG>245853</ARTG><ARTG>157545</ARTG><ARTG>222182</ARTG></ARTGs><MinimumBenefit>2648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH631</BillingCode><Name>MUTARS Stems</Name><Description>MUTARS Stems</Description><Size>120 -240 mm length, 11 - 23 mm diameter</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108690</GroupID><ARTGs><ARTG>245435</ARTG><ARTG>244312</ARTG><ARTG>236017</ARTG><ARTG>244314</ARTG><ARTG>244315</ARTG></ARTGs><MinimumBenefit>2648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW646</BillingCode><Name>METS Integral Shaft &amp; Stem Coated</Name><Description>HA coated titanium collar, shaft and stem</Description><Size>Shaft Length 15-55mm, stem length 120mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108690</GroupID><ARTGs><ARTG>277396</ARTG><ARTG>278020</ARTG></ARTGs><MinimumBenefit>2648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK330</BillingCode><Name>MRS (Modular Replacement System) Femoral Stems</Name><Description>MRS Femoral stems with female taper, Titanium, uncemented, </Description><Size>11 x 127mm,    13 x 127mm,    15 x 127mm,    17 x 127mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108690</GroupID><ARTGs><ARTG>244952</ARTG></ARTGs><MinimumBenefit>2648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW647</BillingCode><Name>METS Intergral Shaft and Stem</Name><Description>Titanium stem for use with tibial collar</Description><Size>Shaft 30-70mm, stem 120mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108690</GroupID><ARTGs><ARTG>276914</ARTG><ARTG>277396</ARTG></ARTGs><MinimumBenefit>2648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA022</BillingCode><Name>Optetrak Logic Total Knee System Tibial Augments</Name><Description>Tibial Augments for Logic CC tibial component, half and third blocks, titanium, screw fixation</Description><Size>Size 0 - 6</Size><SupplierCode>40074</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>250092</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI145</BillingCode><Name>NexGen  Femoral Augments</Name><Description>Femoral blocks, combined posterior distal block </Description><Size>C - G</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>242593</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI120</BillingCode><Name>Anatomic Knee Tibial Half Blocks</Name><Description>Tibial Half Blocks Cemented</Description><Size>Sizes 0/1/2, 3/4/5, 6/7/8  Thickness 5mm to 15mm  </Size><SupplierCode>40041</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>241999</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI144</BillingCode><Name>Femoral Augments</Name><Description>Femoral blocks, posterior, distal and anterior, titanium </Description><Size>5-20MM</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>357912</ARTG><ARTG>242593</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST604</BillingCode><Name>Duracon Knee System Tibial Augments </Name><Description>Tibial Augments Half (hemi) wedge (angled) &amp; Half (hemi) block (flat), CoCr (Vitallium), cemented</Description><Size>LM/RL &amp; LL/RM in 5mm, 10mm thicknesses</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>242298</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW153</BillingCode><Name>Kinemax Knee System &amp; Modular Rotating Hinge Distal &amp; Posterior Femoral Augments &amp; Spacers</Name><Description>Distal &amp; posterior femoral blocks &amp; spacers, CoCr (Vitallium), cemented</Description><Size>Kinemax: Full, Distal &amp; Posterior Augments: xs-xl; 5mm /10mm         MRH Distal Femoral Augments xs-xl; 5mm / 10mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>242300</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK441</BillingCode><Name>Triathlon Knee System Femoral Augments</Name><Description>Femoral blocks distal &amp; posterior, CoCr, mechanical attachment</Description><Size>Left &amp; Right 5mm size 1-8 10mm size 1-8 15mm size 1-8</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>242298</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR036</BillingCode><Name>Triathlon Knee System Hemi Augments</Name><Description>Half (hemi) tibial blocks, CoCr, mechanical attachment </Description><Size>LM/RL &amp; LL/RM, 1 to 8, 5mm and 10mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>242298</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA025</BillingCode><Name>Optetrak Logic Total Knee System Femoral Augments</Name><Description>Femoral Augments for Logic CC femoral component, distal and posterior blocks, titanium, screw fixation</Description><Size>Size 1 - 5</Size><SupplierCode>40074</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>250092</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY153</BillingCode><Name>LCS Complete Knee System Augments </Name><Description>Femoral distal and posterior augments, CoCr, with screws</Description><Size>Sizes small to large+.  5-15mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>237112</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY159</BillingCode><Name>MBT Knee System tibial augments </Name><Description>Tibial blocks, with screws, CoCr </Description><Size>Sizes 1-5; 5-15mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>237112</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN821</BillingCode><Name>Legion Knee System Femoral Augment</Name><Description>Femoral Augment, posterior, distal and combined posterior and distal, Titanium, includes screws for fixation</Description><Size>size 1-8, 5-15mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>238696</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF133</BillingCode><Name>SHiVA Hinge Knee Revision System - Spacer</Name><Description>SHiVA Hinge Knee Revision  Spacer including locking screws</Description><Size>Size 2 -4, Thickness 5 and 10 mm for Distal Femoral and Posterior Femoral Reference
Size 2-5 , Thickness 5 and 10 mm for Tibial Reference</Size><SupplierCode>40413</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>192962</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST018</BillingCode><Name>Scorpio Knee System Femoral &amp; Tibial Augment</Name><Description>Femoral &amp; tibial blocks distal, posterior and full, CoCr, cemented</Description><Size>5mm &amp; 10mm for all sizes of femur and tibia. 5 degrees for all tibia sizes</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>242298</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI065</BillingCode><Name>Score Knee System Tibial and Femoral Augments </Name><Description>Femoral blocks, tibial blocks cemented </Description><Size>31 sizes  Size A-D, Thickness 4-8mm  Size 1/2, 3/4/5, 6/7, Thickness 5-10-15mm</Size><SupplierCode>40041</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>241999</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF132</BillingCode><Name>SHiVA Modular Knee Hinge Prosthesis</Name><Description>SHiVA Modular Knee Hinge Prosthesis - Tibial Spacer</Description><Size>Size 2,3 and 4 x 5mm and 10mm thick</Size><SupplierCode>40413</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>192962</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB355</BillingCode><Name>EnduRo Rotating Hinge Knee Tibial and Femoral Augments/Spacers</Name><Description>The EnduRo is a Rotating Hinge Knee prosthesis that enables the Orthopaedic Surgeon to
treat complex revision knee arthoplasty as well as unstable knees</Description><Size>Tibial Spacer(augment) to match Tibial component 4, 8, 12 &amp; 16mm Femoral Spacer distal (augment) to match femoral component 4, 8 &amp; 12mm
Femoral Spacer posterior/distal (augment) to match femoral component
4x4,4x8,4x12,8x4,8x8,8x12, 12x4, 12x8 and 12x12</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>247596</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH678</BillingCode><Name>MUTARS GenuX MK Augments</Name><Description>MUTARS GenuX MK Augments</Description><Size>1-6 Femoral distal,  Femoral posterior and 1-6 Tibial spacers. 5-20mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>221737</ARTG><ARTG>284264</ARTG><ARTG>284265</ARTG><ARTG>284266</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB320</BillingCode><Name>Emotion Total Knee System Tibial and Femoral Augments</Name><Description>Medial/Lateral Tibial, Distal Femoral and Postero-Distal Augments</Description><Size>4mm to 12mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>96481</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB380</BillingCode><Name>Aesculap AS Tibial and Femoral Augments</Name><Description>Tibial and Femoral Augments/Spacers CoCr with ZrN coating</Description><Size>All Sizes</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>247596</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH614</BillingCode><PriorBillingCodes><PriorBillingCode>OO026</PriorBillingCode></PriorBillingCodes><Name>ACS Knee System-ACS spacer (tibial and femoral)</Name><Description>ACS tibial and femoral augments for use with mobile bearing and Revision FB tibial base plates</Description><Size>Left and Right, medial, lateral, posterior and distal.</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>221737</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR291</BillingCode><PriorBillingCodes><PriorBillingCode>GO260</PriorBillingCode></PriorBillingCodes><Name>Apex Revision Knee</Name><Description>Apex Revision Knee Femoral and Tibial Augments</Description><Size>Femoral, Size 0-6+, 5mm/10mm/15mm  Tibial, Size 0-6, 4mm</Size><SupplierCode>39996</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>252312</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR253</BillingCode><Name>Unity Knee - Augments</Name><Description>Tibial Full and Half block Augments, Femoral distal and posterior augments</Description><Size>All components available in Size: 1-9;
Thickness: 5 and 10mm

Tibia: Full, LM-RL, RM-LL,</Size><SupplierCode>39996</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>274559</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI952</BillingCode><Name>Vanguard Total Knee System</Name><Description>Femoralor Tibial Augments, anatomic, distal or posterior, Ti alloy</Description><Size>5-15mm x 55-91mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>169733</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI140</BillingCode><Name>Tibial Augments</Name><Description>Tibial Augments, wedges, hemi and one third and tibial blocks hemi, titanium</Description><Size>5-20MM</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>242592</ARTG><ARTG>357912</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EX025</BillingCode><Name>Optetrak Total Knee System Tibial Augments</Name><Description>Tibial Augments for CCK tibial component, half and third blocks, titanium, screw fixation</Description><Size>Size 1 - 6</Size><SupplierCode>40074</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>250092</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW099</BillingCode><Name>Duracon Knee System Tibial Augments </Name><Description>Tibial Augments Full wedge (angled) &amp; Full block (flat), CoCr (Vitallium), cemented</Description><Size>Left &amp; right, full &amp; angled, 5mm &amp; 10mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>242298</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EX026</BillingCode><Name>Optetrak Total Knee System Femoral Augments</Name><Description>Femoral Augments for CCK femoral component, distal and posterior blocks, titanium, screw fixation</Description><Size>Size 1-6</Size><SupplierCode>40074</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>250092</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA508</BillingCode><Name>Balansys Revision Knee, Augments</Name><Description>Revision Femoral/Tibial Augments, complete with screws</Description><Size>5 and 10mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>257053</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP158</BillingCode><Name>PFC Sigma Knee System femoral  augments</Name><Description>Distal and posterior femoral augments, CoCr , with screws</Description><Size>Sizes  1.5 - 5.  4-16mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>237112</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN225</BillingCode><Name>Attune Knee System</Name><Description>Femoral and tibial augments</Description><Size>Size 1 to 10</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>298543</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM153</BillingCode><Name>Legion Hinge Femoral Wedge</Name><Description>A distal femoral Wedge for use with the Legion Hinge system.</Description><Size>Size 2 to 7 5,10,15,20mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>238696</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN330</BillingCode><Name>Genesis II Knee System Tibial and Femoral Augments</Name><Description>Tibial Augments, half blocks and half wedges, (CoCr) and Femoral Augments, distal and posterior or distal and posterior combined</Description><Size>1-8</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>238696</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI143</BillingCode><Name>NexGen Knee Tibial Augments</Name><Description>NexGen Tibial Blocks - half and full, Titanium</Description><Size>1 - 10</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>109936</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV052</BillingCode><Name>Evolution Medial Pivot Knee System</Name><Description>Femoral Distal and Posterior Augments</Description><Size>4-12mm thickness, 
Size 3-8</Size><SupplierCode>40177</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>196520</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO180</BillingCode><Name>Endo-Model Rotational and Hinge Knee Prosthesis</Name><Description>Augments, spacers, segments</Description><Size>(5-15) mm height, (X-Small, Small, Medium or Large) footprint  UHMWPE</Size><SupplierCode>40190</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>245854</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU094</BillingCode><Name>GMK Revision tibial wedge</Name><Description>Cemented tibial baseplate augmentation</Description><Size>Size 0 to 6   4 thicknesses available: 5, 10, 15, 20 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>254755</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH416</BillingCode><Name>Trekking Knee System - TCK Revision Tibial and Femoral Augments</Name><Description>TCK Revision Tibial and Femoral Augments (Knee Wedge)</Description><Size>Size: T1 - T5
Size: 5mm - 10mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>283166</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU087</BillingCode><Name>GMK Revision femoral posterior wedge</Name><Description>Screwed femoral posterior augmentation</Description><Size>Size 1 to 6, each one available in 4 thicknesses: 4mm, 5mm, 8mm 10mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>254755</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU085</BillingCode><Name>GMK Revision femoral distal wedge</Name><Description>Screwed femoral distal augmentation</Description><Size>Size 1 to 6, each one available in 5 thicknesses: 4mm, 8mm, 12mm, 16 mm, 20 mm.</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>254755</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV045</BillingCode><Name>Evolution Medial Pivot Knee System</Name><Description>Revision Tibial Base Augment</Description><Size>Sizes 1 - 8+  5mm - 15mm  Medial, Lateral  Left, Right</Size><SupplierCode>40177</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>196520</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN822</BillingCode><Name>Legion Knee System Tibial Augement</Name><Description>Tibial Augments, half blocks and half wedges, full blocks and full wedges, Titanium includes screws for fixation</Description><Size>5-15mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>238696</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP269</BillingCode><Name>SROM Noiles Knee System femoral augments </Name><Description>Distal femoral augmentation blocks</Description><Size>5 and 10 mm distal thickness, for use with femoral sizes XS/S/M</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108694</GroupID><ARTGs><ARTG>237112</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN901</BillingCode><Name>Legion Hinge Axle</Name><Description>Is used to secure the Legion Hinge femoral component to baseplate.</Description><Size>Sizes 2-7</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108695</GroupID><ARTGs><ARTG>232073</ARTG></ARTGs><MinimumBenefit>635</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ705</BillingCode><Name>LPS &amp; SROM Systems - Hinge Pin</Name><Description>Rotating Hinge Axle - uncemented, CoCr</Description><Size>xxsmall - medium</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108695</GroupID><ARTGs><ARTG>243112</ARTG></ARTGs><MinimumBenefit>635</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH635</BillingCode><PriorBillingCodes><PriorBillingCode>OO089</PriorBillingCode></PriorBillingCodes><Name>MUTARS - Genux Locking screw for locking mechanism</Name><Description>Locking screw, axel, for Genux hinge locking mechanism</Description><Size>1 Size</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108695</GroupID><ARTGs><ARTG>250192</ARTG></ARTGs><MinimumBenefit>635</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW201</BillingCode><Name>HMRS (Howmedica Modular Replacement System) Fixed Hinged Knee Axle Pin </Name><Description>HMRS Fixed Hinged Knee Axle Pin, CrCo, (Vitallium), uncemented, Fixed</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108695</GroupID><ARTGs><ARTG>262257</ARTG></ARTGs><MinimumBenefit>635</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR315</BillingCode><PriorBillingCodes><PriorBillingCode>GO313</PriorBillingCode></PriorBillingCodes><Name>APEX knee Retaining Bolt</Name><Description>Tibial insert, Retaining Bolt, Uncoated knee tibia prosthesis, metallic  for PS, PS-C, PS-R, Congruent, Ultra inserts/ Tibial Baseplates</Description><Size>10-32 mm</Size><SupplierCode>39996</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108696</GroupID><ARTGs><ARTG>309120</ARTG></ARTGs><MinimumBenefit>212</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR283</BillingCode><PriorBillingCodes><PriorBillingCode>GO190</PriorBillingCode></PriorBillingCodes><Name>Apex Knee, Locking Bolt</Name><Description>Tibial Insert Locking Bolt</Description><Size>One size</Size><SupplierCode>39996</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108696</GroupID><ARTGs><ARTG>309120</ARTG></ARTGs><MinimumBenefit>212</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH636</BillingCode><PriorBillingCodes><PriorBillingCode>OO090</PriorBillingCode></PriorBillingCodes><Name>MUTARS - Genux Locking screws</Name><Description>Locking screws for augments</Description><Size>Various</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108696</GroupID><ARTGs><ARTG>221737</ARTG></ARTGs><MinimumBenefit>212</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB404</BillingCode><Name>Aesculap Knee System Insert Bolt</Name><Description>Tibial insert locking bolt</Description><Size>10mm - 24mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108696</GroupID><ARTGs><ARTG>277357</ARTG><ARTG>277359</ARTG></ARTGs><MinimumBenefit>212</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH693</BillingCode><PriorBillingCodes><PriorBillingCode>OO145</PriorBillingCode></PriorBillingCodes><Name>MUTARS - KRI Screw M8</Name><Description>KRI Screw M8 - Tumour System and Arthrodesis Interlocking System</Description><Size>25mm - 50mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108696</GroupID><ARTGs><ARTG>250193</ARTG></ARTGs><MinimumBenefit>212</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP155</BillingCode><Name>PFC Sigma Knee System femoral stem bolts</Name><Description>Bolts to connect femoral stem, straight and offset </Description><Size>Neutral +/- 2mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108696</GroupID><ARTGs><ARTG>131657</ARTG></ARTGs><MinimumBenefit>212</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW229</BillingCode><Name>HMRS (Howmedica Modular Replacement System) Rotating Hinge Femoral Bushing</Name><Description>HMRS Rotating Hinge Femoral Bushing - UHMWPE, (Duration) </Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108697</GroupID><ARTGs><ARTG>242298</ARTG><ARTG>247554</ARTG></ARTGs><MinimumBenefit>2454</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI571</BillingCode><Name>Zimmer segmental system - segmental poly insert</Name><Description>Segmental poly insert</Description><Size>B &amp; C</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108697</GroupID><ARTGs><ARTG>292689</ARTG></ARTGs><MinimumBenefit>2454</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN322</BillingCode><Name>Attune Knee System</Name><Description>ATTUNE Revision LPS Insert</Description><Size>XX-Small, X-Small, Small and Medium; 12-32 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108697</GroupID><ARTGs><ARTG>375180</ARTG></ARTGs><MinimumBenefit>2454</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM154</BillingCode><Name>Legion Hinge Sleeve and Bolt</Name><Description>Is used to secure the Legion Hinge femoral component to the hinge mechanism attached to the baseplate.</Description><Size>Sizes 2-7</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108697</GroupID><ARTGs><ARTG>232076</ARTG></ARTGs><MinimumBenefit>2454</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY196</BillingCode><Name>Limb Preservation System</Name><Description>Tibial Hinge Insert</Description><Size>XX-Small, X-Small, Small, Medium, Height (mm) 12 - 31</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108697</GroupID><ARTGs><ARTG>228695</ARTG><ARTG>314170</ARTG></ARTGs><MinimumBenefit>2454</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO163</BillingCode><Name>Link Modular Knee ProsthesisSystem</Name><Description>Hinge components</Description><Size>Small, Medium, Large</Size><SupplierCode>40190</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108697</GroupID><ARTGs><ARTG>226253</ARTG><ARTG>223279</ARTG></ARTGs><MinimumBenefit>2454</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW231</BillingCode><Name>GMRS (Global Modular Replacement System) &amp; MRH (Modular Rotating Hinge) Tibial Rotating Component</Name><Description>GMRS &amp; MRH Tibial Rotating Hinge component (not baseplate) separated from femoral component by bumper and rotates on top of tibial insert , Fixed</Description><Size>GMRS-small  MRH/crossover                      MRH - xs-xl  &amp; l-xl</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108697</GroupID><ARTGs><ARTG>222421</ARTG></ARTGs><MinimumBenefit>2454</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW230</BillingCode><Name>HMRS (Howmedica Modular Replacement System) &amp; MRH (Modular Rotating Hinge) Rotating Hinge Bumper</Name><Description>HMRS &amp; MRH Rotating Hinge Bumper - (Duration) UHMWPE</Description><Size>HMRS: 0°, 3°, 5°       MRH: 0°, 3°</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108697</GroupID><ARTGs><ARTG>247297</ARTG></ARTGs><MinimumBenefit>2454</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW228</BillingCode><Name>HMRS (Howmedica Modular Replacement System) Rotating Hinge Axle</Name><Description>HMRS Rotating Hinge Axle - uncemented, CoCr (Vitallium)</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108697</GroupID><ARTGs><ARTG>246993</ARTG></ARTGs><MinimumBenefit>2454</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI309</BillingCode><Name>Nexgen Rotating Hinge Replacement </Name><Description>Rotating hinge replacement which includes metal rotating hinge plus Polyethylene bushing and fixation pin</Description><Size>B-F</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108697</GroupID><ARTGs><ARTG>109936</ARTG></ARTGs><MinimumBenefit>2454</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW145</BillingCode><Name>GMRS (Global Modular Replacement System) MRH (Modular Rotating Hinge) Kinematic Rotating Hinge (KRH) Femoral Bushings &amp; Bumpers </Name><Description>GMRS, MRH, KRH Rotating Hinge Femoral Bushings &amp; Bumpers UHMWPE, (Duration) </Description><Size>Small &amp; standard</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108697</GroupID><ARTGs><ARTG>247296</ARTG></ARTGs><MinimumBenefit>2454</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK331</BillingCode><Name>MRH (Modular Rotating Hinge) Rotating Hinge Assembly Pack</Name><Description>MRH Assembly pack consists of: Tibial sleeve, Bumper insert &amp; Femoral Bushing components UHMWPE (Duration)</Description><Size>1 Tibial Sleeve, 1  Bumper Insert, 2 Femoral Bushing Components</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108697</GroupID><ARTGs><ARTG>223925</ARTG></ARTGs><MinimumBenefit>2454</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH136</BillingCode><Name>Orthopaedic Salvage System</Name><Description>OSS connector accessories - Polyethylenefemoral and tibial bushings, Polyethylene Lock Pin, CoCrMo standard axle, CoCrMo reinforced yoke</Description><Size>One size only</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108697</GroupID><ARTGs><ARTG>249554</ARTG><ARTG>250658</ARTG><ARTG>250659</ARTG><ARTG>251392</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Description, Size</ChangeExplanation><MinimumBenefit>2454</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH640</BillingCode><PriorBillingCodes><PriorBillingCode>OO098</PriorBillingCode></PriorBillingCodes><Name>MUTARS Genux Hinge locking mechanism</Name><Description>Connecting piece; connecting distal femoral and proximal tibial replacement.</Description><Size>Genux Hinge Component</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108697</GroupID><ARTGs><ARTG>234172</ARTG></ARTGs><MinimumBenefit>2454</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW144</BillingCode><Name>KRH (Kinematic Rotating Hinge) Tibial Bearing Component</Name><Description>KRH Rotating Hinge Tibial bearing component, CoCr, Mobile</Description><Size>Small and Medium 11mm/15mm by 110mm/180mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108697</GroupID><ARTGs><ARTG>247934</ARTG></ARTGs><MinimumBenefit>2454</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI573</BillingCode><Name>Zimmer segmental system - hinge servicing kit</Name><Description>Segmental femoral hinge servicing kit</Description><Size>B &amp; C</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108697</GroupID><ARTGs><ARTG>292690</ARTG></ARTGs><MinimumBenefit>2454</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH699</BillingCode><Name>MUTARS GenuX MK Coupling</Name><Description>MUTARS GenuX MK Coupling</Description><Size>12.5, 15, 17.5mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108697</GroupID><ARTGs><ARTG>244653</ARTG></ARTGs><MinimumBenefit>2454</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR293</BillingCode><PriorBillingCodes><PriorBillingCode>GO284</PriorBillingCode></PriorBillingCodes><Name>Apex Revision Knee Modular Tibia Cup</Name><Description>Modular Tibia Cup</Description><Size>Only One size</Size><SupplierCode>39996</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108699</GroupID><ARTGs><ARTG>276775</ARTG></ARTGs><MinimumBenefit>633</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH651</BillingCode><PriorBillingCodes><PriorBillingCode>OO110</PriorBillingCode></PriorBillingCodes><Name>Mutars – end piece</Name><Description>Mutars – end piece</Description><Size>1 size</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108699</GroupID><ARTGs><ARTG>221738</ARTG><ARTG>284235</ARTG></ARTGs><MinimumBenefit>633</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB241</BillingCode><Name>Emotion Total Knee System (TKS) Tibial Stem</Name><Description>Tibial Stem (cap), cemented or uncemented, short (mini) (obturator stem) CoCr, usually required when stem not used</Description><Size>12mm, 14mm &amp; 16mm in cemented and uncemented</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108699</GroupID><ARTGs><ARTG>96481</ARTG></ARTGs><MinimumBenefit>633</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB210</BillingCode><Name>Columbus Total Knee System (TKS) Tibial Stems</Name><Description>Tibial Stem (cap), cemented or uncemented, short (mini) (obturator stem) CoCr, usually required when stem not used</Description><Size>Small &amp; Large D: 12mm &amp; D: 14mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108699</GroupID><ARTGs><ARTG>96481</ARTG></ARTGs><MinimumBenefit>633</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV050</BillingCode><Name>Evolution Medial Pivot Knee System</Name><Description>Revision Stem Cap</Description><Size>one size</Size><SupplierCode>40177</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108699</GroupID><ARTGs><ARTG>196521</ARTG></ARTGs><MinimumBenefit>633</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ654</BillingCode><Name>PFC Sigma - Femoral Adaptor</Name><Description>Offset Adaptor</Description><Size>5 and 7 degree</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108700</GroupID><ARTGs><ARTG>131657</ARTG></ARTGs><MinimumBenefit>1178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU088</BillingCode><Name>GMK Revision offset adaptor</Name><Description>Offset adaptor for tibial and femoral revision extension stem</Description><Size>3mm and 5mm offset</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108700</GroupID><ARTGs><ARTG>211488</ARTG></ARTGs><MinimumBenefit>1178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV053</BillingCode><Name>Evolution Medial Pivot Knee System</Name><Description>Revision CCK Femoral Offset Adapters</Description><Size>4 and 8mm offset</Size><SupplierCode>40177</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108700</GroupID><ARTGs><ARTG>196521</ARTG></ARTGs><MinimumBenefit>1178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV047</BillingCode><Name>Evolution Medial Pivot Knee System</Name><Description>Revision Offset Stem Adapter</Description><Size>4mm - 8mm x 25mm</Size><SupplierCode>40177</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108700</GroupID><ARTGs><ARTG>196521</ARTG></ARTGs><MinimumBenefit>1178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN885</BillingCode><Name>Genesis II/Legion Knee System Offset Couplers</Name><Description>Offset Coupler, titanium</Description><Size>2-6</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108700</GroupID><ARTGs><ARTG>246212</ARTG></ARTGs><MinimumBenefit>1178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN228</BillingCode><Name>Attune Knee System</Name><Description>Offset adaptor</Description><Size>2 to 6mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108700</GroupID><ARTGs><ARTG>288501</ARTG></ARTGs><MinimumBenefit>1178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI956</BillingCode><Name>Offset Tibial Tray System </Name><Description>Offset Adapter for connection to tibial stems and baseplate, titanium </Description><Size>2.5mm, 5mm, 7.5mm Offset</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108700</GroupID><ARTGs><ARTG>310090</ARTG></ARTGs><MinimumBenefit>1178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST603</BillingCode><Name>Duracon Knee System Tibial / Femoral Offset Adaptor</Name><Description>Tibial / Femoral Offset Adaptor, CoCr, (Vitallium)</Description><Size>2mm, 4mm, 6mm, 8mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108700</GroupID><ARTGs><ARTG>242297</ARTG></ARTGs><MinimumBenefit>1178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH414</BillingCode><Name>Trekking Knee System - TCK Femoral and Tibial Offsets</Name><Description>TCK Femoral, Tibial Offset Adaptors</Description><Size>Size (mm): 2, 4, 6
Offsets: Straight, Posterior, Lateral, Medial</Size><SupplierCode>40113</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108700</GroupID><ARTGs><ARTG>287512</ARTG><ARTG>287513</ARTG></ARTGs><MinimumBenefit>1178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI067</BillingCode><Name>Score Knee System Offset Connector</Name><Description>Connector for stems to alter stem offset morse taper but also including screw for additional fixation, titanium</Description><Size>2mm, 4mm, 6mm</Size><SupplierCode>40041</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108700</GroupID><ARTGs><ARTG>242001</ARTG></ARTGs><MinimumBenefit>1178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH615</BillingCode><PriorBillingCodes><PriorBillingCode>OO027</PriorBillingCode></PriorBillingCodes><Name>ACS Knee System - ACS double taper adapter</Name><Description>ACS offset adapters for use with ACS FB, MB tibial and femoral components and stems</Description><Size>0, +2mm, +4mm, +6mm.</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108700</GroupID><ARTGs><ARTG>265644</ARTG><ARTG>265635</ARTG></ARTGs><MinimumBenefit>1178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH637</BillingCode><PriorBillingCodes><PriorBillingCode>OO093</PriorBillingCode></PriorBillingCodes><Name>MUTARS - Genux offset adapter</Name><Description>Offset Adapter</Description><Size>0, 2.5mm, 5mm, 7.5mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108700</GroupID><ARTGs><ARTG>250452</ARTG></ARTGs><MinimumBenefit>1178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH680</BillingCode><PriorBillingCodes><PriorBillingCode>OO162</PriorBillingCode></PriorBillingCodes><Name>MUTARS GenuX MK Offset Adapter</Name><Description>MUTARS GenuX MK Offset Adapter</Description><Size>Offset adapter 0mm, +2mm, +4mm, +6mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108700</GroupID><ARTGs><ARTG>245856</ARTG></ARTGs><MinimumBenefit>1178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA026</BillingCode><Name>Optetrak Logic Offset Stem Extension Couplers</Name><Description>Cemented Offset Couplers with 2, 4, 6, or 8mm of offset</Description><Size>2mm - 8mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108700</GroupID><ARTGs><ARTG>250092</ARTG></ARTGs><MinimumBenefit>1178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK435</BillingCode><Name>Triathlon Knee System Tibial / Femoral Offset Adaptor </Name><Description>Tibial &amp; femral offset adaptor, CoCr</Description><Size>2,4,6,8mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108700</GroupID><ARTGs><ARTG>242297</ARTG></ARTGs><MinimumBenefit>1178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI406</BillingCode><Name>Natural Knee Tibial Augment Fixation </Name><Description>Tibial Augment Fixation peg and screws  </Description><Size>One size only</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108701</GroupID><ARTGs><ARTG>109936</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR317</BillingCode><PriorBillingCodes><PriorBillingCode>GO314</PriorBillingCode></PriorBillingCodes><Name>Apex Revision Knee - Tibial Insert Locking Peg/Bolt</Name><Description>Tibial Insert Locking Peg/Bolt</Description><Size>10; 11; 12; 14; 16; 18; 20; 24 and 28mm</Size><SupplierCode>39996</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108701</GroupID><ARTGs><ARTG>276775</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI741</BillingCode><Name>Zimmer Segmental System - TM Tibia Washer Kit</Name><Description>Zimmer Segmental System - TM Tibia Washer Kit</Description><Size>one size only</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108701</GroupID><ARTGs><ARTG>95761</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO043</BillingCode><Name>LINK Endo Model Rotational and Hinge Knee Prosthesis System</Name><Description>Full tibial blocks made of UHMWPE </Description><Size>Small, Medium, Large</Size><SupplierCode>40190</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108701</GroupID><ARTGs><ARTG>140652</ARTG><ARTG>51002</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN342</BillingCode><Name>Genesis</Name><Description>Custom Flex Lock Peg</Description><Size>Left &amp; right</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108701</GroupID><ARTGs><ARTG>230143</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO159</BillingCode><Name>LINK Endo Model M Modular Knee Prostheses System</Name><Description>Centering Stars</Description><Size>Small, medium, large</Size><SupplierCode>40190</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108701</GroupID><ARTGs><ARTG>257592</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN318</BillingCode><Name>Genesis II</Name><Description>Lugs</Description><Size>Various sizes</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108701</GroupID><ARTGs><ARTG>230143</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP255</BillingCode><Name>SROM Noiles Knee System bumper and hinge bearing replacements </Name><Description>Replacements for UHMWPE axis bearings and bumpers, for hinged prosthesis </Description><Size>Sizes xxsmall - medium.</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108701</GroupID><ARTGs><ARTG>97698</ARTG><ARTG>131657</ARTG><ARTG>97981</ARTG><ARTG>132151</ARTG><ARTG>98088</ARTG><ARTG>98092</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI173</BillingCode><Name>Maxim Complete Knee System Tibial Locking Bar</Name><Description>Insert locking pin, Titanium</Description><Size>One size only</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108701</GroupID><ARTGs><ARTG>98451</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT021</BillingCode><PriorBillingCodes><PriorBillingCode>TZ022</PriorBillingCode></PriorBillingCodes><Name>Genus Uni Tibial Screw</Name><Description>Bone Screws for use with the Genus Uni Tibia</Description><Size>6.5mm 20-50mm</Size><SupplierCode>40232</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108702</GroupID><ARTGs><ARTG>237073</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EX030</BillingCode><Name>Optetrak Total Knee System Tibial Stem Extension Screw</Name><Description>Tibial Stem Screw for Tibial stem fixation</Description><Size>One size only</Size><SupplierCode>40074</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108702</GroupID><ARTGs><ARTG>252474</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR285</BillingCode><PriorBillingCodes><PriorBillingCode>GO192</PriorBillingCode></PriorBillingCodes><Name>Apex Knee, Bone Screw</Name><Description>6.5mm Bone Screw</Description><Size>15mm, 20mm, 25mm, 30mm, 35mm, 40mm, 45mm, 50mm, 55mm, 60mm, 65mm, 70mm.</Size><SupplierCode>39996</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108702</GroupID><ARTGs><ARTG>242554</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH616</BillingCode><PriorBillingCodes><PriorBillingCode>OO029</PriorBillingCode></PriorBillingCodes><Name>ACS Knee System - ACS Screws</Name><Description>Screw for spacers and augments</Description><Size>2 sizes</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108702</GroupID><ARTGs><ARTG>221737</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR290</BillingCode><PriorBillingCodes><PriorBillingCode>GO259</PriorBillingCode></PriorBillingCodes><Name>Apex Revision Knee - Femoral and Tibial Augment Locking Screw/Bolt</Name><Description>Femoral and Tibial Locking Screw/Bolt</Description><Size>Femoral Augment Locking Screw/Bolt - one size only  Tibial Augment Locking Screw/Bolt - 4mm, 8mm, 12mm</Size><SupplierCode>39996</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108702</GroupID><ARTGs><ARTG>252312</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW195</BillingCode><Name>HMRS (Howmedica Modular Replacement System) Plug screw Axis</Name><Description>HMRS Plug Screw Axis, UHMWPE, (Duration) for fixation of HMRS Axis within HMRS bearing component of HMRS Distal Femur / Proximal Tibia and HMRS Femoral / Tibial Joint. </Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108702</GroupID><ARTGs><ARTG>261512</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV017</BillingCode><Name>Cancellous Bone Screw</Name><Description>Option bone screw for tibial component</Description><Size>6.5mm x 1.5 - 6cm in 0.5cm increments long</Size><SupplierCode>40177</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108702</GroupID><ARTGs><ARTG>247558</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU036</BillingCode><Name>Evolis Knee System Fixation Screw </Name><Description>Tibial screw for baseplate fixation to bone, titanium, optional </Description><Size>20/25/30/35/40/45mm (6.5mm diameter)</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108702</GroupID><ARTGs><ARTG>219907</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN329</BillingCode><Name>Genesis II</Name><Description>Tibial screws</Description><Size>15-50mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108702</GroupID><ARTGs><ARTG>230143</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV049</BillingCode><Name>Evolution Medial Pivot Knee System</Name><Description>Revision System Screws</Description><Size>Pass Through, Stem Extension, Side Lock, CCK Pass Through 10-24mm</Size><SupplierCode>40177</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108702</GroupID><ARTGs><ARTG>247558</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB200</BillingCode><Name>Emotion Total Knee System (TKS) Tibial and Femoral Stems</Name><Description>Tibial and femoral stems, CoCr, cemented or uncemented</Description><Size>Short, D: 10mm to 20mm , Medium, D: 10mm to 20mm, Long, D: 10mm to 20mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>277356</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH662</BillingCode><PriorBillingCodes><PriorBillingCode>OO122</PriorBillingCode></PriorBillingCodes><Name>ACS Knee system, ACS stems, straight and offset</Name><Description>ACS tibial and femoral stems</Description><Size>12/14/16/18/20/22mm dia stems, 25/50/75/100/150/200mm length</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>241989</ARTG><ARTG>265633</ARTG><ARTG>265634</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH638</BillingCode><PriorBillingCodes><PriorBillingCode>OO094</PriorBillingCode></PriorBillingCodes><Name>MUTARS - Genux stems</Name><Description>Genux cemented. Press fit stems</Description><Size>130-240mm length, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20mm wide</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>241989</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB242</BillingCode><Name>Columbus Total Knee System (TKS) Tibial Stem</Name><Description>Tibial Stem, cemented or uncemented, CoCr</Description><Size>12mm &amp; 14mm,  in uncemented, 12mm &amp; 14mm in cemented. </Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>277359</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB379</BillingCode><Name>Aesculap AS Tibial and Femoral Stems</Name><Description>Tibial and Femoral Stems, cemented or uncemented, CoCr with ZrN coating</Description><Size>All Sizes</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>277356</ARTG><ARTG>277359</ARTG><ARTG>277357</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR035</BillingCode><Name>Triathlon Knee System TS stem</Name><Description>Tibial stem, Titanium, cemented</Description><Size>9x50mm, 9x100mm, 9x150mm, 12x50mm, 12x100mm, 12x150mm, 15x50mm, 15x100mm, 15x150mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>242297</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV048</BillingCode><Name>Evolution Medial Pivot Knee System</Name><Description>Revision Stems - Cemented, Canal Filling</Description><Size>17mm - 18mm x 25mm - 75mm
10mm - 24mm x 100m - 150mm</Size><SupplierCode>40177</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>196521</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST606</BillingCode><Name>Duracon Knee System Tibial &amp; Femoral stem</Name><Description>Stem, femoral &amp; tibial, titanium, cemented</Description><Size>10mm-19mm, 21mm, 23mm in 80mm and 155mm lengths</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>242297</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO173</BillingCode><Name>Link Endo Model Rotational and Hinge Knee Prostheses</Name><Description>Stems</Description><Size>Extra small - Extra large</Size><SupplierCode>40190</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>157545</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU069</BillingCode><Name>GMK Tibial Extension Stem</Name><Description>Tibial Baseplate extension stem</Description><Size>diameter 11mm, length 65mm &amp; 30mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>241989</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU035</BillingCode><Name>Evolis Knee System Tibial Stem </Name><Description>Tibial stems, titanium, cemented</Description><Size>30/60mm length (12mm diameter)</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>254754</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU086</BillingCode><Name>GMK Revision uncemented extension stem</Name><Description>Uncemented tibia and femur extension stem</Description><Size>Multiple diameters (10, 11, 12, 13, 14, 15, 16, 18, 19, 20, 22mm) each one available in 3 lengths (65, 105, 150mm)</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>254754</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH418</BillingCode><Name>Trekking Knee System - TCK Femoral and Tibial Stems</Name><Description>TCK Femoral and Tibial Stems</Description><Size>Size (mm): 10 - 23
Size (mm): 40 - 120</Size><SupplierCode>40113</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>283167</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR292</BillingCode><PriorBillingCodes><PriorBillingCode>GO283</PriorBillingCode></PriorBillingCodes><Name>Apex Revision Knee Stems</Name><Description>Apex Revision Knee Femoral and Tibial Stems</Description><Size>Modular Stem - 9-25mm x 75-150mm  Offset - 9-25mm x 75-15mm x 2-4mm  Angled Stem - 9-25mm x 75x150mm  Modular Tibial Keels 1-16</Size><SupplierCode>39996</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>276775</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EX027</BillingCode><Name>Optetrak Total Knee System Femoral and Tibial Stems</Name><Description>Femoral and Tibial Stems for Optetrak Knee System, titanium, cemented or uncemented, femoral stem requires stem extension adapter on every occasion, tibial stem requires screw fixation</Description><Size>Size 1 - 6</Size><SupplierCode>40074</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>250112</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI146</BillingCode><Name>NexGen Femoral and Tibial Stems</Name><Description>Femoral and Tibial Stems, straight and offset, cemented </Description><Size>Length - 35 - 245mm, Diameters - 10 - 24 mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>242181</ARTG><ARTG>242180</ARTG><ARTG>242182</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Size</ChangeExplanation><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA094</BillingCode><Name>Persona Revision Stem Extension, Splined, Smooth and Tapered</Name><Description>Composed of Tivanium alloy, for hybrid or cemented fixation</Description><Size>Length-     +30, +75 mm (tapered)  +135, +175 mm ( splined and smooth)           Diameter-     11, 14 mm (tapered)   10, 12, 14, 16, 18, 20, 22, 24 mm (smooth)  10, 11, 12, 13, 14, 15, 16, 17, 18, 20, 22, 24 mm (splined)</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>374555</ARTG><ARTG>374553</ARTG><ARTG>374554</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI184</BillingCode><Name>Biomet Universal Tibial and femoral stems</Name><Description>Tibial and Femoral Stems, Titanium, curved and straight, cemented</Description><Size>40-200mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>177878</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA507</BillingCode><Name>Balansys Revision Knee, Stems</Name><Description>Ti uncemented Stem, straight and offset, complete with locking screw</Description><Size>80 to 200mm, straight and offset 4mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>257054</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA021</BillingCode><Name>Optetrak Logic Stem Extension Femoral and Tibial</Name><Description>Femoral and Tibial Stems for Logic CC System, titanium, cemented or uncemented</Description><Size>10mm - 24mm, length 25mm - 160mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>250112</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN226</BillingCode><Name>Attune Knee System</Name><Description>Revision stems</Description><Size>10 to 24mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>288501</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN208</BillingCode><Name>Attune Knee System</Name><Description>Revision Stems</Description><Size>14mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>288501</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP143</BillingCode><Name>PFC Sigma Knee System tibial stems</Name><Description>Tibial stems cemented and fluted uncemented, titanium</Description><Size>Sizes 30-150mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>238732</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN377</BillingCode><Name>Profix</Name><Description>Metaphyseal Tibial Stem</Description><Size>14-20mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>246212</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN319</BillingCode><Name>Genesis II</Name><Description>Metaphyseal Stem</Description><Size>1-8</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>246212</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU082</BillingCode><Name>GMK Revision cemented extension stem</Name><Description>Cemented tibia and femur extension stem</Description><Size>Diameters 11, 13 and 16mm, available in 2 or 3 lengths (65, 105, 150mm)</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>254754</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF137</BillingCode><Name>SHiVA Hinge Knee Revision System - Stems</Name><Description>Knee revision Extension Stem</Description><Size>Straight 10 - 18mm Diameter; 50 to 150mm Length
Offset 10 - 16 mm Diameter; 75mm Length</Size><SupplierCode>40413</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>192962</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ655</BillingCode><Name>PFC Knee System - Universal Slotted Stem</Name><Description>Tibial/Femoral Stem-Titanium</Description><Size>Lengths 75, 115, 150mm; widths 10 to 24mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>238732</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK434</BillingCode><Name>Triathlon Knee System TS Titanium stem</Name><Description>Stem, Titanium, uncemented</Description><Size>10-25 (100mm) 10-25 (150mm)</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>242297</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN316</BillingCode><Name>Genesis II Knee System Tibial and Femoral Stems</Name><Description>Tibial and Femoral Stems, titanium, cemented or press fit</Description><Size>10-24x100mm, 10-20 x 150mm 10-16x 200mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>246212</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN823</BillingCode><Name>Legion Knee System Femoral and Tibial Stems</Name><Description>Femoral and Tibial stems, Titanium, Cemented or press fit</Description><Size>120-280mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>246212</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR037</BillingCode><Name>Triathlon Knee System Femoral Distal Fixation Peg</Name><Description>Modular Femoral Distal Fixation Peg CoCr</Description><Size>one size</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>242294</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW171</BillingCode><Name>Duracon Knee System / Kinemax Knee System stem</Name><Description>Stem, femoral &amp; tbial, CoCr, (Vitallium), cemented</Description><Size>40mm, 80mm, 155mm for each size</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>242297</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI936</BillingCode><Name>Persona Knee System</Name><Description>Stem Extension</Description><Size>14mm x 30mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>250072</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI066</BillingCode><Name>Amplitude Femoral and Tibial Stems</Name><Description>Femoral and Tibial Stems, Titanium, cemented</Description><Size>7 diameters (10-22), 4 lengths (75-200mm)</Size><SupplierCode>40041</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>275851</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH679</BillingCode><Name>MUTARS GenuX MK Stems</Name><Description>MUTARS GenuX MK Stems</Description><Size>11/12/13/14/15/16/17/18/19/20/22/24/26/28mm dia. 125/150/200/250 length</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>241989</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB353</BillingCode><Name>EnduRo Rotating Hinge Knee Tibial and Femoral Extension Stems cementless and cemented</Name><Description>The EnduRo is a Rotating Hinge Knee prosthesis that enables the Orthopaedic Surgeon to  treat complex revision knee arthoplasty as well as unstable knees</Description><Size>Length Tibial: 52,92&amp;172mm Length Femoral: 77,117,157&amp;177mm - Tibial Cemented: x 12,15,18mm - Tibial Cementless: x 11-20cm - Femoral Cemented: x 12,15,18mm - Femoral Cementless: x 13-20mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108703</GroupID><ARTGs><ARTG>277359</ARTG><ARTG>277356</ARTG></ARTGs><MinimumBenefit>1098</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA023</BillingCode><Name>Optetrak Logic Femoral Metaphyseal Cones</Name><Description>3D printed titanium femoral metaphyseal cones to achieve metaphyseal fixation in cases where bone stock is compromised.</Description><Size>Femoral cones: small, medium, large, and x-large with heights 32mm, 42mm, and 52mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><Suffix>Metaphyseal</Suffix><ARTGs><ARTG>250092</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI485</BillingCode><Name>Trabecular Metal Tibial Cone</Name><Description>Trabecular Metal Tibial void filling cone for proximal metaphyseal bone surrounding stem, full or stepped</Description><Size>XSMALL/SMALL/MED/LARGE/XL</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><Suffix>Metaphyseal</Suffix><ARTGs><ARTG>357912</ARTG><ARTG>242592</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO189</BillingCode><Name>TrabecuLink Tibial Cones</Name><Description>Trabecular Tilastan Tibial void filling cone intended for proximal metaphyseal bone surrounding stem, full or stepped</Description><Size>Full; right half; left half  XS - x-small; S - small; M - medium; L - large  Depth: 33.00 mm - 37.50 mm  Width: 48 mm - 66 mm  Height: 12 mm - 30 mm</Size><SupplierCode>40190</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><Suffix>Metaphyseal</Suffix><ARTGs><ARTG>373076</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO190</BillingCode><Name>TrabecuLink Femoral Cones</Name><Description>Trabecular Tilastan Femoral void filling cone intended for proximal metaphyseal bone surrounding stem, full or stepped</Description><Size>3 - Zones: 2- Zones: Proximal:  right; left:  XS - x-small; S - small; M - medium; L - large:  Depth: 26.00 mm - 32 mm:  Width: 37 mm - 52 mm:  Height: 30 mm - 60 mm</Size><SupplierCode>40190</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><Suffix>Metaphyseal</Suffix><ARTGs><ARTG>373076</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ706</BillingCode><Name>LCS, PFC &amp; SROM Knee System - Universal Fully Porous Femoral Metaphyseal Sleeve</Name><Description>Universal Fully Beaded (Porocoat) Femoral Metaphyseal Titanium Sleeve</Description><Size>31-46mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><Suffix>Metaphyseal</Suffix><ARTGs><ARTG>237112</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW233</BillingCode><Name>KRH (Kinemax Knee System Rotating Hinge) &amp; MRH (Modular Rotating Hinge) Rotating Hinge Sleeve</Name><Description>KRH &amp; MRH Rotating Hinge Tibial Sleeve, UHMWPE, (Duration) houses Rotating Hinge Tibial Rotating component sHydroxyapatiteft</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><ARTGs><ARTG>247298</ARTG></ARTGs><MinimumBenefit>681</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN227</BillingCode><Name>Attune Knee System</Name><Description>Metaphyseal Sleeves, femoral and tibial</Description><Size>29 to 69mm plus cemented</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><Suffix>Metaphyseal</Suffix><ARTGs><ARTG>298543</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU152</BillingCode><Name>3D Metal Tibial Cone</Name><Description>Tibial Cone</Description><Size>Centred cones, sizes from XS to L, Height 20-25 mm
Eccentric cones, sizes from S to L, Height 20-25 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><Suffix>Metaphyseal</Suffix><ARTGs><ARTG>254755</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY156</BillingCode><Name>LCS, PFC and SROM  Knee Systems, femoral metaphyseal sleeve</Name><Description>Universal femoral metaphyseal sleeve, Porocoat, smaller size cemented, larger sizes uncemented, titanium</Description><Size>20 - 46mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><Suffix>Metaphyseal</Suffix><ARTGs><ARTG>237112</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU175</BillingCode><Name>3DMetal Diaphyseal Femoral Cones</Name><Description>Femoral cone</Description><Size>Small, Medium, Large, Extra Large</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><Suffix>Metaphyseal</Suffix><ARTGs><ARTG>254755</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA027</BillingCode><Name>Optetrak Logic Tibial Metaphyseal Cones</Name><Description>3D printed titanium tibial metaphyseal cones to achieve metaphyseal fixation in cases where bone stock is compromised.</Description><Size>29, 32, 39, 48, 57, and 65mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><Suffix>Metaphyseal</Suffix><ARTGs><ARTG>250092</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW576</BillingCode><Name>Triathlon Tritanium Asymmetric Tibial Cone Augments</Name><Description>3D printed Tritanium Cone Augments intended for filling bone voids in metaphyseal region of bone. CPTi porous foam for biological fixation or cement interdigitation, for use with Triathlon TS cemented or uncemented stems.</Description><Size>Asymmetric Tibial Cone Augments, 4 sizes, LM/RL &amp; RM/LL, (B-E).</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><Suffix>Metaphyseal</Suffix><ARTGs><ARTG>262263</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW574</BillingCode><Name>Triathlon Tritanium Femoral Cone Augments</Name><Description>3D printed Tritanium Cone Augments intended for filling bone voids in metaphyseal region of bone. CPTi porous foam for biological fixation or cement interdigitation, for use with Triathlon TS cemented or uncemented stems</Description><Size>Femoral Cone Augments, 6 sizes, L &amp; R (Size 1-2, Size 3, 4, 5, 6 and Size 7-8)</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><Suffix>Metaphyseal</Suffix><ARTGs><ARTG>262263</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY157</BillingCode><Name>MBT  Knee Systems tibial metaphyseal sleeve</Name><Description>Universal tibial metaphyseal sleeve, Porocoat, smaller size cemented or uncemented, larger sizes uncemented, titanium</Description><Size>29 - 61mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><Suffix>Metaphyseal</Suffix><ARTGs><ARTG>237112</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL074</BillingCode><Name>Legion Femoral Cone</Name><Description>Femoral cone augment intended to fill cavitary bone defects in the femoral metaphyseal bone</Description><Size>left/right, 18-30mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><Suffix>Metaphyseal</Suffix><ARTGs><ARTG>238696</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV046</BillingCode><Name>Evolution Medial Pivot Knee System</Name><Description>Revision Stem Extension Adapter</Description><Size>25mm - 50mm</Size><SupplierCode>40177</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><ARTGs><ARTG>196521</ARTG></ARTGs><MinimumBenefit>681</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV051</BillingCode><Name>Evolution Medial Pivot Knee System</Name><Description>Revision Tibial Base Modular Keel</Description><Size>Small, Medium, Large</Size><SupplierCode>40177</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><ARTGs><ARTG>196521</ARTG></ARTGs><MinimumBenefit>681</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EX029</BillingCode><Name>Opetrak Total Knee System Femoral Stem Extension Adpater</Name><Description>Femoral Stem Extension Adapter that provides for set changes in angulation of stem needs to be used on every occasion</Description><Size>2 - 7 Degree</Size><SupplierCode>40074</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><ARTGs><ARTG>250092</ARTG></ARTGs><MinimumBenefit>681</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB381</BillingCode><Name>Aesculap AS Femoral Stem Locking Nut</Name><Description>Femoral Stem Locking Nut, CoCr with ZrN coating</Description><Size>One size</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><ARTGs><ARTG>277359</ARTG></ARTGs><MinimumBenefit>681</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL073</BillingCode><Name>Legion Tibial Cone</Name><Description>Tibial cone augment intended to fill cavitary bone defects in the proximal tibial metaphyseal bone.</Description><Size>Short-long, 18-30 mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><Suffix>Metaphyseal</Suffix><ARTGs><ARTG>238696</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR265</BillingCode><Name>Unity Knee – Stem Extenders</Name><Description>Tibial Stem extenders and offset couplings -cemented</Description><Size>3mm, 6mm  Diameter Ø10-18  Length 60 , 30 and 100mm  Offset and straight</Size><SupplierCode>39996</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><ARTGs><ARTG>274747</ARTG></ARTGs><MinimumBenefit>681</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB319</BillingCode><Name>Emotion Total Knee System Femoral Stem Extension</Name><Description>Revision nut for Femur Extension Stem</Description><Size>One size only</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><ARTGs><ARTG>96481</ARTG></ARTGs><MinimumBenefit>681</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB351</BillingCode><Name>Enduro Rotating Hinge Knee Femoral Stem locking nut neutral</Name><Description>The EnduRo is a Rotating Hinge Knee prosthesis that enables the Orthopaedic Surgeon to treat complex revision knee arthroplasty as well as unstable knees.</Description><Size>1 size neutral (for all femoral stems)</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><ARTGs><ARTG>96481</ARTG></ARTGs><MinimumBenefit>681</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI516</BillingCode><Name>Trabecular Metal Femoral Cone </Name><Description>Trabecular Metal femoral void filling cone for distal metaphyseal bone surrounding stem</Description><Size>SMALL/MED/LARGE/XL</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><Suffix>Metaphyseal</Suffix><ARTGs><ARTG>357912</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW575</BillingCode><Name>Triathlon Tritanium Symmetric Tibial Cone Augments</Name><Description>3D printed Tritanium Cone Augments intended for filling bone voids in metaphyseal region of bone. CPTi porous foam for biological fixation or cement interdigitation, for use with Triathlon TS cemented or uncemented stems</Description><Size>Symmetric Tibial Cone Augments, 5 sizes (A – E)</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><Suffix>Metaphyseal</Suffix><ARTGs><ARTG>262263</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH684</BillingCode><PriorBillingCodes><PriorBillingCode>OO174</PriorBillingCode></PriorBillingCodes><Name>EPORE Cones/Components</Name><Description>Femoral/Tibial metaphyseal Cones and Components, 3D Printed titanium</Description><Size>Sizes 2-6 for Femur and Tibia, Left and Right</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><Suffix>Metaphyseal</Suffix><ARTGs><ARTG>221737</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH063</BillingCode><Name>Regenerex Sleeve Augment</Name><Description>Augment, cone or finned sleeve, SSK/OSS Systems, Ti</Description><Size>(25mm to 40mm, Type A or B) x Extra small to Large</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><Suffix>Metaphyseal</Suffix><ARTGs><ARTG>169733</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK442</BillingCode><Name>Triathlon Knee System Stem Extender</Name><Description>Stem extender, cemented, CoCr </Description><Size>25mm &amp; 50mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108704</GroupID><ARTGs><ARTG>242297</ARTG></ARTGs><MinimumBenefit>681</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UK005</BillingCode><PriorBillingCodes><PriorBillingCode>ER297</PriorBillingCode></PriorBillingCodes><Name>Spacer-K</Name><Description>Temporary implantable device for the treatment of infected total knee replacement, Composition - stainless steel core surrounded by PMMA impregnated with Gentamicin</Description><Size>Small, Medium, Large</Size><SupplierCode>40267</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107692</SubCategoryID><GroupID>108705</GroupID><ARTGs><ARTG>155141</ARTG></ARTGs><MinimumBenefit>1814</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JI003</BillingCode><PriorBillingCodes><PriorBillingCode>LH579</PriorBillingCode></PriorBillingCodes><Name>CP Stent</Name><Description>CP Stent Uncovered</Description><Size>16,22,28,34,39,&amp;45mm length</Size><SupplierCode>40458</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107748</SubCategoryID><GroupID>109104</GroupID><ARTGs><ARTG>121892</ARTG></ARTGs><MinimumBenefit>1199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JI002</BillingCode><PriorBillingCodes><PriorBillingCode>LH581</PriorBillingCode></PriorBillingCodes><Name>CP Stent</Name><Description>CP Stent Uncovered, mounted on BIB balloon</Description><Size>16,22,28,34,39,&amp;45mm length</Size><SupplierCode>40458</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107748</SubCategoryID><GroupID>109104</GroupID><Suffix>Balloon- in-Balloon</Suffix><ARTGs><ARTG>121892</ARTG></ARTGs><MinimumBenefit>2124</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JI005</BillingCode><PriorBillingCodes><PriorBillingCode>LH580</PriorBillingCode></PriorBillingCodes><Name>CP Stent</Name><Description>CP Stent Covered</Description><Size>16,22,28,34,39,&amp;45mm length</Size><SupplierCode>40458</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107748</SubCategoryID><GroupID>109105</GroupID><ARTGs><ARTG>121892</ARTG></ARTGs><MinimumBenefit>1998</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JI004</BillingCode><PriorBillingCodes><PriorBillingCode>LH582</PriorBillingCode></PriorBillingCodes><Name>CP Stent</Name><Description>CP Stent Covered, mounted on BIB balloon</Description><Size>16,22,28,34,39,&amp;45mm length</Size><SupplierCode>40458</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107748</SubCategoryID><GroupID>109105</GroupID><Suffix>Balloon-in-Balloon</Suffix><ARTGs><ARTG>121892</ARTG></ARTGs><MinimumBenefit>2923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ482</BillingCode><Name>Navitor™ Transcatheter Aortic Valve</Name><Description>Self-expanding transcatheter aortic tissue valve, nitinol stent, bovine valve with delivery system</Description><Size>23-29</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107749</SubCategoryID><GroupID>109113</GroupID><ARTGs><ARTG>396571</ARTG><ARTG>399973</ARTG><ARTG>410058</ARTG></ARTGs><Note>The listed item [billing code] covers the Navitor System, containing Transcatheter Aortic Valve (cat. numbers NVTR-23, NVTR-25, NVTR-27, NVTR-29), FlexNav™ Delivery System (cat. numbers FNAV-DS-SM, FNAV-DS-LG) and Loading System (NVTR-LS-SM and NVTR-LS-LG), and the benefit is payable for the listed item if the Navitor System is used for the surgical procedure described in item 38495 in Group T8 of the Regulations.</Note><MinimumBenefit>22932</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EL063</BillingCode><Name>Edwards SAPIEN 3 Transcatheter Heart Valve</Name><Description>Transcatheter, balloon expanded aortic heart valve with Commander Delivery System</Description><Size>20mm, 23mm, 26mm and 29mm</Size><SupplierCode>40072</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107749</SubCategoryID><GroupID>109113</GroupID><ARTGs><ARTG>284496</ARTG></ARTGs><MinimumBenefit>22932</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ159</BillingCode><Name>Medtronic Evolut FX transcatheter aortic valve</Name><Description>Transcatheter aortic valve, self-expanding, re-sheath and/or complete recapture after partial deployment and redeployment including a loading system (L-EVOLUTFX-2329, L-EVOLUTFX-34) and a delivery catheter system (D-EVOLUTFX-2329, D-EVOLUTFX-34)</Description><Size>23mm-34mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107749</SubCategoryID><GroupID>109113</GroupID><ARTGs><ARTG>430190</ARTG></ARTGs><MinimumBenefit>22932</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EL067</BillingCode><Name>Edwards SAPIEN 3 Ultra Transcatheter Heart Valve System </Name><Description>The Edwards SAPIEN 3 Ultra Transcatheter Heart Valve (THV) system is an Aortic transcatheter heart valve bioprosthesis, with stent-like framework. It  consists of the Edwards SAPIEN 3 Ultra transcatheter heart valves and delivery systems. The Edwards SAPIEN 3 Ultra Valve is comprised of a balloon-expandable, radiopaque, cobalt-chromium frame, trileaflet bovine pericardial tissue valve, and polyethylene terephthalate inner and outer fabric skirts. </Description><Size> (mm) 20, 23, 26</Size><SupplierCode>40072</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107749</SubCategoryID><GroupID>109113</GroupID><ARTGs><ARTG>343715</ARTG></ARTGs><MinimumBenefit>22932</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI259</BillingCode><Name>Medtronic CoreValve™ Evolut™ R transcatheter aortic valve</Name><Description>Transcatheter aortic valve, self-expanding, re-sheath and/or complete recapture after partial deployment and redeployment</Description><Size>23mm-34mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107749</SubCategoryID><GroupID>109113</GroupID><ARTGs><ARTG>284003</ARTG></ARTGs><MinimumBenefit>22932</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI315</BillingCode><Name>Medtronic CoreValve™ Evolut™ PRO transcatheter aortic valve</Name><Description>Transcatheter aortic valve, self-expanding, re-sheath and/or complete recapture after partial deployment and redeployment</Description><Size>23mm-29mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107749</SubCategoryID><GroupID>109113</GroupID><ARTGs><ARTG>319850</ARTG></ARTGs><MinimumBenefit>22932</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ394</BillingCode><Name>Portico transcatheter aortic valve</Name><Description>Self-expanding transcatheter aortic tissue valve, nitinol stent, bovine valve</Description><Size>23-29</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107749</SubCategoryID><GroupID>109113</GroupID><ARTGs><ARTG>254835</ARTG></ARTGs><MinimumBenefit>22932</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS417</BillingCode><Name>LUX-Dx™ </Name><Description>Insertable Cardiac Monitor</Description><Size>7.2 mm x 44.8 mm x 4.0 mm, 1.2 cm3</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107751</SubCategoryID><GroupID>109117</GroupID><ARTGs><ARTG>411051</ARTG></ARTGs><MinimumBenefit>2886</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ390</BillingCode><Name>Confirm RX</Name><Description>Insertable Cardiac Monitor</Description><Size>5cm X 0.95cm X 0.33cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107751</SubCategoryID><GroupID>109117</GroupID><ARTGs><ARTG>292930</ARTG></ARTGs><MinimumBenefit>2886</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI438</BillingCode><Name>Reveal LINQ II™</Name><Description>Insertable Cardiac Monitor</Description><Size>45.1 mm x 8mm x 4.2mm, 1.4cc</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107751</SubCategoryID><GroupID>109117</GroupID><Suffix>i</Suffix><ARTGs><ARTG>391830</ARTG></ARTGs><MinimumBenefit>2886</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI141</BillingCode><Name>Reveal LINQ</Name><Description>Insertable Cardiac Monitor</Description><Size>44.8 mm x 7.2 mm x 4.0 mm,1.2 cm3</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107751</SubCategoryID><GroupID>109117</GroupID><Suffix>i</Suffix><ARTGs><ARTG>391831</ARTG></ARTGs><MinimumBenefit>2886</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ481</BillingCode><Name>Jot Dx</Name><Description>Insertable Cardiac Monitor - with integrated remote monitoring capability via the myMerlin smart device App, including accessories for insertion (an incision tool and an insertion tool)</Description><Size>49 x 9.4 x 3.1 mm  </Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107751</SubCategoryID><GroupID>109117</GroupID><ARTGs><ARTG>401857</ARTG></ARTGs><MinimumBenefit>2886</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT244</BillingCode><Name>BIOMONITOR III  </Name><Description>Injectable cardiac monitor for continuous remote monitoring of patients </Description><Size>77.5 mm x 8.6 mm x 4.6 mm; 4 g; 1.9 cm3</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107751</SubCategoryID><GroupID>109117</GroupID><Suffix>i</Suffix><ARTGs><ARTG>396024</ARTG></ARTGs><MinimumBenefit>2886</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT247</BillingCode><Name>BIOMONITOR III m  </Name><Description>Injectable cardiac monitor for continuous remote monitoring of patients with extended AF Detection</Description><Size>77.5 mm x 8.6 mm x 4.6 mm; 4 g; 1.9 cm3</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107751</SubCategoryID><GroupID>109117</GroupID><Suffix>i</Suffix><ARTGs><ARTG>396023</ARTG></ARTGs><MinimumBenefit>2886</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ236</BillingCode><Name>Prevail DCB</Name><Description>Paclitaxel-Coated PTCA Balloon Catheter
</Description><Size>Length (mm): 10-30; Diameter (mm): 2-4</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107753</SubCategoryID><GroupID>109118</GroupID><ARTGs><ARTG>427408</ARTG></ARTGs><MinimumBenefit>854</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT256</BillingCode><Name>Pantera Lux</Name><Description>Coronary Drug-Coated Balloon Catheter</Description><Size>Diameter (mm) - 2.0 to 4.0  Length (mm) -10 to 30</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107753</SubCategoryID><GroupID>109118</GroupID><ARTGs><ARTG>422261</ARTG></ARTGs><MinimumBenefit>854</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS419</BillingCode><Name>Agent Paclitaxel-Coated Balloon Catheter</Name><Description>Coronary angioplasty balloon catheter, drug-eluting</Description><Size>Length (mm) 8-30; Diameter (mm) 2.00-4.00</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107753</SubCategoryID><GroupID>109118</GroupID><ARTGs><ARTG>385816</ARTG></ARTGs><MinimumBenefit>854</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB409</BillingCode><Name>SeQuent Please/SeQuent Please NEO</Name><Description>Drug eluting balloon catheter for percutaneous transluminal coronary angioplasty (PTCA)</Description><Size>SeQuent Please:  Diameter (mm) 2.0 to 4.0  Length (mm) 10.0 to 30.0      SeQuent Please NEO:  Diameter (mm) 2.0 to 4.0  Length (mm) 10.0 to 40.0  </Size><SupplierCode>40020</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107753</SubCategoryID><GroupID>109118</GroupID><ARTGs><ARTG>181392</ARTG></ARTGs><MinimumBenefit>854</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI180</BillingCode><Name>MyCareLink Patient Monitor</Name><Description>Electronic cellular patient monitor which gathers and transmits cardiac information from an implanted cardiac device (CIED) to your health care professional for assessment.</Description><Size>One size</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107754</SubCategoryID><GroupID>109119</GroupID><ARTGs><ARTG>297224</ARTG></ARTGs><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ370</BillingCode><Name>Merlin@Home Inductive</Name><Description>Home cardiac monitor (inductive) with landline, cellular and broadband connectivity</Description><Size>one size </Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107754</SubCategoryID><GroupID>109119</GroupID><ARTGs><ARTG>163472</ARTG></ARTGs><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI296</BillingCode><Name>MyCareLink Relay Home Communicator</Name><Description>Electronic cellular (optional wifi) patient monitor which gathers and transmits cardiac information from an implanted cardiac device (CIED) to your health care professional for assessment</Description><Size>One size</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107754</SubCategoryID><GroupID>109119</GroupID><ARTGs><ARTG>313825</ARTG></ARTGs><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT246</BillingCode><Name>CardioMessenger Smart 4G</Name><Description>Bedside/Remote transmitter w/ pacemaker/ICD device life network access to Biotronik standard home monitoring data management service.</Description><Size>Length - 130mm, Width - 65mm,  Height - 13mm        Weight - 75g</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107754</SubCategoryID><GroupID>109119</GroupID><ARTGs><ARTG>352258</ARTG></ARTGs><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF018</BillingCode><PriorBillingCodes><PriorBillingCode>SA173</PriorBillingCode></PriorBillingCodes><Name>Smartview Remote Monitoring Solution</Name><Description>The Smartview PSTN monitor and Smartview Monitor GPRS - Pacemaker programmer is designed to allow physicians and nurses following patients with a Sorin PARADYMTM RF or INTENSIA family of ICD and CRT-D devices to access valuable cardiac data and alert messages from the device while the patient is at home.</Description><Size>Single Device Product</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107754</SubCategoryID><GroupID>109119</GroupID><ARTGs><ARTG>217760</ARTG><ARTG>217759</ARTG></ARTGs><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF038</BillingCode><Name>SmartView Connect™</Name><Description>Bluetooth Remote Monitoring Device</Description><Size>Monitor: 65 X118 X 15mm  Docking Station: 84 X46 X 115mm</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107754</SubCategoryID><GroupID>109119</GroupID><ARTGs><ARTG>379251</ARTG></ARTGs><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF033</BillingCode><Name>Smart Monitor</Name><Description>Monitoring Device for Smartview Remote Monitoring System</Description><Size>One size only</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107754</SubCategoryID><GroupID>109119</GroupID><ARTGs><ARTG>350770</ARTG></ARTGs><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF036</BillingCode><Name>Smart Spot</Name><Description>Remote Monitoring System</Description><Size>One size only</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107754</SubCategoryID><GroupID>109119</GroupID><ARTGs><ARTG>355435</ARTG></ARTGs><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS294</BillingCode><Name>Latitude Communicator</Name><Description>Remote patient management system for implanted cardiac devices </Description><Size>One size only</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107754</SubCategoryID><GroupID>109119</GroupID><ARTGs><ARTG>230414</ARTG><ARTG>201875</ARTG></ARTGs><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT187</BillingCode><Name>CardioMessenger Smart 3G</Name><Description>Bedside/Remote transmitter w/ pacemaker/ICD device life network access to Biotronik standard home monitoring data management service.</Description><Size>Length - 130mm, Width - 65mm,  Height - 13mm        Weight - 75g</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107754</SubCategoryID><GroupID>109119</GroupID><ARTGs><ARTG>273716</ARTG></ARTGs><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI196</BillingCode><Name>MyCareLink Smart Patient Reader</Name><Description>Electronic cellular patient reader which gathers and transmits cardiac information from an implanted cardiac device (CIED) to your health care professional for assessment.</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107754</SubCategoryID><GroupID>109119</GroupID><ARTGs><ARTG>235570</ARTG></ARTGs><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ369</BillingCode><Name>Merlin@Home wireless</Name><Description>Home cardiac monitor (RF) with landline, cellular and broadband connectivity</Description><Size>one size</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107754</SubCategoryID><GroupID>109119</GroupID><ARTGs><ARTG>161670</ARTG></ARTGs><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ154</BillingCode><Name>LUX-Dx Mobile Monitor</Name><Description>Mobile applications for patient monitoring and remote programming that run on a handheld mobile/smart device. LUX-Dx Clinic Assistant application is for healthcare professionals while myLUX patient application is intended for patients to interact with the system and
their clinic and stay connected. The applications communicate with the LUX-Dx ICM via Bluetooth Low Energy (BLE) and the LATITUDE Server via cellular or Wi-Fi for collection and transmission of event, patient, and device data.</Description><Size>One size</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107754</SubCategoryID><GroupID>109120</GroupID><ARTGs><ARTG>413400</ARTG></ARTGs><MinimumBenefit>502</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ144</BillingCode><Name>Aurora EV-ICD MRI SureScan System </Name><Description>The Aurora EV-ICD System comprises the Aurora EV-ICD MRI SureScan Model DVEA3E4 single chamber, implantable cardioverter defibrillator (and torque wrench) and the Epsila EV MRI SureScan Model EV2401 extravascular lead .</Description><Size>Generator: 33cm3 77g , Leads: lengths 52 cm and 63 cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109121</GroupID><ARTGs><ARTG>450444</ARTG><ARTG>450443</ARTG></ARTGs><MinimumBenefit>28398</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI385</BillingCode><Name>Crome™ VR ICD MRI SureScan™</Name><Description>Single Chamber Implantable Cardioverter Defibrillator with PhysionCurve Design, MRI compatible, Optimised Battery Chemistry, SmartShock 2.0 Technology, Complete Capture Management, BlueSync technology, DF1</Description><Size>33.2 cm3, 79 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d</Suffix><ARTGs><ARTG>392256</ARTG></ARTGs><MinimumBenefit>23920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI256</BillingCode><Name>VISIA AF S ICDs/ VISIA AF MRI S SureScan ICDs</Name><Description>Digital single chamber implantable cardioverter defibrillator. PhysioCurve™ Design, SmartShock™ Technology, OptiVol™ 2.0 Fluid Status Monitoring, Complete Capture Management™ Diagnostic (RVCM), AF Diagnostics including SureScan/ MRI models</Description><Size>33cm³ 77g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d</Suffix><ARTGs><ARTG>393380</ARTG></ARTGs><MinimumBenefit>23920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI112</BillingCode><Name>Evera XT VR DF1/ Evera MRI XT VR SureScan DF1</Name><Description>Single Chamber Implantable Cardioverter Defibrillator with PhysionCurve Design, Optimised Battery Chemistry, SmartShock Technology 2.0, Optivol 2.0 Fluid Status Monitoring, Complete Capture Management. DF1</Description><Size>33cm³ 77g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d</Suffix><ARTGs><ARTG>392334</ARTG><ARTG>393381</ARTG></ARTGs><MinimumBenefit>23920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI394</BillingCode><Name>Cobalt™ XT VR ICD MRI SureScan™</Name><Description>Single Chamber Implantable Cardioverter Defibrillator with PhysionCurve Design, MRI compatible, Optimised Battery Chemistry, SmartShock 2.0+ Technology, Optivol 2.0 Fluid Status Monitoring, Complete Capture Management, BlueSync technology, DF1</Description><Size>33.2 cm3, 79 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d</Suffix><ARTGs><ARTG>392254</ARTG></ARTGs><MinimumBenefit>23920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ333</BillingCode><Name>Fortify Assura VR CD1359-40/CD1359-40C</Name><Description>Single Chamber Cardioverter Defibrillator with 40J delivered energy</Description><Size>76g , 35cc</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d</Suffix><ARTGs><ARTG>207195</ARTG></ARTGs><MinimumBenefit>23920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI114</BillingCode><Name>Evera MRI S VR SureScan DF1</Name><Description>Single Chamber Implantable Cardioverter Defibrillator with PhysioCurve Design, Optimised Battery Chemistry, Smart Shock Technology 2.0, DF1</Description><Size>33cm³ 77g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d</Suffix><ARTGs><ARTG>393538</ARTG></ARTGs><MinimumBenefit>23920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI386</BillingCode><Name>Cobalt™ VR ICD MRI SureScan™</Name><Description>Single Chamber Implantable Cardioverter Defibrillator with PhysionCurve Design, MRI compatible, Optimised Battery Chemistry, SmartShock 2.0 Technology, Complete Capture Management, BlueSync technology, DF1</Description><Size>33.2 cm3, 79 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d</Suffix><ARTGs><ARTG>392255</ARTG></ARTGs><MinimumBenefit>23920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS340</BillingCode><Name>MOMENTUM EL VR DF-1</Name><Description>Single Chamber implantable cardioverter defibrillation, 4IJ, DF-1 RV connector. ENDURALIFE Battery Technology</Description><Size>29.5cc, 68.9g, 5.37 x 7.79 x 0.99 cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d</Suffix><ARTGs><ARTG>399064</ARTG></ARTGs><MinimumBenefit>23920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ326</BillingCode><Name>Ellipse VR CD1377-36/CD1377-36C</Name><Description>Single Chamber Cardioverter Defribrillator</Description><Size>31cc, 66g</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d</Suffix><ARTGs><ARTG>207181</ARTG><ARTG>207183</ARTG></ARTGs><MinimumBenefit>23920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI255</BillingCode><Name>VISIA AF XT ICDs/ VISIA AF MRI XT SureScan ICDs</Name><Description>Digital single chamber implantable cardioverter defibrillator. PhysioCurve™ Design, SmartShock™ Technology, OptiVol™ 2.0 Fluid Status Monitoring, Complete Capture Management™ Diagnostic (RVCM), AF Diagnostics including SureScan/ MRI models</Description><Size>33cm³ 77g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d</Suffix><ARTGs><ARTG>393270</ARTG></ARTGs><MinimumBenefit>23920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF052</BillingCode><Name>ULYS™  VR 2210 </Name><Description>Single chamber implantable cardioverter defibrillator</Description><Size>Weight - 85g  Volume - 33cc</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d</Suffix><ARTGs><ARTG>400117</ARTG></ARTGs><MinimumBenefit>23920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS278</BillingCode><Name>AUTOGEN ICD VR DF-1</Name><Description>Single Chamber implantable cardioverter defibrillation, 4IJ, DF-1 RV connector</Description><Size>28.5cc -31.5cc, 61.9g - 70.7g, 9.9mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d</Suffix><ARTGs><ARTG>400123</ARTG><ARTG>400437</ARTG></ARTGs><MinimumBenefit>23920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT229</BillingCode><Name>Intica Neo 7 VR-T</Name><Description>Single Chamber ICD, ventricular capture control, physiological rate adaption, automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry, Home Monitoring w/ QuickCheck, MRI conditional and AutoDetect, DF-1, IS-1 connector</Description><Size>W x H x D (mm) 65 x 55 x 11, Volume: 33cc, Mass: 82g</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d</Suffix><ARTGs><ARTG>396014</ARTG></ARTGs><MinimumBenefit>23920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT230</BillingCode><Name>Intica Neo 7 VR-T DX</Name><Description>Single Chamber ICD, ventricular capture control, physiological rate adaption, additional atrial detection (DX),automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry, Home Monitoring w/ QuickCheck, MRI conditional and AutoDetect, DF-1, IS-1 connector</Description><Size>65mm x 55mm x 11mm, 33cm3, 82grams</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d</Suffix><ARTGs><ARTG>396018</ARTG></ARTGs><MinimumBenefit>23920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI408</BillingCode><Name>Cobalt™ VR ICD MRI SureScan™ with BlueSync mobile remote monitoring</Name><Description>Single Chamber Implantable Cardioverter Defibrillator with PhysionCurve Design, MRI compatible, Optimised Battery Chemistry, SmartShock 2.0 Technology, Complete Capture Management, BlueSync technology, DF4 with BlueSync mobile remote monitoring</Description><Size>32.8 cm3, 79 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a,d,e Remote Monitoring Service</Suffix><ARTGs><ARTG>392259</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>25817</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI409</BillingCode><Name>Crome™ VR ICD MRI SureScan™ with BlueSync mobile remote monitoring</Name><Description>Single Chamber Implantable Cardioverter Defibrillator with PhysionCurve Design, MRI compatible, Optimised Battery Chemistry, SmartShock 2.0 Technology, Complete Capture Management, BlueSync technology, DF4 with BlueSync mobile remote monitoring</Description><Size>32.8 cm3, 79 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a,d,e Remote Monitoring Service</Suffix><ARTGs><ARTG>392265</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>25817</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI407</BillingCode><Name>Cobalt™ XT VR ICD MRI SureScan™ with BlueSync mobile remote monitoring</Name><Description>Single Chamber Implantable Cardioverter Defibrillator with PhysionCurve Design, MRI compatible, Optimised Battery Chemistry, SmartShock 2.0+ Technology, Optivol 2.0 Fluid Status Monitoring, Complete Capture Management, BlueSync technology, DF4</Description><Size>32.8 cm3, 79 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a,d,e Remote Monitoring Service</Suffix><ARTGs><ARTG>392264</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>25817</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF001</BillingCode><PriorBillingCodes><PriorBillingCode>SA176</PriorBillingCode></PriorBillingCodes><Name>Platinium VR 1210</Name><Description>PLATINIUM VR  is an implantable single-chamber cardioverter defibrillator. It is equipped with an accelerometer to allow adaptation of pacing to suit the patient’s activity. PLATINIUM VR is also equipped with the RF wireless technology which enables remote monitoring of patients who have the Sorin SMARTVIEW Monitor installed at home, wireless interrogation and device programming by Orchestra Plus programmer equipped with ORCHESTRA PLUS LINK accessory. PLATINIUM VR provides high energy shocks (42 J) for enhanced safety, as well as automatic lead measurements to monitor system integrity. PLATINIUM VR is protected against high-frequency signals emitted by cellular telephones. The PLATINIUM VR ICD device and programming system. The programming system includes the Sorin dedicated programmer with the SMARTVIEW programming software connected to a CPR3 programming head. The programming system is configured and furnished by Sorin. The PLATINIUM VR can serve as a defibrillation electrode (active housing) with a total surface area of 63 cm2. PLATINIUM VR 1210 has two DF-1 and one IS-1 connector ports. The PLATINIUM VR is designed to recognize and treat slow or fast VT and VF by continuously monitoring ventricular activity to identify persistent ventricular arrhythmias and to deliver appropriate therapies. PLATINIUM VR features DISCRIMINATION algorithm.</Description><Size>Dimensions 73 x 54.3 x 11.1mm
Weight 85 g
Volume 33 cm3
Active surface area of casing 62.7cm2
Connector IS-1 bipolar, 2*DF-1.</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d</Suffix><ARTGs><ARTG>282817</ARTG></ARTGs><MinimumBenefit>23920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS338</BillingCode><Name>RESONATE EL VR DF-4</Name><Description>Single Chamber implantable cardioverter defibrillation, 4IJ, DF-4 RV connector. ENDURALIFE Battery Technology and IMAGEREADY MR-Conditional</Description><Size>29.5cc, 68.9g, 5.37 x 7.36 x 0.99 (cm)</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d, e</Suffix><ARTGs><ARTG>399063</ARTG></ARTGs><MinimumBenefit>24367</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF049</BillingCode><Name>Ulys™ VR 2240 </Name><Description>MRI Conditional Single Chamber Cardioverter Defibrillator</Description><Size>Weight - 84g  Volume - 31.2 cc  </Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d, e</Suffix><ARTGs><ARTG>400118</ARTG></ARTGs><MinimumBenefit>24367</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS276</BillingCode><Name>AUTOGEN ICD VR DF-4</Name><Description>Single Chamber implantable cardioverter defibrillation, 4IJ, DF-4 RV connector</Description><Size>26.5cc - 29.5cc, 60.0g - 68.9g, 9.9mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d, e</Suffix><ARTGs><ARTG>400181</ARTG><ARTG>400122</ARTG></ARTGs><MinimumBenefit>24367</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF004</BillingCode><PriorBillingCodes><PriorBillingCode>SA178</PriorBillingCode></PriorBillingCodes><Name>Platinium VR 1240</Name><Description>PLATINIUM VR 1240 is an implantable single-chamber cardioverter defibrillator. It is equipped with an accelerometer to allow adaptation of pacing to suit the patient’s activity. PLATINIUM VR is also equipped with the RF wireless technology which enables remote monitoring of patients who have the Sorin SMARTVIEW Monitor installed at home, wireless interrogation and device programming by Orchestra Plus programmer equipped with ORCHESTRA PLUS LINK accessory. PLATINIUM VR provides high energy shocks (42 J) for enhanced safety, as well as automatic lead measurements to monitor system integrity. PLATINIUM VR is protected against high-frequency signals emitted by cellular telephones. The PLATINIUM VR can serve as a defibrillation electrode (active housing) with a total surface area of 63 cm2.
The PLATINIUM VR is designed to recognize and treat slow or fast VT and VF by continuously monitoring ventricular activity to identify persistent ventricular arrhythmias and to deliver appropriate therapies. PLATINIUM VR features DISCRIMINATION algorithm, which is specifically designed to differentiate ventricular tachycardias from fast rhythms of supraventricular origin. DISCRIMINATION continuously monitors R-R interval stability, searches for long cycles and evaluates sudden onset.</Description><Size>Dimensions 65.8 x 54.3 x 11.1 mm
Weight 84 g
Volume 31.2 cm3
Active surface area of casing 62.9cm2
Connector DF4.</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d, e</Suffix><ARTGs><ARTG>282816</ARTG></ARTGs><MinimumBenefit>24367</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ199</BillingCode><Name>NEUTRINO NxT VR ICD Model CDVRA600Q</Name><Description>Single Chamber Cardioverter Defibrillator    </Description><Size>30cc, 69g</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a,d,e Remote Monitoring Service</Suffix><ARTGs><ARTG>394064</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>25817</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ417</BillingCode><Name>Gallant VR ICD Model CDVRA500Q</Name><Description>Single Chamber Cardioverter Defibrillator    </Description><Size>30cc, 69g</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a,d,e Remote Monitoring Service</Suffix><ARTGs><ARTG>395510</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>25817</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI410</BillingCode><Name>Cobalt™ XT VR ICD MRI SureScan™ with BlueSync mobile remote monitoring</Name><Description>Single Chamber Implantable Cardioverter Defibrillator with PhysionCurve Design, MRI compatible, Optimised Battery Chemistry, SmartShock 2.0+ Technology, Optivol 2.0 Fluid Status Monitoring, Complete Capture Management, BlueSync technology, DF1 with BlueSync mobile remote monitoring</Description><Size>33.2 cm3, 79 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a,d Remote Monitoring Service</Suffix><ARTGs><ARTG>392254</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>25370</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI412</BillingCode><Name>Crome™ VR ICD MRI SureScan™ with BlueSync mobile remote monitoring</Name><Description>Single Chamber Implantable Cardioverter Defibrillator with PhysionCurve Design, MRI compatible, Optimised Battery Chemistry, SmartShock 2.0 Technology, Complete Capture Management, BlueSync technology, DF1 with BlueSync mobile remote monitoring</Description><Size>33.2 cm3, 79 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a,d Remote Monitoring Service</Suffix><ARTGs><ARTG>392256</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>25370</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI411</BillingCode><Name>Cobalt™ VR ICD MRI SureScan™ with BlueSync mobile remote monitoring</Name><Description>Single Chamber Implantable Cardioverter Defibrillator with PhysionCurve Design, MRI compatible, Optimised Battery Chemistry, SmartShock 2.0 Technology, Complete Capture Management, BlueSync technology, DF1 with BlueSync mobile remote monitoring</Description><Size>33.2 cm3, 79 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a,d Remote Monitoring Service</Suffix><ARTGs><ARTG>392255</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>25370</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI384</BillingCode><Name>Crome™ VR ICD MRI SureScan™</Name><Description>Single Chamber Implantable Cardioverter Defibrillator with PhysionCurve Design, MRI compatible, Optimised Battery Chemistry, SmartShock 2.0 Technology, Complete Capture Management, BlueSync technology, DF4</Description><Size>32.8 cm3, 79 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d, e</Suffix><ARTGs><ARTG>392265</ARTG></ARTGs><MinimumBenefit>24367</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ318</BillingCode><Name>Fortify Assura VR CD1359-40Q/CD1359-40QC</Name><Description>Single Chamber Cardioverter Defibrillator</Description><Size>75g, 35cc</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d, e</Suffix><ARTGs><ARTG>207188</ARTG><ARTG>207196</ARTG></ARTGs><MinimumBenefit>24367</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI258</BillingCode><Name>Evera MRI S VR ICD</Name><Description>Single chamber implantable cardioverter defibrillators with SureScan MRI Technology</Description><Size>33cm3 77g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d, e</Suffix><ARTGs><ARTG>392914</ARTG></ARTGs><MinimumBenefit>24367</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI254</BillingCode><Name>VISIA AF S MRI ICD</Name><Description>Single Chamber, MRI compatible, Implantable Cardioverter Defibrillator with AF detection and diagnosis, PhysioCurve Design, Optimised Battery Chemistry, Smart Shock Technology 2.0, Optivol 2.0 Fluid Status Monitoring, Complete Capture Management. DF4</Description><Size>33cm³ 77g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d, e</Suffix><ARTGs><ARTG>393251</ARTG></ARTGs><MinimumBenefit>24367</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT239</BillingCode><Name>Rivacor 7 VR-T</Name><Description>Single Chamber ICD, ventricular capture control, physiological rate adaption, automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry, Home Monitoring w/ QuickCheck, MRI Conditional and AutoDetect, ComfortDesign, DF4, IS-1 connector</Description><Size>W x H x D (mm) 61.5 x 60 x 10, Volume: 30cc, Mass: 75g</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d, e</Suffix><ARTGs><ARTG>396233</ARTG></ARTGs><MinimumBenefit>24367</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT235</BillingCode><Name>Rivacor 5 VR-T DX</Name><Description>Single Chamber ICD, ventricular capture control, physiological rate adaption, additional atrial detection (DX),automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry, Home Monitoring, MRI conditional and AutoDetect, ComfortDesign,  DF4, IS-1 connector</Description><Size>66.5mm x 60mm x 10mm, 32cm3, 77grams</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d, e</Suffix><ARTGs><ARTG>396251</ARTG></ARTGs><MinimumBenefit>24367</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT234</BillingCode><Name>Rivacor 5 VR-T</Name><Description>Single Chamber ICD, ventricular capture control, physiological rate adaption, automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry, Home Monitoring, MRI Conditional and AutoDetect, Comfort Design , DF4, IS-1 connector</Description><Size>61.5mm x 60mm x 10mm, 30cm3, 75grams</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d, e</Suffix><ARTGs><ARTG>396217</ARTG></ARTGs><MinimumBenefit>24367</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI388</BillingCode><Name>Cobalt™ VR ICD MRI SureScan™</Name><Description>Single Chamber Implantable Cardioverter Defibrillator with PhysionCurve Design, MRI compatible, Optimised Battery Chemistry, SmartShock 2.0 Technology, Complete Capture Management, BlueSync technology, DF4</Description><Size>32.8 cm3, 79 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d, e</Suffix><ARTGs><ARTG>392259</ARTG></ARTGs><MinimumBenefit>24367</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI257</BillingCode><Name>Evera MRI XT VR ICD</Name><Description>Single chamber implantable cardioverter defibrillators with SureScan MRI Technology</Description><Size>33cm³ 77g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d, e</Suffix><ARTGs><ARTG>393520</ARTG></ARTGs><MinimumBenefit>24367</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ332</BillingCode><Name>Ellipse VR CD1377-36QC</Name><Description>Single Chamber Cardioverter Defibrillator with 36 J delivered energy</Description><Size>67g, 30cc</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d, e</Suffix><ARTGs><ARTG>401132</ARTG><ARTG>207184</ARTG></ARTGs><MinimumBenefit>24367</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI393</BillingCode><Name>Cobalt™ XT VR ICD MRI SureScan™</Name><Description>Single Chamber Implantable Cardioverter Defibrillator with PhysionCurve Design, MRI compatible, Optimised Battery Chemistry, SmartShock 2.0+ Technology, Optivol 2.0 Fluid Status Monitoring, Complete Capture Management, BlueSync technology, DF4</Description><Size>32.8 cm3, 79 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d, e</Suffix><ARTGs><ARTG>392264</ARTG></ARTGs><MinimumBenefit>24367</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI253</BillingCode><Name>VISIA AF XT MRI ICD</Name><Description>Single Chamber, MRI compatible, Implantable Cardioverter Defibrillator with AF detection and diagnosis, PhysioCurve Design, Optimised Battery Chemistry, Smart Shock Technology 2.0, Optivol 2.0 Fluid Status Monitoring, Complete Capture Management. DF4</Description><Size>33cm³ 77g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d, e</Suffix><ARTGs><ARTG>393250</ARTG></ARTGs><MinimumBenefit>24367</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT226</BillingCode><Name>Rivacor 7 VR-T DX</Name><Description>Single Chamber ICD, ventricular capture control, physiological rate adaption, additional atrial detection (DX),automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry, Home Monitoring w/ QuickCheck, MRI conditional and AutoDetect, ComfortDesign DF4, IS-1 connector</Description><Size>66.5mm x 60mm x 10mm, 32cm3, 77grams</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109123</GroupID><Suffix>a, d, e</Suffix><ARTGs><ARTG>396258</ARTG></ARTGs><MinimumBenefit>24367</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS329</BillingCode><Name>Emblem MRI S-ICD Pulse Generator</Name><Description>Subcutaneous Implantable Cardioverter Defibrillator with AF Monitor, SMART Pass and MRI Conditional</Description><Size>59.5cc: (W) 83.1mm x (H) 69.1mm x (D)12.7mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107755</SubCategoryID><GroupID>109124</GroupID><ARTGs><ARTG>399599</ARTG></ARTGs><MinimumBenefit>28398</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI383</BillingCode><Name>Crome™ DR ICD MRI SureScan™</Name><Description>Dual Chamber Implantable Cardioverter Defibrillator with PhysioCurve Design, MRI compatible, Optimised Battery Chemistry, SmartShock 2.0 Technology, Complete Capture Management, BlueSync technology, DF1</Description><Size>33.1 cm3, 79 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,c,d</Suffix><ARTGs><ARTG>392253</ARTG></ARTGs><MinimumBenefit>26162</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI382</BillingCode><Name>Cobalt™ DR ICD MRI SureScan™</Name><Description>Dual Chamber Implantable Cardioverter Defibrillator with PhysioCurve Design, MRI compatible, Optimised Battery Chemistry, SmartShock 2.0 Technology, Complete Capture Management, BlueSync technology, DF1</Description><Size>33.1 cm3, 79 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,c,d</Suffix><ARTGs><ARTG>392252</ARTG></ARTGs><MinimumBenefit>26162</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI379</BillingCode><Name>Cobalt™ XT DR ICD MRI SureScan™</Name><Description>Dual Chamber Implantable Cardioverter Defibrillator with PhysioCurve Design, MRI compatible, Optimised Battery Chemistry, SmartShock 2.0+ Technology, Optivol 2.0 Fluid Status Monitoring, Complete Capture Management, BlueSync technology, DF4</Description><Size>33.7 cm3, 80 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,c,d,e</Suffix><ARTGs><ARTG>392257</ARTG></ARTGs><MinimumBenefit>26619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI251</BillingCode><Name>Evera MRI XT DR ICD</Name><Description>Dual chamber implantable cardioverter defibrillator with SureScan MRI Technology</Description><Size>34cm3 78g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,c,d,e</Suffix><ARTGs><ARTG>393519</ARTG></ARTGs><MinimumBenefit>26619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI380</BillingCode><Name>Cobalt™ DR ICD MRI SureScan™</Name><Description>Dual Chamber Implantable Cardioverter Defibrillator with PhysioCurve Design, MRI compatible, Optimised Battery Chemistry, SmartShock 2.0 Technology, Complete Capture Management, BlueSync technology, DF4</Description><Size>33.7 cm3, 80 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,c,d,e</Suffix><ARTGs><ARTG>392261</ARTG></ARTGs><MinimumBenefit>26619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI381</BillingCode><Name>Crome™ DR ICD MRI SureScan™</Name><Description>Dual Chamber Implantable Cardioverter Defibrillator with PhysioCurve Design, MRI compatible, Optimised Battery Chemistry, SmartShock 2.0 Technology, Complete Capture Management, BlueSync technology, DF4</Description><Size>33.7 cm3, 80 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,c,d,e</Suffix><ARTGs><ARTG>392262</ARTG></ARTGs><MinimumBenefit>26619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ200</BillingCode><Name>Neutrino NxT DR ICD Model CDDRA600Q</Name><Description>Dual Chamber Cardioverter Defibrillator</Description><Size>31cc, 71g</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,d,e Remote Monitoring Service</Suffix><ARTGs><ARTG>394112</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>28069</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ418</BillingCode><Name>Gallant DR ICD Model CDDRA500Q</Name><Description>Dual Chamber Cardioverter Defibrillator</Description><Size>31cc, 71g</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,d,e Remote Monitoring Service</Suffix><ARTGs><ARTG>395511</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>28069</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT227</BillingCode><Name>Rivacor 7 DR-T</Name><Description>Dual Chamber ICD, ventricular capture control, physiological rate adaption, automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry, Home Monitoring w/ QuickCheck, MRI conditional and AutoDetect, ComfortDesign DF4, IS-1 connector</Description><Size>66.5mm x 60mm x 10mm, 32cm3, 77grams</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>396045</ARTG></ARTGs><MinimumBenefit>26619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT236</BillingCode><Name>Rivacor 5 DR-T</Name><Description>Dual Chamber ICD, ventricular capture control, physiological rate adaption, automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry, Home Monitoring, MRI conditional and AutoDetect, ComfortDesign, DF4, IS-1 connector</Description><Size>66.5mm x 60mm x 10mm, 32cm3, 77grams</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>396264</ARTG></ARTGs><MinimumBenefit>26619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI252</BillingCode><Name>Evera MRI S DR ICD</Name><Description>Dual chamber implantable cardioverter defibrillator with SureScan MRI Technology</Description><Size>34cm3 78g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,c,d,e</Suffix><ARTGs><ARTG>392893</ARTG></ARTGs><MinimumBenefit>26619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS279</BillingCode><Name>AUTOGEN ICD DR DF-1</Name><Description>Dual Chamber implantable cardioverter defibrillation, 4IJ, DF-1 RV connector</Description><Size>28.5cc - 31.5cc, 62.3g - 71g, 9.9mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,d</Suffix><ARTGs><ARTG>400129</ARTG><ARTG>400131</ARTG></ARTGs><MinimumBenefit>26162</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ325</BillingCode><Name>Fortify Assura DR CD2359-40Q/CD2359-40QC</Name><Description>Dual Chamber Cardioverter Defibrillator with 40J delivered energy</Description><Size>75g, 35cc</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>207192</ARTG><ARTG>207194</ARTG></ARTGs><MinimumBenefit>26619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF002</BillingCode><PriorBillingCodes><PriorBillingCode>SA183</PriorBillingCode></PriorBillingCodes><Name>Platinium DR 1510</Name><Description>PLATINIUM DR 1510 is an implantable dual-chamber cardioverter defibrillator. It is equipped with an accelerometer to allow adaptation of pacing to suit the patient’s activity. PLATINIUM DR 1510 is also equipped with the RF wireless technology which enables remote monitoring of patients who have the Sorin SMARTVIEW Monitor installed at home and wireless interrogation and device programming by Orchestra Plus programmer equipped with ORCHESTRA PLUS LINK accessory. The PLATINIUM DR 1510 is designed to recognize and treat slow or fast VT and VF by continuously monitoring atrial and ventricular activity to identify persistent ventricular arrhythmias and to deliver appropriate therapies. PLATINIUM DR 1510 features the PARAD/PARAD+ algorithm, which is specifically designed to differentiate ventricular tachycardias from fast rhythms of supraventricular origin. PARAD/PARAD+ continuously monitors R-R interval stability, searches for long cycles, assesses the degree of P-R association, evaluates sudden onset and determines the chamber of arrhythmia acceleration.</Description><Size>Dimensions 73 x 54.3 x 11.1 mm
Weight 86 g
Volume 33 cm3 
Active surface area of casing 62.7cm2
Connector Atrium: IS-1 bipolar. Ventricle: IS-1 bipolar, 2*DF-1.</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,d</Suffix><ARTGs><ARTG>282818</ARTG></ARTGs><MinimumBenefit>26162</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF045</BillingCode><Name>Ulys™ DR 2510</Name><Description>Dual chamber implantable cardioverter defibrilator</Description><Size>Weight: 86g  Volume: 33cc</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,d</Suffix><ARTGs><ARTG>400134</ARTG></ARTGs><MinimumBenefit>26162</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS341</BillingCode><Name>MOMENTUM EL DR DF-1</Name><Description>Dual Chamber implantable cardioverter defibrillation, 4IJ, DF-1 RV connector. ENDURALIFE Battery Technology</Description><Size>31.5cc, 71.0g, 5.37 x 7.79 x 0.99cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,d</Suffix><ARTGs><ARTG>399571</ARTG></ARTGs><MinimumBenefit>26162</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI413</BillingCode><Name>Crome™ DR ICD MRI SureScan™ with BlueSync mobile remote monitoring</Name><Description>Dual Chamber Implantable Cardioverter Defibrillator with PhysioCurve Design, MRI compatible, Optimised Battery Chemistry, SmartShock 2.0 Technology, Complete Capture Management, BlueSync technology, DF1 with BlueSync mobile remote monitoring</Description><Size>33.1 cm3, 79 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,c,d Remote Monitoring Service</Suffix><ARTGs><ARTG>392253</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>27612</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI406</BillingCode><Name>Cobalt™ DR ICD MRI SureScan™ with BlueSync mobile remote monitoring</Name><Description>Dual Chamber Implantable Cardioverter Defibrillator with PhysioCurve Design, MRI compatible, Optimised Battery Chemistry, SmartShock 2.0 Technology, Complete Capture Management, BlueSync technology, DF1 with BlueSync mobile remote monitoring</Description><Size>33.1 cm3, 79 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,c,d Remote Monitoring Service</Suffix><ARTGs><ARTG>392252</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>27612</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI405</BillingCode><Name>Cobalt™ XT DR ICD MRI SureScan™ with BlueSync mobile remote monitoring</Name><Description>Dual Chamber Implantable Cardioverter Defibrillator with PhysioCurve Design, MRI compatible, Optimised Battery Chemistry, SmartShock 2.0+ Technology, Optivol 2.0 Fluid Status Monitoring, Complete Capture Management, BlueSync technology, DF1 with BlueSync mobile remote monitoring</Description><Size>33.1 cm3, 79 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,c,d Remote Monitoring Service</Suffix><ARTGs><ARTG>392251</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>27612</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI403</BillingCode><Name>Cobalt™ DR ICD MRI SureScan™ with BlueSync mobile remote monitoring</Name><Description>Dual Chamber Implantable Cardioverter Defibrillator with PhysioCurve Design, MRI compatible, Optimised Battery Chemistry, SmartShock 2.0 Technology, Complete Capture Management, BlueSync technology, DF4 with BlueSync mobile remote monitoring</Description><Size>33.7 cm3, 80 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,c,d,e Remote Monitoring Service</Suffix><ARTGs><ARTG>392261</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>28069</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI402</BillingCode><Name>Cobalt™ XT DR ICD MRI SureScan™ with BlueSync mobile remote monitoring</Name><Description>Dual Chamber Implantable Cardioverter Defibrillator with PhysioCurve Design, MRI compatible, Optimised Battery Chemistry, SmartShock 2.0+ Technology, Optivol 2.0 Fluid Status Monitoring, Complete Capture Management, BlueSync technology, DF4 with BlueSync mobile remote monitoring</Description><Size>33.7 cm3, 80 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,c,d,e Remote Monitoring Service</Suffix><ARTGs><ARTG>392257</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>28069</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT231</BillingCode><Name>Intica Neo 7 DR-T</Name><Description>Dual Chamber ICD, ventricular capture control, physiological rate adaption, automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry, Home Monitoring w/ QuickCheck, MRI conditional and AutoDetect, DF-1, IS-1 connector</Description><Size>65mm x 55mm x 11mm, 33cm3, 82grams</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,d</Suffix><ARTGs><ARTG>396265</ARTG></ARTGs><MinimumBenefit>26162</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ324</BillingCode><Name>Fortify Assura DR CD2359-40C</Name><Description>Dual Chamber Cardioverter   Defibrillator</Description><Size>75g, 35cc</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,d</Suffix><ARTGs><ARTG>207193</ARTG><ARTG>401133</ARTG></ARTGs><MinimumBenefit>26162</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ327</BillingCode><Name>Ellipse DR CD2377-36/CD2377-36C</Name><Description>Dual Chamber ICD</Description><Size>66g, 31cc</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,d</Suffix><ARTGs><ARTG>207186</ARTG><ARTG>207189</ARTG></ARTGs><MinimumBenefit>26162</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI404</BillingCode><Name>Crome™ DR ICD MRI SureScan™ with BlueSync mobile remote monitoring</Name><Description>Dual Chamber Implantable Cardioverter Defibrillator with PhysioCurve Design, MRI compatible, Optimised Battery Chemistry, SmartShock 2.0 Technology, Complete Capture Management, BlueSync technology, DF4 with BlueSync mobile remote monitoring</Description><Size>33.7 cm3, 80 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,c,d,e Remote Monitoring Service</Suffix><ARTGs><ARTG>392262</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>28069</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ331</BillingCode><Name>Ellipse DR CD2377-36Q/CD2377-36QC</Name><Description>Dual Chamber Cardioverter Defibrillator with 36J delivered energy</Description><Size>68g, 31cc</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>207187</ARTG><ARTG>207185</ARTG></ARTGs><MinimumBenefit>26619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS339</BillingCode><Name>RESONATE EL DR DF-4</Name><Description>Dual Chamber implantable cardioverter defibrillation, 4IJ, DF-4 RV connector. ENDURALIFE Battery Technology and IMAGEREADY MR-Conditional</Description><Size>71.4g, 31.0cc, 5.37 x 7.68 x 0.99cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>399570</ARTG></ARTGs><MinimumBenefit>26619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF051</BillingCode><Name>Ulys™ DR 2540</Name><Description>MRI compatible dual chamber cardioverter defibrillator with DF-4 connector.</Description><Size>Weight - 86g  Volume - 33cc</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>400135</ARTG></ARTGs><MinimumBenefit>26619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS277</BillingCode><Name>AUTOGEN ICD DR DF-4</Name><Description>Dual Chamber implantable cardioverter defibrillation, 4IJ, DF-4 RV connector</Description><Size>28.0cc - 31.0cc, 62.5g - 71.4g, 9.9mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>400130</ARTG><ARTG>400259</ARTG></ARTGs><MinimumBenefit>26619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF005</BillingCode><PriorBillingCodes><PriorBillingCode>SA181</PriorBillingCode></PriorBillingCodes><Name>Platinium DR 1540</Name><Description>PLATINIUM DR is an implantable dual-chamber cardioverter defibrillator. It is equipped with an accelerometer to allow adaptation of pacing to suit the patient’s activity. PLATINIUM DR is also equipped with the RF wireless technology which enables remote monitoring of patients who have the Sorin SMARTVIEW Monitor installed at home, wireless interrogation and device programming by Orchestra Plus programmer equipped with ORCHESTRA PLUS LINK accessory. PLATINIUM DR provides high energy shocks (42 J) for enhanced safety, as well as automatic lead measurements to monitor system integrity.The PLATINIUM DR can serve as a defibrillation electrode (active housing) with a total surface area of 63 cm². The PLATINIUM DR is designed to recognize and treat slow or fast VT and VF by continuously monitoring atrial and ventricular activity to identify persistent ventricular arrhythmias and to deliver appropriate therapies. PLATINIUM DR features the PARAD/PARAD+ algorithm, which is specifically designed to differentiate ventricular tachycardias from fast rhythms of supraventricular origin. PARAD/PARAD+ continuously monitors R-R interval stability, searches for long cycles, assesses the degree of P-R association, evaluates sudden onset and determines the chamber of arrhythmia acceleration. In addition to the advanced detection scheme, PLATINIUM DR offers programmable dual or single-chamber pacing</Description><Size>Dimensions 72.3 x 54.3 x 11.1 mm
Weight 86 g
Volume 33 cm3
Active surface area of casing 62.8cm2
Connector Atrium: IS-1 bipolar. Ventricle: DF4.</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>282819</ARTG></ARTGs><MinimumBenefit>26619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI392</BillingCode><Name>Cobalt™ XT DR ICD MRI SureScan™</Name><Description>Dual Chamber Implantable Cardioverter Defibrillator with PhysioCurve Design, MRI compatible, Optimised Battery Chemistry, SmartShock 2.0+ Technology, Optivol 2.0 Fluid Status Monitoring, Complete Capture Management, BlueSync technology, DF1</Description><Size>33.1 cm3, 79 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,c,d</Suffix><ARTGs><ARTG>392251</ARTG></ARTGs><MinimumBenefit>26162</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI116</BillingCode><Name>Evera MRI XT DR SureScan IS1/DF1</Name><Description>Dual Chamber Implantable Cardioverter Defibrillator with PhysioCurve Design, Optimised Battery Chemistry, Smart Shock Technology 2.0, Optivol 2.0 Fluid Status Monitoring, Complete Capture Management and Atrial Therapies. DF1</Description><Size>33cm³ 77g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,c,d</Suffix><ARTGs><ARTG>393537</ARTG></ARTGs><MinimumBenefit>26162</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI118</BillingCode><Name>Evera MRI S DR SureScan IS1/DF1</Name><Description>Dual Chamber Implantable Cardioverter Defibrillator with PhysioCurve Design, Optimised Battery Chemistry, Smart Shock Technology 2.0, DF1</Description><Size>33cm³ 77g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107756</SubCategoryID><GroupID>109136</GroupID><Suffix>a,c,d</Suffix><ARTGs><ARTG>393536</ARTG></ARTGs><MinimumBenefit>26162</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI235</BillingCode><Name>Amplia MRI CRT-D SureScan IS1/DF1</Name><Description>Digital implantable cardioverter defibrillator with cardiac resynchronization therapy and SureScan™ Technology (DDE-DDDR), DF1</Description><Size>35cm3 80g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d</Suffix><ARTGs><ARTG>393377</ARTG></ARTGs><MinimumBenefit>29923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI109</BillingCode><Name>VIVA QUAD XT CRT-D IS4/DF4</Name><Description>ICD with CRT. PhysioCurve Design, AdaptivCRT Algorithm, CardioSync Optimisation, VextorExpress, LV Automated Test, Optimised Battery Chemistry, Smart Shock Technology 2.0, Optivol 2.0 Fluid Status Monitoring, Complete Capture Management and Atrial Therapies. IS4 DF4</Description><Size>35cm³ 81g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>392333</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI210</BillingCode><Name>Claria MRI CRT-D</Name><Description>Digital implantable cardioverter defibrillator with cardiac resynchronisation therapy and SureScan™ Technology</Description><Size>35cm3 80g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>393376</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI200</BillingCode><Name>Claria Quad MRI CRT-D</Name><Description>Digital implantable cardioverter defibrillator with cardiac resynchronisation therapy and SureScan™ Technology</Description><Size>35cm3 81g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>393252</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ329</BillingCode><Name>Unify Assura CD3361-40Q/CD3361-40QC</Name><Description>Cardiac Resynchronisation Therapy Cardioverter Defibrillator</Description><Size>77g, 36cc</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>207190</ARTG><ARTG>207198</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI206</BillingCode><Name>Amplia MRI Quad CRT-D</Name><Description>ICD with CRT. MRI compatible, PhysioCurve Design, CardioSync Optimisation, VectorExpress, V Automated Test, Optimised Battery Chemistry, Smart Shock Technology 2.0. Complete Capture management. Quad DF4.</Description><Size>35cm3 81g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>393374</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ321</BillingCode><Name>Quadra Assura MP CD3371-40Q/CD3371-40QC</Name><Description>Cardiac Resynchronisation Therapy Defibrillator</Description><Size>80gm, 38cc</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>207156</ARTG><ARTG>207158</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS285</BillingCode><Name>AUTOGEN X4 CRT-D DF-4</Name><Description>ICD with cardiac resynchronization therapy.</Description><Size>32.5cc, 73.8g, 9.9mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>400264</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS342</BillingCode><Name>RESONATE X4 CRT-D DF-4</Name><Description>High energy CRT-D with DF-4 RV connector &amp; lS4 LV connector. SmartCRT, Heart Failure Sensor Suite, ENDURALIFE Battery Technology, IMAGEREADY MR-Conditional</Description><Size>32.5cc, 73.8g, 5.37 x 8.18 x 0.99cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>399058</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF048</BillingCode><Name>Gali™ SonR CRT-D 2841</Name><Description>Implantable cardioverter defibrillator with cardiac resynchronisation therapy and DF4 connector</Description><Size>Weight - 87g  Volume - 33cc</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>400139</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF020</BillingCode><Name>Platinium 4LV CRT-D 1744</Name><Description>Implantable cardioverter defibrillator with cardiac resynchronisation therapy and remote monitoring</Description><Size>78.1 X 54.3 X 11.1 mm  91g  33.7cc</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>321362</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF046</BillingCode><Name>Gali™ 4LV SonR CRT-D 2844</Name><Description>Implantable cardioverter defibrillator with cardiac resynchronisation therapy and DF4 connector</Description><Size>Weight- 91g  Volume - 33.7cc</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>400140</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF008</BillingCode><PriorBillingCodes><PriorBillingCode>SA180</PriorBillingCode></PriorBillingCodes><Name>Platinium CRT-D 1741</Name><Description>PLATINIUM CRT-D 1741 is an implantable cardioverter defibrillator for the recognition and treatment of ventricular tachycardia and fibrillation, with ventricular resynchronization, in patients with spontaneous or inducible tachyarrhythmias. PLATINIUM CRT-D 1741 is equipped with an accelerometer to allow adaptation of pacing to suit the patient’s activity. PLATINIUM CRT-D 1741 is also equipped with the RF wireless technology which enables remote monitoring of patients who have the Sorin SMARTVIEW Monitor installed at home and wireless interrogation and device programming by Orchestra Plus programmer equipped with ORCHESTRA PLUS LINK accessory.
PLATINIUM CRT-D 1741 provides a range of therapeutic and diagnostic functions including high energy shocks,  atrial tachyarrhythmia prevention, automatic lead measurements, and advanced diagnostic functions. PLATINIUM CRT-D is protected against high-frequency signals emitted by cellular telephones.</Description><Size>Dimensions 72.3 x 54.3 x 11.1 mm
Weight 87 g
Volume 33 cm3
Active surface area of casing 62.8cm2
Connector Atrium: IS-1 bipolar. Right ventricle: DF4. Left ventricle: IS-1
bipolar (unipolar compatible).</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>282821</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS284</BillingCode><Name>AUTOGEN CRT-D DF-4</Name><Description>ICD with cardiac resynchronization therapy. PaceSafe RV, RA, and LV auto threshold.</Description><Size>32.5cc, 73.6g, 9.9mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>398271</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF019</BillingCode><Name>Platinium 4LV SonR CRT-D 1844</Name><Description>Implantable cardioverter defibrillator with remote monitoring, cardiac resynchronisation therapy and SonR optimisation.</Description><Size>78.1 X 54.3 X 11.1 mm  33.7cc  91g</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>321363</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS344</BillingCode><Name>MOMENTUM CRT-D DF-4</Name><Description>High energy CRT-D with DF-4 RV connector &amp; IS-1 LV connector. SmartCRT, Heart Failure Sensor Suite, ENDURALIFE Battery Technology</Description><Size>32.5cc, 73.6g, 5.37 x 8.18 x 0.99cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>399059</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF007</BillingCode><PriorBillingCodes><PriorBillingCode>SA179</PriorBillingCode></PriorBillingCodes><Name>Platinium CRT-D SonR 1841 DF4</Name><Description>PLATINIUM SonR CRT-D is an implantable cardioverter defibrillator for the recognition and treatment of ventricular tachycardia and fibrillation, with ventricular resynchronization, in patients with spontaneous or inducible tachyarrhythmias. PLATINIUM SonR CRT-D is equipped with an  accelerometer to allow adaptation of pacing to suit the patient’s activity.
PLATINIUM SonR CRT-D is also equipped with the RF wireless technology which enables remote monitoring of patients who have the Sorin SMARTVIEW Monitor installed at home, wireless interrogation and device programming by Orchestra Plus programmer equipped with ORCHESTRA PLUS LINK accessory. If used in conjunction with a dedicated atrial lead featuring the SonR sensor, PLATINIUM SonR CRT-D can analyze micro-accelerations of the heart walls to derive information pertaining to cardiac contractility. The signal picked-up by the SonR sensor can be processed by PLATINIUM SonR CRT-D in order to automatically adjust AV and VV delays for optimal resynchronization therapy. PLATINIUM SonR CRT-D provides a range of therapeutic and diagnostic functions:
─ high energy shocks
─ atrial tachyarrhythmia prevention
─ automatic lead measurements
─ advanced diagnostic functions
─ automatic AV and VV delay optimization
PLATINIUM SonR CRT-D is protected against high-frequency signals emitted by cellular telephones.</Description><Size>1841 MODEL:
Dimensions 72.3 x 54.3 x 11.1 mm
Weight 87 g
Volume 33 cm3
Active surface area of casing 62.8cm2
Connector Atrium: SonR (IS-1 bipolar compatible). Right ventricle: DF4.
Left ventricle: IS-1 bipolar (unipolar compatible).</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>282823</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI427</BillingCode><Name>Cobalt™ HF CRT-D MRI SureScan™ with BlueSync mobile remote monitoring</Name><Description>Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy with PhysioCurve Design, MRI compatible, SmartShock 2.0 Technology, OptiVol 2.0 Fluid Status Monitoring, CardioSync Optimisation Test, Complete Capture Management, BlueSync technology, DF4 with BlueSync mobile remote monitoring</Description><Size>35 cm3, 82.1 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d,e Remote Monitoring Service</Suffix><ARTGs><ARTG>392273</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>31796</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI423</BillingCode><Name>Crome™ HF CRT-D MRI SureScan™ with BlueSync mobile remote monitoring</Name><Description>Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy with PhysioCurve Design, MRI compatible, SmartShock 2.0 Technology, OptiVol 2.0 Fluid Status Monitoring, CardioSync Optimisation Test, Complete Capture Management, BlueSync technology, DF4 with BlueSync mobile remote monitoring</Description><Size>35 cm3, 82.1 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d,e Remote Monitoring Service</Suffix><ARTGs><ARTG>392274</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>31796</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI421</BillingCode><Name>Cobalt™ XT HF CRT-D MRI SureScan™ with BlueSync mobile remote monitoring</Name><Description>Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy with PhysioCurve Design, MRI compatible, SmartShock 2.0+ Technology, OptiVol 2.0 Fluid Status Monitoring, CardioSync Optimisation Test, Complete Capture Management, BlueSync technology, DF4 with BlueSync mobile remote monitoring</Description><Size>35 cm3, 82.1 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d,e Remote Monitoring Service</Suffix><ARTGs><ARTG>392422</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>31796</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI420</BillingCode><Name>Cobalt™ XT HF Quad CRT-D MRI SureScan™ with BlueSync mobile remote monitoring</Name><Description>Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy with PhysioCurve Design, MRI compatible, SmartShock 2.0+ Technology, OptiVol 2.0 Fluid Status Monitoring, CardioSync Optimisation Test, VectorExpress LV Automated Test, Complete Capture Management, BlueSync technology, Quad DF4 with BlueSync mobile remote monitoring</Description><Size>35.5 cm3, 83 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d,e Remote Monitoring Service</Suffix><ARTGs><ARTG>392241</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>31796</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI422</BillingCode><Name>Crome™ HF Quad CRT-D MRI SureScan™ with BlueSync mobile remote monitoring</Name><Description>Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy with PhysioCurve Design, MRI compatible, SmartShock 2.0 Technology, OptiVol 2.0 Fluid Status Monitoring, CardioSync Optimisation Test, VectorExpress LV Automated Test, Complete Capture Management, BlueSync technology, Quad DF4 with BlueSync mobile remote monitoring</Description><Size>35.5 cm3, 83 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d,e Remote Monitoring Service</Suffix><ARTGs><ARTG>392239</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>31796</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI416</BillingCode><Name>Cobalt™ HF Quad CRT-D MRI SureScan™ with BlueSync mobile remote monitoring</Name><Description>Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy, MRI compatible, SmartShock 2.0 Technology, OptiVol 2.0 Fluid Status Monitoring, CardioSync Optimisation Test, VectorExpress LV Automated Test, Complete Capture Management, BlueSync technology, DF1 with BlueSync mobile remote monitoring</Description><Size>36.3 cm3, 83 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d Remote Monitoring Service</Suffix><ARTGs><ARTG>392420</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>31373</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI425</BillingCode><Name>Cobalt™ XT HF CRT-D MRI SureScan™ with BlueSync mobile remote monitoring</Name><Description>Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy, MRI compatible, SmartShock 2.0+ Technology, OptiVol 2.0 Fluid Status Monitoring, CardioSync Optimisation Test, Complete Capture Management, BlueSync technology, DF1 with BlueSync mobile remote monitoring</Description><Size>35 cm3, 82 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d Remote Monitoring Service</Suffix><ARTGs><ARTG>392240</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>31373</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI418</BillingCode><Name>Crome™ HF Quad CRT-D MRI SureScan™ with BlueSync mobile remote monitoring</Name><Description>Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy, MRI compatible, SmartShock 2.0 Technology, OptiVol 2.0 Fluid Status Monitoring, CardioSync Optimisation Test, VectorExpress LV Automated Test, Complete Capture Management, BlueSync technology, DF1 with BlueSync mobile remote monitoring</Description><Size>36.3 cm3, 83 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d Remote Monitoring Service</Suffix><ARTGs><ARTG>392421</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>31373</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI378</BillingCode><Name>Crome™ HF CRT-D MRI SureScan™ </Name><Description>Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy, MRI compatible, SmartShock 2.0 Technology, OptiVol 2.0 Fluid Status Monitoring, CardioSync Optimisation Test, Complete Capture Management, BlueSync technology, DF1</Description><Size>35 cm3, 82 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d</Suffix><ARTGs><ARTG>392418</ARTG></ARTGs><MinimumBenefit>29923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI391</BillingCode><Name>Crome™ HF Quad CRT-D MRI SureScan™ </Name><Description>Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy, MRI compatible, SmartShock 2.0 Technology, OptiVol 2.0 Fluid Status Monitoring, CardioSync Optimisation Test, VectorExpress LV Automated Test, Complete Capture Management, BlueSync technology, DF1</Description><Size>36.3 cm3, 83 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d</Suffix><ARTGs><ARTG>392421</ARTG></ARTGs><MinimumBenefit>29923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI376</BillingCode><Name>Cobalt™ HF Quad CRT-D MRI SureScan™ </Name><Description>Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy, MRI compatible, SmartShock 2.0 Technology, OptiVol 2.0 Fluid Status Monitoring, CardioSync Optimisation Test, VectorExpress LV Automated Test, Complete Capture Management, BlueSync technology, DF1</Description><Size>36.3 cm3, 83 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d</Suffix><ARTGs><ARTG>392420</ARTG></ARTGs><MinimumBenefit>29923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI390</BillingCode><Name>Cobalt™ XT HF CRT-D MRI SureScan™ </Name><Description>Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy, MRI compatible, SmartShock 2.0+ Technology, OptiVol 2.0 Fluid Status Monitoring, CardioSync Optimisation Test, Complete Capture Management, BlueSync technology, DF1</Description><Size>35 cm3, 82g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d</Suffix><ARTGs><ARTG>392240</ARTG></ARTGs><MinimumBenefit>29923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI377</BillingCode><Name>Cobalt™ HF CRT-D MRI SureScan™ </Name><Description>Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy, MRI compatible, SmartShock 2.0 Technology, OptiVol 2.0 Fluid Status Monitoring, CardioSync Optimisation Test, Complete Capture Management, BlueSync technology, DF1</Description><Size>35 cm3, 83 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d</Suffix><ARTGs><ARTG>392417</ARTG></ARTGs><MinimumBenefit>29923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI232</BillingCode><Name>Claria MRI CRT-D SureScan</Name><Description>Digital implantable cardioverter defibrillator with cardiac resynchronisation therapy and SureScanTM technology</Description><Size>35cm3 80g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d</Suffix><ARTGs><ARTG>393378</ARTG></ARTGs><MinimumBenefit>29923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI372</BillingCode><Name>Cobalt™ XT HF Quad CRT-D MRI SureScan™ </Name><Description>Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy, MRI compatible, SmartShock 2.0+ Technology, OptiVol 2.0 Fluid Status Monitoring, CardioSync Optimisation Test, VectorExpress LV Automated Test, Complete Capture Management, BlueSync technology, DF1</Description><Size>36.3 cm3, 83 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d</Suffix><ARTGs><ARTG>392419</ARTG></ARTGs><MinimumBenefit>29923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI373</BillingCode><Name>Cobalt™ HF CRT-D MRI SureScan™</Name><Description>Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy with PhysioCurve Design, MRI compatible, SmartShock 2.0 Technology, OptiVol 2.0 Fluid Status Monitoring, CardioSync Optimisation Test, Complete Capture Management, BlueSync technology, DF4</Description><Size>35 cm3, 82.1g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d,e</Suffix><ARTGs><ARTG>392273</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI375</BillingCode><Name>Crome™ HF CRT-D MRI SureScan™</Name><Description>Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy with PhysioCurve Design, MRI compatible, SmartShock 2.0 Technology, OptiVol 2.0 Fluid Status Monitoring, CardioSync Optimisation Test, Complete Capture Management, BlueSync technology, DF4</Description><Size>35 cm3, 82.1 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d,e</Suffix><ARTGs><ARTG>392274</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ164</BillingCode><Name>Neutrino NxT HF CRT-D Model CDHFA600Q</Name><Description>Cardiac Resynchronisation Therapy Defibrillator  </Description><Size>34cc, 81g</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d,e Remote Monitoring Service</Suffix><ARTGs><ARTG>394114</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>31796</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI374</BillingCode><Name>Crome™ HF Quad CRT-D MRI SureScan™</Name><Description>Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy with PhysioCurve Design, MRI compatible, SmartShock 2.0 Technology, OptiVol 2.0 Fluid Status Monitoring, CardioSync Optimisation Test, VectorExpress LV Automated Test, Complete Capture Management, BlueSync technology, Quad DF4</Description><Size>35.5 cm3, 83 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d,e</Suffix><ARTGs><ARTG>392239</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI205</BillingCode><Name>Amplia MRI CRT-D</Name><Description>ICD with CRT. MRI compatible, PhysioCurve Design, CardioSync Optimisation, VectorExpress, V Automated Test, Optimised Battery Chemistry, Smart Shock Technology 2.0. Complete Capture management. DF4.</Description><Size>35cm3 80g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d,e</Suffix><ARTGs><ARTG>393375</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI371</BillingCode><Name>Cobalt™ XT HF CRT-D MRI SureScan™</Name><Description>Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy with PhysioCurve Design, MRI compatible, SmartShock 2.0+ Technology, OptiVol 2.0 Fluid Status Monitoring, CardioSync Optimisation Test, Complete Capture Management, BlueSync technology, DF4</Description><Size>35 cm3, 82.1 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d,e</Suffix><ARTGs><ARTG>392422</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI426</BillingCode><Name>Cobalt™ HF Quad CRT-D MRI SureScan™ with BlueSync mobile remote monitoring</Name><Description>Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy with PhysioCurve Design, MRI compatible, SmartShock 2.0 Technology, OptiVol 2.0 Fluid Status Monitoring, CardioSync Optimisation Test, VectorExpress LV Automated Test, Complete Capture Management, BlueSync technology, Quad DF4 with BlueSync mobile remote monitoring</Description><Size>35.5 cm3, 83 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d,e Remote Monitoring Service</Suffix><ARTGs><ARTG>392242</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>31796</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI389</BillingCode><Name>Cobalt™ HF Quad CRT-D MRI SureScan™</Name><Description>Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy with PhysioCurve Design, MRI compatible, SmartShock 2.0 Technology, OptiVol 2.0 Fluid Status Monitoring, CardioSync Optimisation Test, VectorExpress LV Automated Test, Complete Capture Management, BlueSync technology, Quad DF4</Description><Size>35.5 cm3, 83 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d,e</Suffix><ARTGs><ARTG>392242</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI370</BillingCode><Name>Cobalt™ XT HF Quad CRT-D MRI SureScan™</Name><Description>Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy with PhysioCurve Design, MRI compatible, SmartShock 2.0+ Technology, OptiVol 2.0 Fluid Status Monitoring, CardioSync Optimisation Test, VectorExpress LV Automated Test, Complete Capture Management, BlueSync technology, Quad DF4</Description><Size>35.5 cm3, 83 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d,e</Suffix><ARTGs><ARTG>392241</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS343</BillingCode><Name>MOMENTUM X4 CRT-D DF-1</Name><Description>High energy CRT-D with DF-1 RV connector &amp; lS4 LV connector. ENDURALIFE Battery Technology</Description><Size>32cc, 73.4g, 5.37 x 8.08 x 0.99cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d</Suffix><ARTGs><ARTG>399592</ARTG></ARTGs><MinimumBenefit>29923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF050</BillingCode><Name>Gali™SonR CRT-D 2811</Name><Description>Implantable cardioverter defibrillator with cardiac resynchronisation therapy and SonR optimisation</Description><Size>Weight - 86g  Volume - 33cc</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d</Suffix><ARTGs><ARTG>400141</ARTG></ARTGs><MinimumBenefit>29923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF003</BillingCode><PriorBillingCodes><PriorBillingCode>SA182</PriorBillingCode></PriorBillingCodes><Name>Platinium CRT-D SonR 1811</Name><Description>PLATINIUM SonR CRT-D is an implantable cardioverter defibrillator for the recognition and treatment of ventricular tachycardia and fibrillation, with ventricular resynchronization, in patients with spontaneous or inducible tachyarrhythmias. PLATINIUM SonR CRT-D is equipped with an accelerometer to allow adaptation of pacing to suit the patient’s activity.
PLATINIUM SonR CRT-D is also equipped with the RF wireless technology which enables remote monitoring of patients who have the Sorin SMARTVIEW Monitor installed at home, and wireless interrogation and device programming by Orchestra Plus programmer equipped with ORCHESTRA PLUS LINK accessory. If used in conjunction with a dedicated atrial lead featuring the SonR sensor, PLATINIUM SonR CRT-D can analyze micro-accelerations of the heart walls to derive information pertaining to cardiac contractility. The signal picked-up by the SonR sensor can be processed by PLATINIUM SonR CRT-D in order to automatically adjust AV and VV delays for optimal resynchronization therapy. PLATINIUM SonR CRT-D provides a range of therapeutic and diagnostic functions:
─ high energy shocks
─ atrial tachyarrhythmia prevention
─ automatic lead measurements
─ advanced diagnostic functions
─ automatic AV and VV delay optimization
PLATINIUM SonR CRT-D is protected against high-frequency signals emitted by cellular telephones.</Description><Size>1811 MODEL:
Dimensions 73 x 54.3 x 11.1 mm
Weight 86 g
Volume 33 cm3
Active surface area of casing 62.7cm2
Connector Atrium: SonR (IS-1 bipolar compatible). Right ventricle: IS-1
bipolar, 2*DF-1. Left ventricle: IS-1 bipolar (unipolar compatible).</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d</Suffix><ARTGs><ARTG>282822</ARTG></ARTGs><MinimumBenefit>29923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS287</BillingCode><Name>AUTOGEN X4 CRT-D DF-1</Name><Description>High energy CRT-D with DF-1 RV connector &amp; lS4 LV connector</Description><Size>32.0cc, 73.4g, 9.9mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d</Suffix><ARTGs><ARTG>400121</ARTG></ARTGs><MinimumBenefit>29923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS345</BillingCode><Name>MOMENTUM CRT-D DF-1</Name><Description>High energy CRT-D with DF-1 RV connector &amp; lS-1/LV-1 LV connector. SmartCRT, Heart Failure Sensor Suite, ENDURALIFE Battery Technology</Description><Size>32cc, 72.8-72.9g, 5.37 x 8.08 x 0.99cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d</Suffix><ARTGs><ARTG>399061</ARTG><ARTG>399060</ARTG></ARTGs><MinimumBenefit>29923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ319</BillingCode><Name>Quadra Assura MP CD3371-40/CD3371/40C</Name><Description>Cardiac Resynchronisation Therapy Cardioverter Defibrillator</Description><Size>83g, 40cc</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d</Suffix><ARTGs><ARTG>207157</ARTG><ARTG>207163</ARTG></ARTGs><MinimumBenefit>29923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ320</BillingCode><Name>Unify Assura CD3361-40/CD3361-40C</Name><Description>Cardiac Resynchronisation Therapy Cardioverter Defibrillator</Description><Size>78g, 36cc</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d</Suffix><ARTGs><ARTG>207199</ARTG><ARTG>207200</ARTG></ARTGs><MinimumBenefit>29923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI230</BillingCode><Name>Claria MRI Quad CRT-D SureScan</Name><Description>Digital implantable cardioverter defibrillator with cardiac resynchronization therapy and SureScan™ Technology (DDE-DDDR), DF1</Description><Size>36 cm3 82 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d</Suffix><ARTGs><ARTG>393379</ARTG></ARTGs><MinimumBenefit>29923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF006</BillingCode><PriorBillingCodes><PriorBillingCode>SA177</PriorBillingCode></PriorBillingCodes><Name>Platinium CRT-D 1711</Name><Description>PLATINIUM CRT-D is an implantable cardioverter defibrillator for the recognition and treatment of ventricular tachycardia and fibrillation, with ventricular resynchronization, in patients with spontaneous or inducible tachyarrhythmias. PLATINIUM CRT-D is equipped with an accelerometer to allow adaptation of pacing to suit the patient’s activity. PLATINIUM CRT-D is also equipped with the RF wireless technology which enables remote monitoring of patients who have the Sorin SMARTVIEW Monitor installed at home and wireless interrogation and device programming by Orchestra Plus programmer equipped with ORCHESTRA PLUS LINK accessory.
PLATINIUM CRT-D provides a range of therapeutic and diagnostic functions including high energy shocks,  atrial tachyarrhythmia prevention, automatic lead measurements, and advanced diagnostic functions.
PLATINIUM CRT-D is protected against high-frequency signals emitted by cellular telephones.</Description><Size>Dimensions 73 x 54.3 x 11.1 mm
Weight 86 g
Volume 33 cm3
Active surface area of casing 62.7cm2
Connector Atrium: IS-1 bipolar. Right ventricle: IS-1 bipolar, 2*DF-1. Left
ventricle: IS-1 bipolar (unipolar compatible).</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d</Suffix><ARTGs><ARTG>282820</ARTG></ARTGs><MinimumBenefit>29923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS286</BillingCode><Name>AUTOGEN CRT-D DF-1</Name><Description>High energy CRT-D with DF-1 RV connector &amp; lS-1 (G173) or LV-1 (G175) LV connector. PaceSafe RV, RA, and LV auto threshold.</Description><Size>32.0cc, 72.8g, 9.9mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d</Suffix><ARTGs><ARTG>400119</ARTG><ARTG>400120</ARTG></ARTGs><MinimumBenefit>29923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT233</BillingCode><Name>Intica Neo 7 HF-T QP</Name><Description>Triple  Chamber ICD, ventricular capture control, physiological rate adaption, automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry, LV Multipolar pacing, Home Monitoring w/ QuickCheck, MRI conditional and AutoDetect, DF-1,IS-1, IS4 quadripolar connectors</Description><Size>65mm x 60.5mm x 11mm, 36cm3, 86grams</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d</Suffix><ARTGs><ARTG>396009</ARTG></ARTGs><MinimumBenefit>29923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT232</BillingCode><Name>Intica Neo 7 HF-T</Name><Description>Triple Chamber ICD, ventricular capture control, physiological rate adaption, automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry, Home Monitoring w/ QuickCheck, MRI conditional and AutoDetect, DF-1, IS-1 connector</Description><Size>65mm x 58.5mm x 11mm, 34cm3, 83grams</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d</Suffix><ARTGs><ARTG>396008</ARTG></ARTGs><MinimumBenefit>29923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ424</BillingCode><Name>Gallant HF CRT-D Model CDHFA500Q</Name><Description>Cardiac Resynchronisation Therapy Defibrillator  </Description><Size>34cc, 81g</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d,e Remote Monitoring Service</Suffix><ARTGs><ARTG>395512</ARTG><ARTG>341252</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>31796</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT237</BillingCode><Name>Rivacor 5 HF-T</Name><Description>Triple Chamber ICD, ventricular capture control, physiological rate adaption, automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry, Home Monitoring, MRI conditional and AutoDetect, ComfortDesign,  DF4, IS-1 connector</Description><Size>71.5mm x 60mm x 10mm, 33cm3, 78grams</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>396015</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT238</BillingCode><Name>Rivacor 5 HF-T QP</Name><Description>Triple  Chamber ICD, ventricular capture control, physiological rate adaption, automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry, LV Multipolar pacing, Home Monitoring, MRI conditional and AutoDetect, Comfort Design, DF4,IS-1, IS-4 quadripolar connectors</Description><Size>75mm x 60mm x 10mm, 35cm3, 82grams</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>396011</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT240</BillingCode><Name>Rivacor 7 HF-T QP</Name><Description>Triple  Chamber ICD, ventricular capture control, physiological rate adaption, automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry, LV Multipole pacing, Home Monitoring w/ Quickcheck, MRI conditional and AutoDetect, ComfortDesign, DF4,IS-1, IS-4 quadripolar connector,</Description><Size>75mm x 60mm x 10mm, 35cm3, 82grams</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>396013</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT228</BillingCode><Name>Rivacor 7 HF-T</Name><Description>Triple Chamber ICD, ventricular capture control, physiological rate adaption, automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry, Home Monitoring, MRI conditional and AutoDetect, ComfortDesign DF4, IS-1 connector</Description><Size>71.5mm x 60mm x 10 mm, 33cm3, 78grams</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,d,e</Suffix><ARTGs><ARTG>396012</ARTG></ARTGs><MinimumBenefit>30346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI419</BillingCode><Name>Crome™ HF CRT-D MRI SureScan™ with BlueSync mobile remote monitoring</Name><Description>Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy, MRI compatible, SmartShock 2.0 Technology, OptiVol 2.0 Fluid Status Monitoring, CardioSync Optimisation Test, Complete Capture Management, BlueSync technology, DF1 with BlueSync mobile remote monitoring</Description><Size>35 cm3, 82 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d Remote Monitoring Service</Suffix><ARTGs><ARTG>392418</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>31373</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI424</BillingCode><Name>Cobalt™ XT HF Quad CRT-D MRI SureScan™ with BlueSync mobile remote monitoring</Name><Description>Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy, MRI compatible, SmartShock 2.0+ Technology, OptiVol 2.0 Fluid Status Monitoring, CardioSync Optimisation Test, VectorExpress LV Automated Test, Complete Capture Management, BlueSync technology, DF1 with BlueSync mobile remote monitoring</Description><Size>36.3 cm3, 83 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d Remote Monitoring Service</Suffix><ARTGs><ARTG>392419</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>31373</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI417</BillingCode><Name>Cobalt™ HF CRT-D MRI SureScan™ with BlueSync mobile remote monitoring</Name><Description>Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy, MRI compatible, SmartShock 2.0 Technology, OptiVol 2.0 Fluid Status Monitoring, CardioSync Optimisation Test, Complete Capture Management, BlueSync technology, DF1 with BlueSync mobile remote monitoring</Description><Size>35 cm3, 82 g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107757</SubCategoryID><GroupID>109138</GroupID><Suffix>a,c,d Remote Monitoring Service</Suffix><ARTGs><ARTG>392417</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>31373</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI516</BillingCode><Name>Micra VR Transcatheter Pacemaker</Name><Description>Single chamber transcatheter leadless pacemaker with SureScan™ technology including a delivery catheter (MC1VR01).    </Description><Size>2.59cm length, 0.67cm outer diameter and 1.75 grams weight</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107758</SubCategoryID><GroupID>109140</GroupID><ARTGs><ARTG>391832</ARTG></ARTGs><MinimumBenefit>10083</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ365</BillingCode><Name>Endurity MRI PM1172</Name><Description>MR Conditional Single Chamber Pacing System</Description><Size>9.7cc, 19g</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107758</SubCategoryID><GroupID>109144</GroupID><Suffix>i</Suffix><ARTGs><ARTG>267515</ARTG></ARTGs><MinimumBenefit>3662</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ363</BillingCode><Name>Assurity MRI PM1272</Name><Description>MRI Conditional RF Single Chamber Rate Responsive Pacemaker</Description><Size>10.4cc, 20g</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107758</SubCategoryID><GroupID>109144</GroupID><Suffix>i</Suffix><ARTGs><ARTG>267512</ARTG></ARTGs><MinimumBenefit>3662</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS271</BillingCode><Name>VITALIO MRI SR</Name><Description>Single Chamber Pacemaker, MRI Compatible</Description><Size>11.5cc</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107758</SubCategoryID><GroupID>109144</GroupID><Suffix>i</Suffix><ARTGs><ARTG>213925</ARTG></ARTGs><MinimumBenefit>3662</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT218</BillingCode><Name>Evity 6 SR-T</Name><Description>Single Chamber Pacemaker, ventricular capture control, physiological rate adaption,  automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry, Home  Monitoring, MRI AutoDect, MRI conditional, IS-1 connector</Description><Size>IS-1 (1x) 10 cm3/ 20.8g 48 mm × 40 mm × 6.5 mm</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107758</SubCategoryID><GroupID>109144</GroupID><ARTGs><ARTG>396022</ARTG></ARTGs><MinimumBenefit>3662</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI228</BillingCode><Name>Attesta SR MRI SureScan pacemaker</Name><Description>MRI, single chamber rate responsive pacemaker (AAIR/VVIR, AAI/VVI)</Description><Size>9.7cm3 21.5g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107758</SubCategoryID><GroupID>109144</GroupID><ARTGs><ARTG>393094</ARTG></ARTGs><MinimumBenefit>3662</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI223</BillingCode><Name>Azure S SR MRI SureScan</Name><Description>MR Conditional single chamber pacemaker with SureScan™ technology and Bluetooth® wireless telemetry (OOE-VVIR)</Description><Size>12.25cm3 22.5g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107758</SubCategoryID><GroupID>109144</GroupID><ARTGs><ARTG>392531</ARTG></ARTGs><MinimumBenefit>3662</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF031</BillingCode><Name>ENO SR</Name><Description>Single Chamber MRI Conditional Pacemaker</Description><Size>Weight -19g  Volume 7.5cc  </Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107758</SubCategoryID><GroupID>109144</GroupID><ARTGs><ARTG>327723</ARTG></ARTGs><MinimumBenefit>3662</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF012</BillingCode><PriorBillingCodes><PriorBillingCode>SA172</PriorBillingCode></PriorBillingCodes><Name>KORA 100 SR</Name><Description>KORA 100 SR is a Single Chamber MRI conditional rate-responsive pacemaker.</Description><Size>Dimensions 37.4 x 41.5 x 6.1mm,  Weight 19g. Volume 7.5cm3. Connector IS-1. Sensors Minute Ventilation (MV) and Accelerometer (G).</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107758</SubCategoryID><GroupID>109144</GroupID><ARTGs><ARTG>260253</ARTG></ARTGs><MinimumBenefit>3662</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI246</BillingCode><Name>Azure XT SR MRI SureScan</Name><Description>MR Conditional single chamber pacemaker with SureScan™ technology and Bluetooth® wireless telemetry (OOE-VVIR)</Description><Size>12.25cm3 22.5g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107758</SubCategoryID><GroupID>109144</GroupID><ARTGs><ARTG>392521</ARTG></ARTGs><MinimumBenefit>3662</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ139</BillingCode><Name>Solvia Rise SR-T</Name><Description>Single Chamber Pacemaker, ventricular capture control, physiological rate adaption,
automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry, Home
Monitoring, MRI Guard 24/7, Closed Loop Stimulation, IS-1 connector</Description><Size>48 x 40  x 6.5 mm,  10cm3   20.8g </Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107758</SubCategoryID><GroupID>109144</GroupID><Suffix>i</Suffix><ARTGs><ARTG>443692</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>3662</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ134</BillingCode><Name>Amvia Sky SR-T </Name><Description>Single Chamber Pacemaker, ventricular capture control, physiological rate adaption, Quick/Early Check, automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry, Home Monitoring, MRI Guard 24/7, Closed Loop Stimulation, IS-1 connector</Description><Size>48 x 40 x 6.5 mm, 10 cm3 , 20.8 grams</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107758</SubCategoryID><GroupID>109144</GroupID><Suffix>i</Suffix><ARTGs><ARTG>443694</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>3662</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS320</BillingCode><Name>ACCOLADE MRI SR</Name><Description>Single Chamber Pacemaker, MRI Conditional</Description><Size>ACCOLADE MRI SR 4.45 x 4.81 x 0.75cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107758</SubCategoryID><GroupID>109144</GroupID><Suffix>i</Suffix><ARTGs><ARTG>400400</ARTG></ARTGs><MinimumBenefit>3662</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF027</BillingCode><Name>OTO SR</Name><Description>Single Chamber MRI Conditional Pacemaker</Description><Size>Weight- 19g  Volume - 7.5cc</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107758</SubCategoryID><GroupID>109144</GroupID><ARTGs><ARTG>327725</ARTG></ARTGs><MinimumBenefit>3662</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF043</BillingCode><Name>Alizea™ SR</Name><Description>Single Chamber MRI Conditional Pacemaker</Description><Size>Volume - 10.5cc    Weight -23.3g</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107758</SubCategoryID><GroupID>109144</GroupID><ARTGs><ARTG>396619</ARTG></ARTGs><MinimumBenefit>3662</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF028</BillingCode><Name>TEO SR</Name><Description>Single Chamber MRI Conditional Pacemaker</Description><Size>Weight - 19g  Volume- 7.5cc</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107758</SubCategoryID><GroupID>109144</GroupID><ARTGs><ARTG>327721</ARTG></ARTGs><MinimumBenefit>3662</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI161</BillingCode><Name>Advisa SR MRI SureScan pacemaker A3SR01</Name><Description>Single chamber pacemaker with SureScan MRI Technology</Description><Size>11.9cm3 21g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107758</SubCategoryID><GroupID>109144</GroupID><ARTGs><ARTG>392335</ARTG></ARTGs><MinimumBenefit>3662</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC728</BillingCode><Name>Adapta Pacemaker</Name><Description>SR Pacemaker
Models ADSR01, ADSR06, ADSR03</Description><Size>9.7 - 11.0cc
21.5 - 22.5g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107758</SubCategoryID><GroupID>109144</GroupID><ARTGs><ARTG>396558</ARTG><ARTG>396556</ARTG><ARTG>396557</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>3662</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT215</BillingCode><Name>Evity 8 SR-T</Name><Description>Single Chamber Pacemaker, ventricular capture control, physiological rate adaption, automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry, Home Monitoring, MRI AutoDect, MRI conditional, IS-1 connector</Description><Size>IS-1 (1x)   10 cm3/ 20.8g     48 mm × 40 mm × 6.5 mm</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107758</SubCategoryID><GroupID>109144</GroupID><Suffix>i</Suffix><ARTGs><ARTG>396034</ARTG></ARTGs><MinimumBenefit>3662</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT203</BillingCode><Name>Edora 8 SR-T</Name><Description>Single Chamber Pacemaker, ventricular capture control, physiological rate adaption, automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry, Home Monitoring, MRI AutoDect, MRI conditional, IS-1 connector</Description><Size>48 x 40 x 6.5 mm, 10 cm3 , 20.8 grams</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107758</SubCategoryID><GroupID>109144</GroupID><Suffix>i</Suffix><ARTGs><ARTG>396052</ARTG></ARTGs><MinimumBenefit>3662</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI447</BillingCode><Name>Azure S SR MRI SureScanTM with BlueSync mobile remote monitoring</Name><Description>MR Conditional single chamber pacemaker with SureScan™ technology and Bluetooth® wireless telemetry (OOE-VVIR) with BlueSync mobile remote monitoring</Description><Size>12.25cm3 22.5g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107758</SubCategoryID><GroupID>109144</GroupID><Suffix>Remote Monitoring Service</Suffix><ARTGs><ARTG>392531</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>5112</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI446</BillingCode><Name>Azure XT SR MRI SureScan  with BlueSync mobile remote monitoring</Name><Description>MR Conditional single chamber pacemaker with SureScan™ technology and Bluetooth® wireless telemetry (OOE-VVIR) with BlueSync mobile remote monitoring</Description><Size>12.25cm3 22.5g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107758</SubCategoryID><GroupID>109144</GroupID><Suffix>Remote Monitoring Service</Suffix><ARTGs><ARTG>392521</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>5112</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI222</BillingCode><Name>Attesta DR MRI SureScan pacemaker</Name><Description>MRI safe, dual chamber rate responsive pacemaker (DDDR)</Description><Size>12.1cm3 23.6g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107759</SubCategoryID><GroupID>109153</GroupID><ARTGs><ARTG>393093</ARTG></ARTGs><MinimumBenefit>5980</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS269</BillingCode><Name>VITALIO MRI EL DR</Name><Description>Dual Chamber Pacemaker, extended life MRI Compatible</Description><Size>14cc</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107759</SubCategoryID><GroupID>109153</GroupID><Suffix>i</Suffix><ARTGs><ARTG>213927</ARTG></ARTGs><MinimumBenefit>5980</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ366</BillingCode><Name>Endurity MRI PM2172</Name><Description>Dual Chamber MR Conditional Rate Responsive Pacemaker</Description><Size>10.4cc, 20g</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107759</SubCategoryID><GroupID>109153</GroupID><Suffix>i</Suffix><ARTGs><ARTG>267514</ARTG></ARTGs><MinimumBenefit>5980</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ364</BillingCode><Name>Assurity MRI PM2272</Name><Description>MR Conditional RF Dual Chamber Rate Responsive Pacemaker</Description><Size>10.4cc, 20g</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107759</SubCategoryID><GroupID>109153</GroupID><Suffix>i</Suffix><ARTGs><ARTG>267513</ARTG></ARTGs><MinimumBenefit>5980</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT193</BillingCode><Name>Edora 8 DR-T</Name><Description>Dual Chamber Pacemaker, ventricular capture control, physiological rate adaption, automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry, Home Monitoring, MRI AutoDetect, MRI conditional, IS-1 connector</Description><Size>48 x 44 x 6.5 mm, 11 cm3,  23.2 grams</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107759</SubCategoryID><GroupID>109153</GroupID><Suffix>g</Suffix><ARTGs><ARTG>396049</ARTG></ARTGs><MinimumBenefit>6870</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT242</BillingCode><Name>Enitra 8 DR-T</Name><Description>Dual Chamber Pacemaker, ventricular capture control, physiological rate adaption,automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry, Home Monitoring, MRI AutoDetect, MRI conditional, IS-1 connector</Description><Size>11 cm3/ 23.2 g        48 mm × 44 mm × 6.5 mm</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107759</SubCategoryID><GroupID>109153</GroupID><Suffix>g</Suffix><ARTGs><ARTG>396044</ARTG></ARTGs><MinimumBenefit>6870</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT214</BillingCode><Name>Evity 8 DR-T</Name><Description>Dual Chamber Pacemaker, ventricular capture control, physiological rate adaption, automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry, Home Monitoring, MRI AutoDetect, MRI conditional, IS-1 connector</Description><Size>IS-1 (2x) 11 cm3/ 23.2 g     48 mm × 44 mm × 6.5 mm</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107759</SubCategoryID><GroupID>109153</GroupID><Suffix>g</Suffix><ARTGs><ARTG>396051</ARTG></ARTGs><MinimumBenefit>6870</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC933</BillingCode><Name>Advisa DR MRI SureScan</Name><Description>Advisa DR MRI SureScan A3DR01 - Dual-chamber pacemaker</Description><Size>12.7cc, 22g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107759</SubCategoryID><GroupID>109153</GroupID><Suffix>g</Suffix><ARTGs><ARTG>396560</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Description, Size</ChangeExplanation><MinimumBenefit>6870</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI243</BillingCode><Name>Azure S DR MRI SureScan</Name><Description>MR Conditional dual chamber pacemaker with SureScan™ technology and Bluetooth® wireless telemetry (OOE-DDDR)</Description><Size>12.75cm3 22.5g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107759</SubCategoryID><GroupID>109153</GroupID><Suffix>g</Suffix><ARTGs><ARTG>392520</ARTG></ARTGs><MinimumBenefit>6870</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI237</BillingCode><Name>Azure XT DR MRI SureScan</Name><Description>MR Conditional dual chamber pacemaker with SureScan™ technology and Bluetooth® wireless telemetry</Description><Size>12.75 cm3 22.5g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107759</SubCategoryID><GroupID>109153</GroupID><Suffix>g</Suffix><ARTGs><ARTG>392519</ARTG></ARTGs><MinimumBenefit>6870</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI448</BillingCode><Name>Azure XT DR MRI SureScan with BlueSync mobile remote monitoring</Name><Description>MR Conditional dual chamber pacemaker with SureScan™ technology and Bluetooth® wireless telemetry with BlueSync mobile remote monitoring</Description><Size>12.75 cm3 22.5g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107759</SubCategoryID><GroupID>109153</GroupID><Suffix>g, Remote Monitoring Service</Suffix><ARTGs><ARTG>392519</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>8320</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI449</BillingCode><Name>Azure S DR MRI SureScan with  BlueSync mobile remote monitoring</Name><Description>MR Conditional dual chamber pacemaker with SureScan™ technology and Bluetooth® wireless telemetry (OOE-DDDR) with BlueSync mobile remote monitoring</Description><Size>12.75 cm3 22.5g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107759</SubCategoryID><GroupID>109153</GroupID><Suffix>g, Remote Monitoring Service</Suffix><ARTGs><ARTG>392520</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>8320</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC726</BillingCode><Name>Adapta Pacemaker</Name><Description>DR Pacemaker
Models ADDR01, ADDRS1, ADDR03</Description><Size>11.1 - 13cc 23.6g - 28.1g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107759</SubCategoryID><GroupID>109153</GroupID><ARTGs><ARTG>396559</ARTG><ARTG>396550</ARTG><ARTG>396551</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Description, Size</ChangeExplanation><MinimumBenefit>5980</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI226</BillingCode><Name>Attesta L DR MRI SureScan pacemaker</Name><Description>MRI, dual chamber rate responsible pacemaker (DDDR)</Description><Size>13.1cm3 31.3g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107759</SubCategoryID><GroupID>109153</GroupID><ARTGs><ARTG>393095</ARTG></ARTGs><MinimumBenefit>5980</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI233</BillingCode><Name>Attesta S DR MRI SureScan pacemaker</Name><Description>MRI, dual chamber rate responsive pacemaker (DDDR)</Description><Size>11.1cm3 23.6g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107759</SubCategoryID><GroupID>109153</GroupID><ARTGs><ARTG>393096</ARTG></ARTGs><MinimumBenefit>5980</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF029</BillingCode><Name>OTO DR</Name><Description>Dual Chamber MRI Conditional  Pacemaker</Description><Size>Weight - 20g  Volume - 8cc</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107759</SubCategoryID><GroupID>109153</GroupID><ARTGs><ARTG>327724</ARTG></ARTGs><MinimumBenefit>5980</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF026</BillingCode><Name>ENO DR</Name><Description>Dual Chamber MRI Conditional Pacemaker</Description><Size>Weight 20g  Volume 8cc</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107759</SubCategoryID><GroupID>109153</GroupID><ARTGs><ARTG>327722</ARTG></ARTGs><MinimumBenefit>5980</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF016</BillingCode><PriorBillingCodes><PriorBillingCode>SA171</PriorBillingCode></PriorBillingCodes><Name>KORA 100 DR</Name><Description>KORA 100 DR is a Dual Chamber MRI conditional, Rate Responsive Pacemaker</Description><Size>41.2 x 41.5 x 6.1mm</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107759</SubCategoryID><GroupID>109153</GroupID><ARTGs><ARTG>260252</ARTG></ARTGs><MinimumBenefit>5980</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF042</BillingCode><Name>Alizea™ DR</Name><Description>Dual chamber MRI conditional pacemaker</Description><Size>Volume - 10.95cc  Weight - 24.2g</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107759</SubCategoryID><GroupID>109153</GroupID><ARTGs><ARTG>396885</ARTG></ARTGs><MinimumBenefit>5980</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ151</BillingCode><Name>Amvia Sky DR-T </Name><Description>Dual Chamber Pacemaker, ventricular capture control, physiological rate adaption, atrial anti-tachycardia pacing,  Quick/Early Check, automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry, Home Monitoring, MRI Guard 24/7, Closed Loop Stimulation, IS-1 connector</Description><Size>48 x 44 x 6.5 mm, 11 cm3,  23.2 grams</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107759</SubCategoryID><GroupID>109153</GroupID><Suffix>g</Suffix><ARTGs><ARTG>443695</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>6870</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF030</BillingCode><Name>TEO DR</Name><Description>Dual Chamber MRI Conditional Pacemaker</Description><Size>Weight - 20g   Volume - 8cc</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107759</SubCategoryID><GroupID>109153</GroupID><ARTGs><ARTG>327720</ARTG></ARTGs><MinimumBenefit>5980</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT219</BillingCode><Name>Evity 6 DR-T</Name><Description>Dual Chamber Pacemaker, ventricular capture control, physiological rate adaption,automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry, Home Monitoring, MRI AutoDetect, MRI conditional, IS-1 connector</Description><Size>IS-1 (2x) 11 cm3/ 23.2 g 48 mm × 44 mm × 6.5 mm</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107759</SubCategoryID><GroupID>109153</GroupID><ARTGs><ARTG>396050</ARTG></ARTGs><MinimumBenefit>5980</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ135</BillingCode><Name>Solvia Rise DR-T</Name><Description>Dual Chamber Pacemaker, ventricular capture control, physiological rate adaption,
EarlyCheck, automatic event (IEGM) &amp; trend triggered transmission. Wandless telemetry,
Home Monitoring, MRI Guard 24/7, Closed Loop Stimulation, IS-1 connector</Description><Size>48 x 44  x 6.5 mm,  11cm3   23.2g </Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107759</SubCategoryID><GroupID>109153</GroupID><Suffix>g</Suffix><ARTGs><ARTG>443693</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>6870</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS321</BillingCode><Name>ACCOLADE MRI DR SL and EL</Name><Description>Dual Chamber Pacemaker, MRI Conditional</Description><Size>ACCOLADE MRI DR SL 4.45 x 5.02 x 0.75cm and ACCOLADE MRI DR EL 4.45 x 5.88 x 0.75cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107759</SubCategoryID><GroupID>109153</GroupID><Suffix>i</Suffix><ARTGs><ARTG>400396</ARTG><ARTG>400399</ARTG></ARTGs><MinimumBenefit>5980</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS326</BillingCode><Name>VISIONIST X4 CRT-P, VISIONIST CRT-P</Name><Description>Cardiac Resynchronization Therapy Pacemaker</Description><Size>U228: 4.45 x 6.17 x 0.75cm. U225 and U226: 4.45 x 6.13 x 0.75cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107760</SubCategoryID><GroupID>109155</GroupID><Suffix>i</Suffix><ARTGs><ARTG>400404</ARTG><ARTG>400405</ARTG><ARTG>400403</ARTG></ARTGs><MinimumBenefit>9004</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI245</BillingCode><Name>Percepta Quad MRI SureScan CRT-P</Name><Description>MR Conditional pacemaker with cardiac resynchronisation therapy, SureScan™ technology, and Bluetooth® wireless telemetry (OAE-DDDR)</Description><Size>20.5cm3 30g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107760</SubCategoryID><GroupID>109155</GroupID><Suffix>g</Suffix><ARTGs><ARTG>393516</ARTG></ARTGs><MinimumBenefit>9004</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ403</BillingCode><Name>Quadra Allure MP MRI</Name><Description>CRT Quadripolar, Rate Responsive Pacemaker with multipoint pacing</Description><Size>27g, 15cc</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107760</SubCategoryID><GroupID>109155</GroupID><Suffix>i</Suffix><ARTGs><ARTG>309821</ARTG></ARTGs><MinimumBenefit>9004</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT243</BillingCode><Name>Enitra 8 HF-T</Name><Description>Triple Chamber CRT Pacemaker, capture management all chambers, physiological rate adaption, atrial overdrive pacing, event triggered IEMG transmission, Wandless telemetry, Home Monitoring, MRI AutoDetect, MRI conditional,  IS-1 connector</Description><Size>14 cm3/ 26.9g                    53 mm × 52 mm × 6.5 mm</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107760</SubCategoryID><GroupID>109155</GroupID><Suffix>i</Suffix><ARTGs><ARTG>395999</ARTG></ARTGs><MinimumBenefit>9004</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT191</BillingCode><Name>Edora 8 HF-T</Name><Description>Triple Chamber CRT Pacemaker, capture management all chambers, physiological rate adaption, atrial overdrive pacing, event triggered IEMG transmission, Wandless telemetry, Home Monitoring, MRI AutoDetect, MRI conditional,  IS-1 connector</Description><Size>53 x 52 x 6.5 mm, 14 cm3,  26.9 grams</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107760</SubCategoryID><GroupID>109155</GroupID><Suffix>i</Suffix><ARTGs><ARTG>396002</ARTG></ARTGs><MinimumBenefit>9004</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT241</BillingCode><Name>Enitra 8 HF-T QP</Name><Description>Triple Chamber CRT-Pacemaker, capture management all chambers, physiological rate adaption, quadripolar LV pacing, atrial overdrive pacing, event triggered IEMG transmission, Wandless telemetry, Home Monitoring, MRI AutoDetect, MRI conditional,  IS-4  IS-1 connectors</Description><Size>15 cm3/ 31.2g          53 mm × 53 mm × 6.5 mm</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107760</SubCategoryID><GroupID>109155</GroupID><Suffix>i</Suffix><ARTGs><ARTG>396000</ARTG></ARTGs><MinimumBenefit>9004</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT199</BillingCode><Name>Edora 8 HF-T QP</Name><Description>Triple Chamber CRT-Pacemaker, capture management all chambers, physiological rate adaption, quadripolar LV pacing, atrial overdrive pacing, event triggered IEMG transmission, Wandless telemetry, Home Monitoring, MRI AutoDetect, MRI conditional,  IS-4  IS-1 connectors</Description><Size>53 x 53 x 6.5 mm, 15cm3,  31.2 grams</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107760</SubCategoryID><GroupID>109155</GroupID><Suffix>i</Suffix><ARTGs><ARTG>396005</ARTG></ARTGs><MinimumBenefit>9004</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI236</BillingCode><Name>Serena Quad MRI SureScan CRT-P</Name><Description>MR Conditional pacemaker with cardiac resynchronisation therapy, SureScan™ technology, and Bluetooth® wireless telemetry (OAE-DDDR)</Description><Size>20.5cm3 30g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107760</SubCategoryID><GroupID>109155</GroupID><Suffix>g</Suffix><ARTGs><ARTG>393518</ARTG></ARTGs><MinimumBenefit>9004</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI244</BillingCode><Name>Serena MRI SureScan CRT-P</Name><Description>MR Conditional pacemaker with cardiac resynchronisation therapy, SureScan™ technology, and Bluetooth® wireless telemetry (OAE-DDDR)</Description><Size>20cm3 30g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107760</SubCategoryID><GroupID>109155</GroupID><Suffix>g</Suffix><ARTGs><ARTG>393517</ARTG></ARTGs><MinimumBenefit>9004</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI440</BillingCode><Name>Percepta MRI SureScan CRT-P  with BlueSync mobile remote monitoring</Name><Description>MR Conditional pacemaker with cardiac resynchronization therapy, SureScan™ technology, and Bluetooth® wireless telemetry (OAE-DDDR) with BlueSync mobile remote monitoring</Description><Size>20cm3 30g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107760</SubCategoryID><GroupID>109155</GroupID><Suffix>g, Remote Monitoring Service</Suffix><ARTGs><ARTG>393515</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>10454</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI442</BillingCode><Name>Serena MRI SureScan CRT-P  with BlueSync mobile remote monitoring</Name><Description>MR Conditional pacemaker with cardiac resynchronisation therapy, SureScan™ technology, and Bluetooth® wireless telemetry (OAE-DDDR) with BlueSync mobile remote monitoring</Description><Size>20cm3 30g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107760</SubCategoryID><GroupID>109155</GroupID><Suffix>g, Remote Monitoring Service</Suffix><ARTGs><ARTG>393517</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>10454</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ133</BillingCode><Name>Amvia Sky HF-T</Name><Description>Triple Chamber CRT Pacemaker, capture management all chambers, physiological rate adaption, atrial overdrive pacing, Quick/Early Check, event triggered IEMG transmission, Wandless telemetry, Home Monitoring, MRI Guard 24/7, MRI AutoDetect, MRI conditional,  IS-1 connector</Description><Size>53 x 52 x 6.5 mm, 14 cm3,  26.9 grams</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107760</SubCategoryID><GroupID>109155</GroupID><Suffix>i</Suffix><ARTGs><ARTG>443690</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>9004</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI439</BillingCode><Name>Percepta Quad MRI SureScan CRT-P  with BlueSync mobile remote monitoring</Name><Description>MR Conditional pacemaker with cardiac resynchronization therapy, SureScan™ technology, and Bluetooth® wireless telemetry (OAE-DDDR) with BlueSync mobile remote monitoring</Description><Size>20.5cm3 30g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107760</SubCategoryID><GroupID>109155</GroupID><Suffix>g, Remote Monitoring Service</Suffix><ARTGs><ARTG>393516</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>10454</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ337</BillingCode><Name>Allure RF PM3222</Name><Description>CRT Rate Responsive Pacemaker with RF Telemetry</Description><Size>14cc, 24g</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107760</SubCategoryID><GroupID>109155</GroupID><Suffix>i</Suffix><ARTGs><ARTG>216290</ARTG></ARTGs><MinimumBenefit>9004</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI441</BillingCode><Name>Serena Quad MRI SureScan CRT-P  with BlueSync mobile remote monitoring</Name><Description>MR Conditional pacemaker with cardiac resynchronisation therapy, SureScan™ technology, and Bluetooth® wireless telemetry (OAE-DDDR) with BlueSync mobile remote monitoring</Description><Size>20.5cm3 30g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107760</SubCategoryID><GroupID>109155</GroupID><Suffix>g, Remote Monitoring Service</Suffix><ARTGs><ARTG>393518</ARTG></ARTGs><Note>The benefit includes a component for remote monitoring services provided via a remote monitoring system or a smart device application. A separate benefit cannot be claimed in respect of a remote monitoring system listed on Part C of the Schedule.</Note><MinimumBenefit>10454</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI231</BillingCode><Name>Percepta MRI SureScan CRT-P</Name><Description>MR Conditional pacemaker with cardiac resynchronization therapy, SureScan™ technology, and Bluetooth® wireless telemetry (OAE-DDDR)</Description><Size>20cm3 30g</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107760</SubCategoryID><GroupID>109155</GroupID><Suffix>g</Suffix><ARTGs><ARTG>393515</ARTG></ARTGs><MinimumBenefit>9004</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ143</BillingCode><Name>Amvia Sky HF-T QP</Name><Description>Triple Chamber CRT Pacemaker, capture management all chambers, physiological rate adaption, quadripolar LV pacing, atrial overdrive pacing, Quick/Early Checks, event triggered IEMG transmission, Wandless telemetry, Home Monitoring, MRI Guard 24/7, MRI AutoDetect, MRI conditional,  IS-1  IS4 connectors</Description><Size>53 x 53 x 6.5 mm, 15cm3,  31.2 grams</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107760</SubCategoryID><GroupID>109155</GroupID><Suffix>i</Suffix><ARTGs><ARTG>443691</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>9004</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC026</BillingCode><Name>Medtronic Transvene SVC Lead Model 6937;</Name><Description>Model 6937-35, Model 6937-52, Model 6937-58, Model 6937-110; Silicone;</Description><Size>35 - 110cm x  660mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109156</GroupID><ARTGs><ARTG>136182</ARTG></ARTGs><MinimumBenefit>1348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC251</BillingCode><Name>Implantable Subcutaneous Defibrillator Lead Model 6996SQ 41cm, 58cm, 85cm</Name><Description>Silicone and Platinum Alloy</Description><Size>Lengths 41-85cm inclusive</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109157</GroupID><ARTGs><ARTG>132315</ARTG></ARTGs><MinimumBenefit>1922</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS183</BillingCode><Name>Endotak Reliance 4-SITE</Name><Description>Passive fixation dual coil defibrillation leads with 4-SITE connector</Description><Size>50-70cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109160</GroupID><Suffix>e</Suffix><ARTGs><ARTG>165643</ARTG></ARTGs><MinimumBenefit>3000</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ346</BillingCode><Name>Optisure ICD Lead LDP210Q/220Q/230Q</Name><Description>Passive fixation ICD lead with DF-4 connector.</Description><Size>52cm-65cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109160</GroupID><Suffix>e</Suffix><ARTGs><ARTG>221037</ARTG><ARTG>221013</ARTG></ARTGs><MinimumBenefit>3000</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS180</BillingCode><Name>Endotak Reliance 4-SITE</Name><Description>Passive fixation dual coil defibrillation leads with 4-SITE connector</Description><Size>50-70cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109160</GroupID><Suffix>e</Suffix><ARTGs><ARTG>165641</ARTG><ARTG>165643</ARTG></ARTGs><MinimumBenefit>3000</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI369</BillingCode><Name>Medtronic Sprint Quattro 6946M Lead</Name><Description>Passive fixation, tined, steroid eluting, quadripolar, dual coil defibrillation leads with silicone backfill and DF-4 connector, including MRI compatible models</Description><Size>55-62 cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109160</GroupID><Suffix>e</Suffix><ARTGs><ARTG>341671</ARTG></ARTGs><MinimumBenefit>3000</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ245</BillingCode><Name>Durata 7170Q, 7171Q and 7172Q</Name><Description>7170Q/7171Q - passive fixation, bipolar, dual coil, 7172Q - passive fixation, bipolar - single coil steroid eluting endocardial defibrillation leads with Optim insulation overlay and SJ4 quadripolar lead connector</Description><Size>52, 58 and 65cm, 7F introducer</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109160</GroupID><Suffix>e</Suffix><ARTGs><ARTG>170592</ARTG><ARTG>170594</ARTG><ARTG>170593</ARTG></ARTGs><MinimumBenefit>3000</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS261</BillingCode><Name>RELIANCE 4-FRONT</Name><Description>Passive, single/dual coil, defibrillation lead</Description><Size>Length: 59cm - 70cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109160</GroupID><Suffix>e</Suffix><ARTGs><ARTG>217434</ARTG><ARTG>217435</ARTG><ARTG>303417</ARTG><ARTG>217433</ARTG></ARTGs><MinimumBenefit>3000</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS181</BillingCode><Name>Endotak Reliance SG 4-SITE</Name><Description>Passive fixation single coil defibrillation leads with ePTFE covered coil &amp; 4-SITE connector</Description><Size>50-70</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109160</GroupID><Suffix>e</Suffix><ARTGs><ARTG>165642</ARTG></ARTGs><MinimumBenefit>3000</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ157</BillingCode><Name>Durata 7120, 7121, 7122</Name><Description>Active fixation bipolar, dual-coil/single coil Steroid-eluting Endocardial Defibrillation Leads</Description><Size>60, 65, 75cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109161</GroupID><ARTGs><ARTG>159846</ARTG><ARTG>159843</ARTG><ARTG>159845</ARTG></ARTGs><MinimumBenefit>3276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC834</BillingCode><Name>Sprint Quattro Secure S (MRI SureScan)</Name><Description>Model 6935, Active Fixation Single Coil Defibrillation Lead, including MRI models</Description><Size>52 - 100cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109161</GroupID><ARTGs><ARTG>286979</ARTG></ARTGs><MinimumBenefit>3276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC208</BillingCode><Name>Medtronic Sprint Quattro Secure Lead Model 6947 (MRI SureScan)</Name><Description>Leads, Defibrillator, Implantable, Silicone, polyurethane, platinized tantalum coils, steroid eluting tip, including MRI compatible versions</Description><Size>58-100cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109161</GroupID><ARTGs><ARTG>286980</ARTG></ARTGs><MinimumBenefit>3276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT209</BillingCode><Name>Plexa ProMRI DF-1 S</Name><Description>Tripolar MR conditional ICD lead
with active fixation</Description><Size>Diameter 7.8 F ; Length 65cm ,75cm</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109161</GroupID><ARTGs><ARTG>298206</ARTG></ARTGs><MinimumBenefit>3276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT211</BillingCode><Name>Plexa ProMRI DF-1 S DX</Name><Description>Pentapolar MR conditional ICD lead
with active fixation</Description><Size>Diameter 7.8F; Length/Dist Dipole to Tip  65/15 cm , 65/17 cm.</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109161</GroupID><ARTGs><ARTG>298208</ARTG></ARTGs><MinimumBenefit>3276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS352</BillingCode><Name>ENDOTAK RELIANCE SG Active</Name><Description>Active Single coil with GORE ePTFE covered coils</Description><Size>59-90cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109161</GroupID><ARTGs><ARTG>119322</ARTG></ARTGs><MinimumBenefit>3276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT245</BillingCode><Name>Plexa ProMRI DF4 S DX</Name><Description>Pentapolar MR conditional ICD lead  with active fixation  </Description><Size>Diameter 7.8F; Length/Dist Dipole to Tip  65/15 cm , 65/17 cm.  </Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109161</GroupID><ARTGs><ARTG>329340</ARTG></ARTGs><MinimumBenefit>3276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT210</BillingCode><Name>Plexa ProMRI DF-1 SD</Name><Description>Quadripolar MR conditional ICD lead
with active fixation</Description><Size>Diameter 7.8F ; Lengths/Dist.Prox Shock coil to Tip - 65/16cm, 65/18cm, 75/18cm</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109161</GroupID><ARTGs><ARTG>298207</ARTG></ARTGs><MinimumBenefit>3276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI108</BillingCode><Name>Sprint Quattro Secure S DF4</Name><Description>Dexamethasone acetate and dexamethasone sodium phosphate steroid-eluting, tripolar, screw-in, ventricular lead with RV defibrillation coil electrode</Description><Size>49 - 97 cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109161</GroupID><Suffix>e</Suffix><ARTGs><ARTG>236885</ARTG><ARTG>212486</ARTG></ARTGs><MinimumBenefit>3276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI033</BillingCode><Name>Sprint Quattro Secure 6947M Lead</Name><Description>Active fixation, true bipolar, dual coil defibrillation leads with silicone backfill and DF-4 connector</Description><Size>45-110cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109161</GroupID><Suffix>e</Suffix><ARTGs><ARTG>191093</ARTG><ARTG>191092</ARTG><ARTG>236884</ARTG></ARTGs><MinimumBenefit>3276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ230</BillingCode><Name>Durata 7120Q, 7121Q and 7122Q</Name><Description>7120/1Q - Adtive fixation, true bipolar; 7122Q - Active fixation true bipolar - single coil steroid eluting endocardial defibrillation leads with Optim insulation overlay and SJ4 quadripolar lead connector.</Description><Size>52cm, 58cm and 65cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109161</GroupID><Suffix>e</Suffix><ARTGs><ARTG>170590</ARTG><ARTG>170589</ARTG><ARTG>170591</ARTG></ARTGs><MinimumBenefit>3276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ344</BillingCode><Name>Optisure ICD Lead LDA210Q/220Q/230Q</Name><Description>Active fixation ICD lead with DF-4 connector</Description><Size>52cm-65cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109161</GroupID><Suffix>e</Suffix><ARTGs><ARTG>221011</ARTG><ARTG>221036</ARTG></ARTGs><MinimumBenefit>3276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT261</BillingCode><Name>Pamira ProMRI SD </Name><Description>Quadripolar MR conditional ICD lead  with active fixation</Description><Size>Diameter 8.4F , Length/Dist prox. shock coil to tip  61/16cm, 65/16cm, 65/18cm, 75/18cm</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109161</GroupID><Suffix>e</Suffix><ARTGs><ARTG>412611</ARTG></ARTGs><MinimumBenefit>3276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT259</BillingCode><Name>Pamira ProMRI S </Name><Description>Tripolar MR conditional ICD lead  with active fixation</Description><Size>Diameter 8.4F ; Length 61cm, 65cm , 75cm</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109161</GroupID><Suffix>e</Suffix><ARTGs><ARTG>412610</ARTG></ARTGs><MinimumBenefit>3276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT213</BillingCode><Name>Plexa ProMRI SD</Name><Description>Quadripolar MR conditional ICD lead  with active fixation</Description><Size>Diamter 7.8F , Length/Dist prox. shock coil to tip  61/16cm, 65/16cm, 65/18cm, 75/18cm</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109161</GroupID><Suffix>e</Suffix><ARTGs><ARTG>298343</ARTG></ARTGs><MinimumBenefit>3276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT212</BillingCode><Name>Plexa ProMRI S</Name><Description>Tripolar MR conditional ICD lead  with active fixation</Description><Size>Diameter 7.8F ; Length 61cm, 65cm , 75cm</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109161</GroupID><Suffix>e</Suffix><ARTGs><ARTG>298187</ARTG></ARTGs><MinimumBenefit>3276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT262</BillingCode><Name>Pamira ProMRI S DX</Name><Description>Pentapolar MR conditional ICD lead  with active fixation  </Description><Size>Diameter 8.4F; Length/Dist Dipole to Tip  65/15 cm , 65/17 cm.  </Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109161</GroupID><Suffix>e</Suffix><ARTGs><ARTG>412612</ARTG></ARTGs><MinimumBenefit>3276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS182</BillingCode><Name>Endotak Reliance 4-SITE</Name><Description>Active fixation dual coil defibrillation leads with 4-SITE connector.</Description><Size>50-70cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109161</GroupID><Suffix>e</Suffix><ARTGs><ARTG>165644</ARTG><ARTG>165639</ARTG></ARTGs><MinimumBenefit>3276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS179</BillingCode><Name>Endotak Reliance S 4-SITE</Name><Description>Active fixation single coil defibrillation leads &amp; 4-SITE connector</Description><Size>50-70cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109161</GroupID><Suffix>e</Suffix><ARTGs><ARTG>327981</ARTG></ARTGs><MinimumBenefit>3276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF053</BillingCode><Name>InVicta™</Name><Description>MRI DF4 Active Fixation Defibrillation Leads including delivery accessories (1 funnel, 1 PSA adaptor, 1 vein filter, 2 fixation tools, 2 x-soft straight stylets, 2 soft straight stylets, 2 firm straight stylets)  </Description><Size>58cm  and 68cm</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109161</GroupID><Suffix>e</Suffix><ARTGs><ARTG>422101</ARTG></ARTGs><MinimumBenefit>3276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS174</BillingCode><Name>Endotak Reliance SG 4-SITE</Name><Description>Active fixation single coil defibrillation leads with ePTFE covered coil &amp; 4-SITE connector.</Description><Size>50-70cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109161</GroupID><Suffix>e</Suffix><ARTGs><ARTG>165645</ARTG></ARTGs><MinimumBenefit>3276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS260</BillingCode><Name>RELIANCE 4-FRONT</Name><Description>Active, Single/Dual coil, defibrillation lead</Description><Size>Length: 59cm -70cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109161</GroupID><Suffix>e</Suffix><ARTGs><ARTG>217430</ARTG><ARTG>217432</ARTG><ARTG>217431</ARTG><ARTG>303416</ARTG></ARTGs><MinimumBenefit>3276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC027</BillingCode><Name>Model 6721 Unipolar Epicardial Patch Leads S/M/L</Name><Description>Model 6721S-50, Model 6721M-50, Model 6721L-50; Silicone</Description><Size>370, 660, 840mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107761</SubCategoryID><GroupID>109162</GroupID><ARTGs><ARTG>136183</ARTG></ARTGs><MinimumBenefit>851</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC011</BillingCode><Name>Capsure EPI steroid eluting bipolar epicardial lead Model 4968 - ventricle</Name><Description>Silicone</Description><Size>25 - 60cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109163</GroupID><ARTGs><ARTG>134287</ARTG></ARTGs><MinimumBenefit>944</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS153</BillingCode><Name>Myopore</Name><Description>Bipolar sutureless myocardial pacing lead</Description><Size>25-54cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109163</GroupID><ARTGs><ARTG>161123</ARTG></ARTGs><MinimumBenefit>944</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC053</BillingCode><Name>Capsure EPI steroid eluting unipolar epicardial lead Model 4965 ventricle</Name><Description>Silicone</Description><Size>25 - 50cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109164</GroupID><ARTGs><ARTG>134427</ARTG></ARTGs><MinimumBenefit>827</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC009</BillingCode><Name>Medtronic Epicardial Pacing Leads IS-1 Model 5071</Name><Description>Silicone</Description><Size>25 - 53 cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109165</GroupID><ARTGs><ARTG>136181</ARTG></ARTGs><MinimumBenefit>762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS133</BillingCode><Name>Acuity Spiral</Name><Description>Unipolar passive fixation</Description><Size>80, 90 &amp; 100cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109168</GroupID><ARTGs><ARTG>155274</ARTG></ARTGs><MinimumBenefit>1213</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS347</BillingCode><Name>Fineline II Sterox IROX Lead</Name><Description>Bipolar, passive fixation</Description><Size>45cm, 52cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109170</GroupID><ARTGs><ARTG>128060</ARTG></ARTGs><MinimumBenefit>520</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS295</BillingCode><Name>Ingevity</Name><Description>Passive MR conditional pacing lead</Description><Size>45cm to 59cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109170</GroupID><ARTGs><ARTG>263513</ARTG><ARTG>263512</ARTG></ARTGs><MinimumBenefit>520</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS346</BillingCode><Name>Fineline II Sterox IROX Lead</Name><Description>Bipolar passive fixation</Description><Size>52cm, 58cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109170</GroupID><ARTGs><ARTG>299176</ARTG></ARTGs><MinimumBenefit>520</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ146</BillingCode><Name>Isoflex 1944T &amp; 1948T</Name><Description>Passive-Fixation, Bipolar, Steriod Eluting, Endocardial Pacing Lead with Optim insulation</Description><Size>46cm, 52cm, 58cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109170</GroupID><ARTGs><ARTG>159532</ARTG><ARTG>159533</ARTG></ARTGs><MinimumBenefit>520</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT163</BillingCode><Name>Solia T</Name><Description>Sub 6F, steoid-eluting transvenous, endocardial, bipolar passive-fixation lead MRI conditional</Description><Size>Lengths: 53, 60cm; Diameter: 5.6Fr</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109170</GroupID><ARTGs><ARTG>224798</ARTG></ARTGs><MinimumBenefit>520</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT216</BillingCode><Name>Solia JT</Name><Description>Sub 6F, steroid-eluting, transvenous, endocardial, bipolar passive fixation lead. MRI conditional</Description><Size>Lengths: 45, 53 cm; Diameter: 5.6Fr</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109170</GroupID><ARTGs><ARTG>294253</ARTG></ARTGs><MinimumBenefit>520</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC372</BillingCode><Name>CapSure Sense MRI SureScan pacemaker leads Models 4074 &amp; 4574</Name><Description>Bipolar, steroid, passive fixation pacing lead</Description><Size>Model 4074:  52 - 58cm; Model 4574: 45 - 53cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109170</GroupID><ARTGs><ARTG>134426</ARTG><ARTG>134331</ARTG></ARTGs><MinimumBenefit>520</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT164</BillingCode><Name>Solia S</Name><Description>Sub 6F, steroid-eluting, transvenous, endocardial, bipolar active fixation lead with an extendable/retractable, electrically active screw. MRI conditional</Description><Size>Lengths: 45, 53, 60cm; Diameter: 5.6Fr</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109171</GroupID><ARTGs><ARTG>224786</ARTG></ARTGs><MinimumBenefit>536</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS390</BillingCode><Name>Ingevity+</Name><Description>Active MR conditional pacing lead</Description><Size>45cm to 59cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109171</GroupID><ARTGs><ARTG>374841</ARTG></ARTGs><MinimumBenefit>536</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS296</BillingCode><Name>Ingevity</Name><Description>Active MR conditional pacing lead</Description><Size>45cm to 59cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109171</GroupID><ARTGs><ARTG>263514</ARTG></ARTGs><MinimumBenefit>536</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS348</BillingCode><Name>Fineline II EZ Sterox IROX Lead</Name><Description>Bipolar, active fixation</Description><Size>45cm, 52cm, 58cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109171</GroupID><ARTGs><ARTG>299177</ARTG></ARTGs><MinimumBenefit>536</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF013</BillingCode><Name>SonR tip PS55D Lead</Name><Description>The SonR tip™ lead is an atrial endocardial pacemaker lead equipped with a hemodynamic sensor embedded in the tip of a straight, bipolar RA pacing lead  · Unlike other automatic optimisation strategies, the signal recorded by  the SonR sensor reflects global ventricular contractility  · Optimisation by SonR is similar to continuous AV and VV optimisation  by echocardiography. It is supplied in a non-MRI and MRI conditional version. The package includes a lead, with a straight stylet inserted, suture sleeve mounted and funnel mounted on the connector pin, a vein lifter and stylets.</Description><Size>Length - 520mm, Diameter 2.6mm, 7.8 F</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109171</GroupID><ARTGs><ARTG>275553</ARTG><ARTG>400444</ARTG></ARTGs><MinimumBenefit>536</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF044</BillingCode><Name>VEGA Pacemaker Lead</Name><Description>Bipolar endocardial pacemaker lead</Description><Size>45cm, 52cm, and 58cm</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109171</GroupID><ARTGs><ARTG>392590</ARTG></ARTGs><MinimumBenefit>536</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC338</BillingCode><Name>Medtronic Capsurefix Novus Model 5076 Pacing Lead</Name><Description>Silicone; Contents: 1 x lead with anchoring sleeve, stylet &amp; guide, 1 x vein lifter, 2 x fixation tools, extra stylets</Description><Size>45-85cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109171</GroupID><ARTGs><ARTG>236828</ARTG></ARTGs><MinimumBenefit>536</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ238</BillingCode><Name>Tendril STS 2088TC</Name><Description>Endocardial Bi-polar Steroid-Eluting Active Fixation Pacing Leads</Description><Size>34cm-100cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109171</GroupID><ARTGs><ARTG>170587</ARTG></ARTGs><MinimumBenefit>536</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC833</BillingCode><Name>CapSureFix Novus Model 4076 Pacing Lead (MRI SureScan)</Name><Description>Active fixation pacemaker lead, including MRI compatible models</Description><Size>35 - 85cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109171</GroupID><ARTGs><ARTG>286952</ARTG></ARTGs><MinimumBenefit>536</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT123</BillingCode><Name>Safio S</Name><Description>Steroid eluting active fixation pacemaker lead with an electrically active extendable/ retractable screw for fixating the lead in the myocardium. The lead body is insulated in Silicone. The entire lead is conditionally safe to be used in a MRI system.</Description><Size>Length: 53, 60cm; Diameter: 6.6F</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109171</GroupID><ARTGs><ARTG>188217</ARTG></ARTGs><MinimumBenefit>536</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC301</BillingCode><Name>SelectSecure Model 3830 and SelectSecure MRI SureScan Model 3830</Name><Description>Steroid eluting, bipolar, implantable, nonretractable screw-in, atrial/ventricular, catheter delivered, transvenous pacemaker lead.</Description><Size>49-110 cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109171</GroupID><Suffix>j</Suffix><ARTGs><ARTG>131307</ARTG><ARTG>301080</ARTG></ARTGs><MinimumBenefit>1284</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF047</BillingCode><Name>NAVIGO™ 4LV</Name><Description>MRI IS4 Quadripolar left ventricular pacing lead</Description><Size>78cm, 88cm</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109173</GroupID><ARTGs><ARTG>396631</ARTG></ARTGs><MinimumBenefit>2554</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ243</BillingCode><Name>Quartet</Name><Description>Quadripolar, Left Ventricular Pacing Lead with Optim Lead Insulation</Description><Size>75, 86 and 92cm, 5 French introducer</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109173</GroupID><ARTGs><ARTG>171332</ARTG></ARTGs><MinimumBenefit>2554</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI201</BillingCode><Name>Attain stability lead</Name><Description>Steroid eluting, active fixation, dual electrode, transvenous, guide wire delivered, cardiac vein pacing lead with an IS-1 connector</Description><Size>88cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109173</GroupID><ARTGs><ARTG>279781</ARTG></ARTGs><MinimumBenefit>2554</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI129</BillingCode><Name>Attain Performa Leads/ Attain Performa SureScan MRI Leads</Name><Description>LV lead family with four electrodes and an IS4 connector for LV pacing w/premium and standard IS4 CRT-D devices. The Attain Perfoma™ Lead provides LV pacing options to avoid the following: phrenic nerve stimulation, high pacing thresholds, and ischemic tissue (including MRI versions)</Description><Size>78, 88cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109173</GroupID><ARTGs><ARTG>284516</ARTG><ARTG>284519</ARTG><ARTG>284517</ARTG></ARTGs><MinimumBenefit>2554</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI283</BillingCode><Name>Attain Stability Quad MRI SureScan</Name><Description>Steroid-eluting, quadripolar electrode, transvenous, over-the-wire, cardiac vein pacing lead with active fixation</Description><Size>88 cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109173</GroupID><ARTGs><ARTG>307331</ARTG></ARTGs><MinimumBenefit>2554</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC811</BillingCode><Name>Attain Ability 4196 LV Lead/ Attain Ability SureScan 4196 MRI LV Lead</Name><Description>Over the wire dual electrode left ventricular lead</Description><Size>78, 88, and 103 cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109173</GroupID><ARTGs><ARTG>284518</ARTG></ARTGs><MinimumBenefit>2554</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI013</BillingCode><Name>Attain Ability Plus 4296/ Attain Ability Plus SureScan MRI 4296</Name><Description>Over the wire electrode left ventricular lead</Description><Size>78cm, 88cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109173</GroupID><ARTGs><ARTG>284542</ARTG></ARTGs><MinimumBenefit>2554</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI014</BillingCode><Name>Attain Ability Straight 4396/ Attain Ability Straight 4396 SureScan MRI</Name><Description>Over the wire dual left ventricular lead</Description><Size>78cm, 88cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109173</GroupID><ARTGs><ARTG>284541</ARTG></ARTGs><MinimumBenefit>2554</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ208</BillingCode><Name>Quick Flex µ 1258T</Name><Description>4F Bipolar Left Ventricular Pacing Lead</Description><Size>75cm, 86cm, 92cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109173</GroupID><Suffix>j</Suffix><ARTGs><ARTG>161391</ARTG></ARTGs><MinimumBenefit>2554</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS292</BillingCode><Name>ACUITY X4</Name><Description>Left ventricular family of quad leads with four pacing and sensing electrodes. Three lead configurations offered to assist in LV lead placement and avoid phrenic nerve stimulation and high thresholds.</Description><Size>86cm, 95cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109173</GroupID><Suffix>j</Suffix><ARTGs><ARTG>235035</ARTG><ARTG>235036</ARTG><ARTG>235037</ARTG></ARTGs><MinimumBenefit>2554</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT185</BillingCode><Name>Sentus ProMRI OTW QP L &amp; S</Name><Description>Quadripolar, steroid eluting left ventricular lead with standard/short pole spacing's and fractal coating. IS4 Connector &amp; MRI Conditional for CRT</Description><Size>Lengths: 77cm, 87 cm, 97cm 4.8F</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107762</SubCategoryID><GroupID>109173</GroupID><ARTGs><ARTG>312682</ARTG><ARTG>272573</ARTG><ARTG>272574</ARTG><ARTG>312683</ARTG></ARTGs><MinimumBenefit>2554</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI045</BillingCode><Name>Adaptor Kits</Name><Description>Lead adaptors</Description><Size>10-50cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107763</SubCategoryID><GroupID>109178</GroupID><ARTGs><ARTG>129420</ARTG><ARTG>137315</ARTG></ARTGs><MinimumBenefit>229</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS335</BillingCode><Name>Unipolar Lead Adaptor Models 6161, 6162</Name><Description>Model 6161: 6mm Unipolar to IS-1; Model 6162: Split 5mm Unipolar to IS-1</Description><Size>10cm-15cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107763</SubCategoryID><GroupID>109178</GroupID><ARTGs><ARTG>189952</ARTG></ARTGs><MinimumBenefit>229</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ393</BillingCode><Name>Lead Adaptor Kit</Name><Description>Lead adaptors/extender for ICD/Pacemakers</Description><Size>one size per model</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107763</SubCategoryID><GroupID>109178</GroupID><ARTGs><ARTG>131928</ARTG><ARTG>160470</ARTG></ARTGs><MinimumBenefit>229</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS334</BillingCode><Name>Bipolar Lead Adaptor Models 6986, 4402, 4403</Name><Description>Model 6986: Bipolar 3.2mm to IS-1; Model 4402: Bipolar IS-1 to Bipolar LV-1; Model 4403: Bipolar or Unipolar LV-1 to Bipolar or Unipolar IS-1</Description><Size>14cm-17cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107763</SubCategoryID><GroupID>109178</GroupID><ARTGs><ARTG>189952</ARTG><ARTG>218790</ARTG></ARTGs><MinimumBenefit>229</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC831</BillingCode><Name>Medtronic Lead Extender Kits</Name><Description>Lead extenders</Description><Size>10 - 50cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107764</SubCategoryID><GroupID>109179</GroupID><ARTGs><ARTG>129420</ARTG><ARTG>137315</ARTG></ARTGs><MinimumBenefit>243</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS333</BillingCode><Name>Bipolar Lead Extender Model 6987</Name><Description>Bipolar 3.2mm to IS-1 lead extender</Description><Size>45cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107764</SubCategoryID><GroupID>109179</GroupID><ARTGs><ARTG>218790</ARTG></ARTGs><MinimumBenefit>243</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS213</BillingCode><Name>Lead Cap Kit</Name><Description>Caps used to protect lead terminal connector pin</Description><Size>4.75mm and 3.2mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107765</SubCategoryID><GroupID>109180</GroupID><ARTGs><ARTG>133934</ARTG><ARTG>133935</ARTG></ARTGs><MinimumBenefit>54</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS336</BillingCode><Name>Pacing Lead Suture Sleeve Models 6773, 6403, 4603</Name><Description>Suture sleeves are used to secure and immobilise Pacing/ICD Leads</Description><Size>One Size Only</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107765</SubCategoryID><GroupID>109180</GroupID><ARTGs><ARTG>132495</ARTG></ARTGs><MinimumBenefit>54</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ391</BillingCode><Name>Pacemaker port safety plug</Name><Description>Plug that seals unused IS-1, DF-1 and DF- 4 port</Description><Size>one size per model</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107765</SubCategoryID><GroupID>109180</GroupID><ARTGs><ARTG>124950</ARTG><ARTG>200956</ARTG></ARTGs><MinimumBenefit>54</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI042</BillingCode><Name>Medtronic Lead End Cap Kit Model: 5867-3M</Name><Description>Lead End Cap Kit</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107765</SubCategoryID><GroupID>109180</GroupID><ARTGs><ARTG>131305</ARTG></ARTGs><MinimumBenefit>54</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI043</BillingCode><Name>Medtronic DF-1 Port Pin Plug Kit: Model 6719; Medtronic IS-1 Port Pin Plug Kit: Model 6725</Name><Description>DF-1 unipolar connector port pin plug, one per kit</Description><Size>One size per model</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107765</SubCategoryID><GroupID>109180</GroupID><ARTGs><ARTG>132184</ARTG></ARTGs><MinimumBenefit>54</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ480</BillingCode><Name>Pacing Lead Suture Sleeve</Name><Description>Suture sleeve used to provide secure fixation and protection of pacing/ICD leads</Description><Size>One size only, 6F</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107765</SubCategoryID><GroupID>109180</GroupID><ARTGs><ARTG>393221</ARTG></ARTGs><MinimumBenefit>54</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI044</BillingCode><Name>Medtronic Upsizing Sleeve: Model 5866-45, Model 5866-46</Name><Description>5866-45: IS1 UNI Lead to 5/6mm UNI IPG; 5866-46: IS1 UNI Lead to 5mm UNI IPG or 5mm Bifurcated BI IPG</Description><Size>18-25mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107765</SubCategoryID><GroupID>109180</GroupID><ARTGs><ARTG>129420</ARTG></ARTGs><MinimumBenefit>54</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS212</BillingCode><Name>Pacemaker/Defibrillator port safety plug</Name><Description>Pacemaker/Defibrillator Plug that seals unused IS-1/DF-1 or IS-4/DF-4 port</Description><Size>3.2mm x 38mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107765</SubCategoryID><GroupID>109180</GroupID><ARTGs><ARTG>190242</ARTG></ARTGs><MinimumBenefit>54</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ392</BillingCode><Name>Lead Cap Kit</Name><Description>Caps used to protect lead terminal connector pin</Description><Size>one size only</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107765</SubCategoryID><GroupID>109180</GroupID><ARTGs><ARTG>124950</ARTG></ARTGs><MinimumBenefit>54</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT217</BillingCode><Name>Biotronik Lead Fixation Sleeves</Name><Description>EFH Lead Fixation Sleeves</Description><Size>EFH-7F,8F,16,20,22,25,27</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107765</SubCategoryID><GroupID>109180</GroupID><ARTGs><ARTG>250355</ARTG></ARTGs><MinimumBenefit>54</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT190</BillingCode><Name>Biotronik BK &amp; BS Sealing Caps &amp; Blind Plugs</Name><Description>BK BS Lead Sealing Caps  BS Device Blind Plugs</Description><Size>BK-IS: IS1/DF1 Caps  BK-IS4/DF4:IS4/DF4 Caps  BS-IS4: BS-IS4 Blind Plugs  BS- IS1 Blind Plugs  BS- DF1 Blind Plugs</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107765</SubCategoryID><GroupID>109180</GroupID><ARTGs><ARTG>302015</ARTG><ARTG>302014</ARTG></ARTGs><MinimumBenefit>54</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI195</BillingCode><Name>TYRX Absorbable Antibacterial Envelope</Name><Description>Antibacterial surgically implanted mesh envelope which stablises EID placement and prevents infection</Description><Size>6.3 x 6.9cm, 7.4 x 8.5cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107765</SubCategoryID><GroupID>109181</GroupID><ARTGs><ARTG>334380</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>867</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ260</BillingCode><Name>Amplatzer Duct Occluder</Name><Description>Nitinol Wire Mesh</Description><Size>5 - 24mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107767</SubCategoryID><GroupID>109188</GroupID><Suffix>o</Suffix><ARTGs><ARTG>345211</ARTG><ARTG>134070</ARTG></ARTGs><MinimumBenefit>7436</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ262</BillingCode><Name>Amplatzer Muscular VSD Occluder</Name><Description>Nitinol Wire Mesh</Description><Size>4 - 24mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107767</SubCategoryID><GroupID>109188</GroupID><Suffix>o</Suffix><ARTGs><ARTG>134071</ARTG><ARTG>134072</ARTG></ARTGs><MinimumBenefit>7436</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RP001</BillingCode><PriorBillingCodes><PriorBillingCode>ME196</PriorBillingCode></PriorBillingCodes><Name>Figulla Flex II ASD Occluder</Name><Description>Occlutech Flexx II ASD Occlusion device</Description><Size>Figulla Flex II ASD Waist Ø (mm): Size 4,5,6,7.5,9,10.5,12,13.5,15,16.5,18,21,24,27,30,33,36,39,40</Size><SupplierCode>39927</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107767</SubCategoryID><GroupID>109188</GroupID><Suffix>o</Suffix><ARTGs><ARTG>201602</ARTG></ARTGs><MinimumBenefit>7436</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RP003</BillingCode><PriorBillingCodes><PriorBillingCode>ME228</PriorBillingCode></PriorBillingCodes><Name>Patent Ductus Arteriosus</Name><Description>The Occlutech® PDA Occluder is an occlusion system, which is percutaneously implanted through a catheter intervention technique and intended for the non-surgical occlusion of  Patent Ductus Arteriosus (PDA)</Description><Size>(PDA) with Standard Shank, D2 Ø 3.5mm, D3 Ø 5mm, D1 Ø 9mm, Length 4.25mm, Introducing System size 6FR;   (PDA) with Standard Shank, D2 Ø 4mm, D3 Ø 6mm, D1 Ø 10mm, Length 5mm, Introducing system size 6FR; (PDA) with Standard Shank, D2 Ø 5mm, D3 Ø 7mm, D1 Ø 11mm, Length 6.05mm, Introducing system size 6FR;   (PDA) with Standard Shank, D2 Ø 6mm, D3 Ø 8mm, D1 Ø 13mm, Length 6.30mm, Introducing system size 6FR;   (PDA) with Standard Shank, D2 Ø 8mm, D3 Ø 10mm, D1 Ø 16mm, Length 7mm, Introducing system size 7FR;   (PDA) with Standard Shank, D2 Ø 10mm, D3 Ø 12mm, D1 Ø 18mm, Length 12mm, Introducing system size 7FR;   (PDA) with Standard Shank, D2 Ø 12mm, D3 Ø 15mm, D1 Ø 20mm, Length 14mm, Introducing system size 8FR;   (PDA) with Standard Shank, D2 Ø 14mm, D3 Ø 18mm, D1 Ø 24mm, Length 16mm, Introducing system size 9FR;   (PDA) with Long Shank, D2 Ø 3.5mm, D3 Ø 5mm, D1 Ø 9mm, Length 7mm, Introducing system size 6FR; (PDA) with Long Shank, D2 Ø 4mm, D3 Ø 6mm, D1 Ø 10mm, Length 7.5mm, Introducing system size 6FR; (PDA) with Long Shank, D2 Ø 5mm, D3 Ø 7mm, D1 Ø 11mm, Length 8.5mm, Introducing system size 6FR; (PDA) with Long Shank, D2 Ø 6mm, D3 Ø 8mm, D1 Ø 13mm, Length 9mm, Introducing system size 6FR; (PDA) with Long Shank, D2 Ø 8mm, D3 Ø 10mm, D1 Ø 16mm, Length 10.5mm, Introducing system size 7FR.</Size><SupplierCode>39927</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107767</SubCategoryID><GroupID>109188</GroupID><ARTGs><ARTG>219253</ARTG></ARTGs><MinimumBenefit>7436</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ429</BillingCode><Name>Amplatzer Piccolo Occluder</Name><Description>Single use implantable transcatheter device for minimally invasive closure of Patent Ductus Arteriosus</Description><Size>0.2cm-0.6cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107767</SubCategoryID><GroupID>109188</GroupID><ARTGs><ARTG>332782</ARTG></ARTGs><MinimumBenefit>7436</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ263</BillingCode><Name>Amplatzer PFO Occluder</Name><Description>Nitinol Wire Mesh</Description><Size>25mm &amp; 35mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107767</SubCategoryID><GroupID>109188</GroupID><Suffix>o</Suffix><ARTGs><ARTG>134069</ARTG><ARTG>345213</ARTG></ARTGs><MinimumBenefit>7436</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RP002</BillingCode><PriorBillingCodes><PriorBillingCode>ME197</PriorBillingCode></PriorBillingCodes><Name>Figulla Flex II PFO Occluder</Name><Description>The Figulla® Flex II PFO is an implant for closure of a patent foramen ovale (PFO) defect in the heart and is deployed via a minimally invasive catheter delivery system.  The Figulla® Flex PFO is intended for patients with substantiated Right-Left-Shunt in the contrast agent echocardiography under Valsalva maneuver and presence of a "cryptogenic", paradoxical thromboembolism.</Description><Size>Figulla Flex II PFO Disc Ø (mm): 23/25, 16/18, 27/30, 31/35</Size><SupplierCode>39927</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107767</SubCategoryID><GroupID>109188</GroupID><Suffix>o</Suffix><ARTGs><ARTG>201603</ARTG></ARTGs><MinimumBenefit>7436</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ280</BillingCode><Name>Amplatzer Duct Occluder II Additional Sizes</Name><Description>Single use implantable transcatheter device for minimally invasive closure of Patent Ductus Arterious</Description><Size>0.2cm-0.6cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107767</SubCategoryID><GroupID>109188</GroupID><ARTGs><ARTG>191422</ARTG><ARTG>348712</ARTG></ARTGs><MinimumBenefit>7436</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ479</BillingCode><Name>Amplatzer Talisman PFO Occluder</Name><Description>Nitinol wire mesh</Description><Size>18-35mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107767</SubCategoryID><GroupID>109188</GroupID><Suffix>o</Suffix><ARTGs><ARTG>398663</ARTG></ARTGs><MinimumBenefit>7436</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT270</BillingCode><Name>GORE® CARDIOFORM Septal Occluder</Name><Description>The GORE® CARDIOFORM Septal Occluder consists of an implantable occluder comprised of a platinum-filled nickel-titanium (Nitinol) wire frame covered with expanded polytetrafluoroethylene (ePTFE). The occluder is available in sizes of 15, 20, 25, and 30 mm.</Description><Size>15mm Nominal Disc Diameter; 20mm Nominal Disc Diameter; 25mm Nominal  Disc Diameter; 30mm Nominal Disc Diameter</Size><SupplierCode>40435</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107767</SubCategoryID><GroupID>109188</GroupID><Suffix>o</Suffix><ARTGs><ARTG>202817</ARTG></ARTGs><MinimumBenefit>7436</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ261</BillingCode><Name>Amplatzer Septal Occluder</Name><Description>Nitinol Wire Mesh</Description><Size>4mm - 40mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107767</SubCategoryID><GroupID>109188</GroupID><Suffix>o</Suffix><ARTGs><ARTG>134067</ARTG></ARTGs><MinimumBenefit>7436</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ267</BillingCode><Name>AMPLATZER Duct Occluder II</Name><Description>Self expandable multiple Nitinol wire mesh PDA occlusion device</Description><Size>Waist diameter 3-6mm, Nominal length 4-6mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107767</SubCategoryID><GroupID>109188</GroupID><Suffix>o</Suffix><ARTGs><ARTG>348711</ARTG><ARTG>154956</ARTG></ARTGs><MinimumBenefit>7436</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS384</BillingCode><Name>WATCHMAN FLX</Name><Description>Left Atrial Appendage Closure Device</Description><Size>20mm to 35mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107767</SubCategoryID><GroupID>109194</GroupID><ARTGs><ARTG>340173</ARTG></ARTGs><MinimumBenefit>11268</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ395</BillingCode><Name>Amplatzer Left Atrial Appendage Closure Device</Name><Description>Amplatzer Amulet Occluder, Amplatzer Cardiac Plug. Nitinol wire mesh</Description><Size>16-34 mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107767</SubCategoryID><GroupID>109194</GroupID><ARTGs><ARTG>345210</ARTG><ARTG>216398</ARTG></ARTGs><MinimumBenefit>11268</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC031</BillingCode><Name>Bander Ureteral Diversion Stent Set</Name><Description>Left or right stent</Description><Size>Multiple French Sizes and Lengths</Size><SupplierCode>40434</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109230</GroupID><ARTGs><ARTG>216072</ARTG></ARTGs><MinimumBenefit>125</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS095</BillingCode><Name>Urinary Diversion Stents</Name><Description>Percuflex urinary diversion stent</Description><Size>Diameters up to 14Fr &amp; lengths up to 95cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109230</GroupID><ARTGs><ARTG>104324</ARTG><ARTG>129379</ARTG></ARTGs><MinimumBenefit>125</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC128</BillingCode><Name>Bander Ureteral Diversion Stent Set</Name><Description>Left and Right Stents</Description><Size>Multiple French Sizes and Lengths</Size><SupplierCode>40434</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109230</GroupID><Suffix>D</Suffix><ARTGs><ARTG>216072</ARTG></ARTGs><MinimumBenefit>201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VO004</BillingCode><Name>Rigi10 - Hydrophilic Malleable Penile Prosthesis  </Name><Description>Hydrophilic Malleable Penile Prosthesis</Description><Size>9mm x 23cm, 10mm x 23cm, 11mm x 25cm, 12mm x 25cm, 13mm x 25cm, 14mm x 25cm.</Size><SupplierCode>40243</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109239</GroupID><Suffix>A</Suffix><ARTGs><ARTG>337610</ARTG></ARTGs><MinimumBenefit>828</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CT007</BillingCode><Name>Genesis Penile Prosthesis (Resist Coated)</Name><Description>Malleable Penile Prosthesis (Resist Coated)</Description><Size>Dia: 9.5 mm (14 - 23cm lengths), Dia: 11mm (16 - 25cm lengths), Dia: 13mm (18 - 27cm lengths)</Size><SupplierCode>40004</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109239</GroupID><Suffix>A</Suffix><ARTGs><ARTG>140302</ARTG></ARTGs><MinimumBenefit>828</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS367</BillingCode><Name>Tactra</Name><Description>Malleable Penile Prosthesis</Description><Size>9.5mm - 13mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109239</GroupID><ARTGs><ARTG>165751</ARTG></ARTGs><MinimumBenefit>776</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MB022</BillingCode><Name>Zephyr Hydraulic  Penile Implant</Name><Description>This hydraulic  penile implant is made from silicone elastomer and comprises of two inflatable cylinders. a reservoir and a pump.</Description><Size>All sizes contained in one system pack. (13, 16, 19 cm)</Size><SupplierCode>40183</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109241</GroupID><Suffix>A</Suffix><ARTGs><ARTG>216415</ARTG></ARTGs><MinimumBenefit>9893</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MB027</BillingCode><Name>Zephyr Hydraulic Phalloplasty Penile Implant</Name><Description>Hydraulic phalloplasty penile implant</Description><Size>120-210 mm</Size><SupplierCode>40183</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109241</GroupID><Suffix>A</Suffix><ARTGs><ARTG>320689</ARTG></ARTGs><MinimumBenefit>9893</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK001</BillingCode><PriorBillingCodes><PriorBillingCode>UQ001</PriorBillingCode></PriorBillingCodes><Name>Testicular Implant</Name><Description>Silicone Elastomer</Description><Size>Small / Medium / Large</Size><SupplierCode>40456</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107774</SubCategoryID><GroupID>109243</GroupID><ARTGs><ARTG>137352</ARTG></ARTGs><MinimumBenefit>620</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CT003</BillingCode><Name>Saline Filled Testicular Prosthesis</Name><Description> Testicular Prosthesis</Description><Size>Extra Small, Small, Medium, Large</Size><SupplierCode>40004</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107774</SubCategoryID><GroupID>109243</GroupID><ARTGs><ARTG>140205</ARTG></ARTGs><MinimumBenefit>620</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JT008</BillingCode><Name>Testicular Implants</Name><Description>Testicular Implants with needle guide or reinforced cap for fixation</Description><Size>The Testicular Implants with needle guide or reinforced cap are available in 5 different sizes ranging from 5, 12, 21, 27 and 36 grams.</Size><SupplierCode>40216</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107774</SubCategoryID><GroupID>109243</GroupID><ARTGs><ARTG>168141</ARTG></ARTGs><MinimumBenefit>620</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VO001</BillingCode><Name>Testi10 Firm Testicular Prosthesis</Name><Description>Firm Silicon Testicular Prosthesis.</Description><Size>XS, S, M, L, XL</Size><SupplierCode>40243</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107774</SubCategoryID><GroupID>109243</GroupID><ARTGs><ARTG>345571</ARTG></ARTGs><MinimumBenefit>620</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET028</BillingCode><Name>Promedon Testicular Prosthesis</Name><Description>Silicone Elastomer</Description><Size>Small - 31 x 23 mm,  Medium - 37 x 28 mm,  Large - 42 x 32 mm,  Xlarge</Size><SupplierCode>40085</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107774</SubCategoryID><GroupID>109243</GroupID><ARTGs><ARTG>136709</ARTG></ARTGs><MinimumBenefit>620</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VO002</BillingCode><Name>Testi10 Saline Filled Testicular Prosthesis</Name><Description>Saline filled testicular prosthesis</Description><Size>XS, S, M, L, XL</Size><SupplierCode>40243</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107774</SubCategoryID><GroupID>109243</GroupID><ARTGs><ARTG>345571</ARTG></ARTGs><MinimumBenefit>620</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EG026</BillingCode><Name>Testicular Implant</Name><Description>Gel Filled Testicular Implant</Description><Size>Height : 25 , 34, 40, 50, 53mm</Size><SupplierCode>40068</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107774</SubCategoryID><GroupID>109243</GroupID><ARTGs><ARTG>343218</ARTG></ARTGs><MinimumBenefit>620</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC755</BillingCode><Name>InterStim II Neurostimulator</Name><Description>Model 3058 neurostimulator</Description><Size>Weight 22g</Size><SupplierCode>40151</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109244</GroupID><ARTGs><ARTG>391141</ARTG></ARTGs><MinimumBenefit>9073</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI500</BillingCode><Name>InterStim Micro MRI rechargeable neurostimulator</Name><Description>Rechargeable neurostimulator</Description><Size>One size</Size><SupplierCode>40151</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109248</GroupID><ARTGs><ARTG>392260</ARTG></ARTGs><MinimumBenefit>9606</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UW003</BillingCode><Name>Axonics Neurostimulator</Name><Description>Rechargeable neurostimulator for sacral nerve stimulation</Description><Size>One size only</Size><SupplierCode>40256</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109248</GroupID><ARTGs><ARTG>390437</ARTG></ARTGs><MinimumBenefit>9606</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC291</BillingCode><Name>Dawson-Mueller Drainage Catheter</Name><Description>A drainage catheter intended for use for Nephrostomy applications either by direct stick or modified seldinger technique.</Description><Size>5-14 Fr, Length: 15-25cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107777</SubCategoryID><GroupID>109251</GroupID><ARTGs><ARTG>139357</ARTG></ARTGs><MinimumBenefit>91</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA250</BillingCode><Name>Navarre Drainage Catheter</Name><Description>A drainage catheter intended for use for Nephrostomy applications either by direct stick or modified seldinger technique.</Description><Size>6-12 French, Length: 15-40cm</Size><SupplierCode>39949</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107777</SubCategoryID><GroupID>109251</GroupID><ARTGs><ARTG>180316</ARTG><ARTG>180317</ARTG></ARTGs><MinimumBenefit>91</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ME216</BillingCode><Name>NEPHRO-CATH Nephrostomy Drainage Catheter</Name><Description>Nephrostomy Drainage Catheter</Description><Size>Diameters: 8fr to 14fr sizes; Lengths 27cm through to 29cm</Size><SupplierCode>40363</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107777</SubCategoryID><GroupID>109251</GroupID><ARTGs><ARTG>98030</ARTG></ARTGs><MinimumBenefit>91</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CB018</BillingCode><Name>Skater Nephrostomy Drainage Catheter</Name><Description>A drainage catheter intended for use for Nephrostomy applications either by direct stick or modified seldinger technique.</Description><Size>6 - 14 Fr</Size><SupplierCode>39993</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107777</SubCategoryID><GroupID>109251</GroupID><ARTGs><ARTG>223260</ARTG></ARTGs><MinimumBenefit>91</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS228</BillingCode><Name>Flexima Nephrostomy Catheter</Name><Description>Urinary drainage catheters for internal and external drainage of the urinary tract.</Description><Size>Length up to 25cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107777</SubCategoryID><GroupID>109251</GroupID><ARTGs><ARTG>132027</ARTG></ARTGs><MinimumBenefit>91</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RW001</BillingCode><Name>Deflux</Name><Description>Deflux is a sterile, highly viscous gel of dextranomer microspheres and non-animal stabilised hyaluronic acid constituting a biocompatible and biodegradable implant for the treatment of vesicoureteral reflux.  The stabilised hyaluronic acid acts mainly as</Description><Size>1ml in syringe</Size><SupplierCode>39939</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107778</SubCategoryID><GroupID>109252</GroupID><ARTGs><ARTG>345790</ARTG></ARTGs><MinimumBenefit>950</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX055</BillingCode><Name>UroLift® System</Name><Description>Prostatic urethral tissue-retaining retractor with adjustable retraction.</Description><Size>One system</Size><SupplierCode>40451</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107779</SubCategoryID><GroupID>109254</GroupID><ARTGs><ARTG>200361</ARTG></ARTGs><MinimumBenefit>712</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS416</BillingCode><Name>Rezum</Name><Description>Single-use radiofrequency delivery device kit for treatment of BPH</Description><Size>One size only</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107779</SubCategoryID><GroupID>109256</GroupID><ARTGs><ARTG>329141</ARTG></ARTGs><Note>Private health insurers are not required to pay benefits in respect of this billing code until 1 March 2024 when a Medicare benefit will be payable for the service.</Note><MinimumBenefit>1950</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL096</BillingCode><Name>iTind Device</Name><Description>Temporary Nitinol Urethral Stent for the treatment of BPH</Description><Size>One size</Size><SupplierCode>40122</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107779</SubCategoryID><GroupID>109257</GroupID><ARTGs><ARTG>318768</ARTG></ARTGs><MinimumBenefit>2205</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG189</BillingCode><PriorBillingCodes><PriorBillingCode>MN158</PriorBillingCode></PriorBillingCodes><Name>MicroSensor Monitoring System</Name><Description>Skull bolt with ICP transducer</Description><Size>0.7mm sensor lead diameter</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107780</SubCategoryID><GroupID>109258</GroupID><Suffix>Skull Bolt</Suffix><ARTGs><ARTG>149558</ARTG></ARTGs><MinimumBenefit>948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG181</BillingCode><PriorBillingCodes><PriorBillingCode>JJ906</PriorBillingCode></PriorBillingCodes><Name>MicroSensor Monitoring System</Name><Description>Ventricular catheter with transducer</Description><Size>Catheter length 38cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107780</SubCategoryID><GroupID>109258</GroupID><Suffix>Catheter</Suffix><ARTGs><ARTG>150087</ARTG></ARTGs><MinimumBenefit>1173</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH755</BillingCode><PriorBillingCodes><PriorBillingCode>LM449</PriorBillingCode></PriorBillingCodes><Name>Intracranial Pressure and Temperature Catheter</Name><Description>Intracranial Pressure and Temperature Catheter</Description><Size>Suitable for all patient anatomy</Size><SupplierCode>40192</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107780</SubCategoryID><GroupID>109258</GroupID><Suffix>Catheter</Suffix><ARTGs><ARTG>308492</ARTG><ARTG>308491</ARTG></ARTGs><MinimumBenefit>1173</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IJ026</BillingCode><PriorBillingCodes><PriorBillingCode>AT086</PriorBillingCode></PriorBillingCodes><Name>NEUROVENT-P catheter</Name><Description>RAUMEDIC NEUROVENT-P catheter for the continuous measurement of ICP (intracranial pressure) within the parenchyma.</Description><Size>5F</Size><SupplierCode>40241</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107780</SubCategoryID><GroupID>109258</GroupID><Suffix>Catheter</Suffix><ARTGs><ARTG>282695</ARTG></ARTGs><MinimumBenefit>1173</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG183</BillingCode><Name>Codman Bactiseal External Ventricular Drain (EVD) Catheter</Name><Description>Antibiotic impregated External Ventricular Drain</Description><Size>1.5mm &amp; 1.9mm lumen diameter</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107782</SubCategoryID><GroupID>109260</GroupID><Suffix>Antibiotics</Suffix><ARTGs><ARTG>343680</ARTG><ARTG>343681</ARTG></ARTGs><MinimumBenefit>424</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI123</BillingCode><Name>EDM Ventricular Catheter</Name><Description>External drainage ventricular catheter, non metallic latex free. Barium impregnated, includes stainless steel stylet.</Description><Size>35cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107782</SubCategoryID><GroupID>109260</GroupID><ARTGs><ARTG>141103</ARTG></ARTGs><MinimumBenefit>167</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG182</BillingCode><PriorBillingCodes><PriorBillingCode>JJ907</PriorBillingCode></PriorBillingCodes><Name>Codman External Ventricular Drain (EVD) Catheter</Name><Description>External Ventricular Drain</Description><Size>1.5mm &amp; 1.9mm diameter</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107782</SubCategoryID><GroupID>109260</GroupID><ARTGs><ARTG>123031</ARTG></ARTGs><MinimumBenefit>167</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH147</BillingCode><Name>Aneurism Clip - T2</Name><Description>Sugita Clips, Titanium 2. L-shape, bayoneted, slightly curved, curved.</Description><Size>One Size Each</Size><SupplierCode>40192</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107783</SubCategoryID><GroupID>109262</GroupID><ARTGs><ARTG>100108</ARTG></ARTGs><MinimumBenefit>233</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB108</BillingCode><Name>Aneurysm Clip</Name><Description>Aneurysm clip</Description><Size>All sizes</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107783</SubCategoryID><GroupID>109262</GroupID><ARTGs><ARTG>138333</ARTG></ARTGs><MinimumBenefit>233</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH119</BillingCode><Name>Aneurism Clip - T2</Name><Description>Sugita Clips, Titanium2. Slim, mini, curved and L-shape.</Description><Size>One Size Each</Size><SupplierCode>40192</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107783</SubCategoryID><GroupID>109262</GroupID><ARTGs><ARTG>100108</ARTG></ARTGs><MinimumBenefit>233</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH170</BillingCode><Name>Aneurism Clip - T1</Name><Description>Sugita Clips, Titanium 1. Titanium alloy (Ti-6AI-4V)</Description><Size>One Size Each</Size><SupplierCode>40192</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107783</SubCategoryID><GroupID>109262</GroupID><ARTGs><ARTG>100108</ARTG></ARTGs><MinimumBenefit>233</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH494</BillingCode><Name>Aneurism Clip - Elgiloy</Name><Description>Sugita Clips, Elgiloy. Cobalt Chrome alloy.</Description><Size>One size each</Size><SupplierCode>40192</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107783</SubCategoryID><GroupID>109262</GroupID><ARTGs><ARTG>100108</ARTG></ARTGs><MinimumBenefit>233</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH148</BillingCode><Name>Aneurism Clip - T2</Name><Description>Sugita Clips, Titanium 2. Mini, temp, straight.</Description><Size>One Size Each</Size><SupplierCode>40192</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107783</SubCategoryID><GroupID>109262</GroupID><ARTGs><ARTG>100108</ARTG></ARTGs><MinimumBenefit>233</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB291</BillingCode><Name>T-Bar Yasargil Aneurysm Clip</Name><Description>T-Bar Yarsargil Aneurysm Clip, Titanium, Permanent Standard Fenestrated</Description><Size>5mm-13mm, 90 Deg</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107783</SubCategoryID><GroupID>109262</GroupID><Suffix>Complex</Suffix><ARTGs><ARTG>123979</ARTG></ARTGs><MinimumBenefit>341</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH294</BillingCode><Name>Aneurism Clip - T2</Name><Description>Sugita Clips, Titanium 2, Fenestrated and Crankshaft.</Description><Size>One size each</Size><SupplierCode>40192</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107783</SubCategoryID><GroupID>109262</GroupID><Suffix>Complex</Suffix><ARTGs><ARTG>100120</ARTG></ARTGs><MinimumBenefit>341</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB292</BillingCode><Name>T-Bar Yasargil Aneurysm Clip</Name><Description>T-Bar Yarsargil Aneurysm Clip, Pyhnox Cobalt Alloy, Permanent Standard Fenestrated</Description><Size>5mm-9mm, 45 Deg</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107783</SubCategoryID><GroupID>109262</GroupID><Suffix>Complex</Suffix><ARTGs><ARTG>123979</ARTG></ARTGs><MinimumBenefit>341</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB293</BillingCode><Name>T-Bar Yasargil Aneurysm Clip</Name><Description>T-Bar Yarsargil Aneurysm Clip, Pyhnox Cobalt Alloy, Permanent Standard Fenestrated</Description><Size>5mm-13mm, 90 Deg</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107783</SubCategoryID><GroupID>109262</GroupID><Suffix>Complex</Suffix><ARTGs><ARTG>123979</ARTG></ARTGs><MinimumBenefit>341</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB290</BillingCode><Name>T-Bar Yasargil Aneurysm Clip</Name><Description>T-Bar Yarsargil Aneurysm Clip, Titanium, Permanent Standard Fenestrated</Description><Size>5mm-9mm, 45 Deg</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107783</SubCategoryID><GroupID>109262</GroupID><Suffix>Complex</Suffix><ARTGs><ARTG>123979</ARTG></ARTGs><MinimumBenefit>341</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH155</BillingCode><Name>Sugita Microneurosurgical AVM Clips</Name><Description>Composition: Cobalt-Chromium-molybdenum based alloy</Description><Size>One Size Each</Size><SupplierCode>40192</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107783</SubCategoryID><GroupID>109263</GroupID><ARTGs><ARTG>100108</ARTG></ARTGs><MinimumBenefit>244</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB356</BillingCode><Name>Lyoplant Onlay</Name><Description>Biological Onlay &amp; Suturable Dura Substitute</Description><Size>2.5 x 2.5cm</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109264</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>264832</ARTG></ARTGs><MinimumBenefit>320</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IJ022</BillingCode><Name>Regenerative Dural Repair Patch (ReDuraTM)</Name><Description>Absorbable synthetic patch with biomimetic design.</Description><Size>Small</Size><SupplierCode>40241</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109264</GroupID><ARTGs><ARTG>363114</ARTG></ARTGs><Note>The the PL benefit is limited to use of the device for procedures related to dura defect repair in spinal and neurosurgical procedures only.</Note><MinimumBenefit>64</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG039</BillingCode><Name>DuraGen Plus</Name><Description>Collagen dural graft matrix</Description><Size>2.5cm x 2.5cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109264</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>158825</ARTG></ARTGs><MinimumBenefit>320</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK492</BillingCode><Name>DuraMatrix</Name><Description>Resorbable Collagen Dura Substitute Membrane</Description><Size>1" x 1" (2.5cm x 2.5cm)</Size><SupplierCode>40329</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109264</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>367947</ARTG><ARTG>154606</ARTG><ARTG>367948</ARTG></ARTGs><MinimumBenefit>320</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG038</BillingCode><Name>DuraGen</Name><Description>Collagen dural graft matrix</Description><Size>2.5cm x 2.5cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109264</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>158829</ARTG></ARTGs><MinimumBenefit>320</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC750</BillingCode><Name>Durepair</Name><Description>Dura Substitute, Collagen</Description><Size>1" x 1"</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109264</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>134482</ARTG></ARTGs><MinimumBenefit>320</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH765</BillingCode><Name>Neodura Dural Repair Patch ≤10cm²</Name><Description>absorbable dural repair patch made of degradable PLLA &amp; Gelatin</Description><Size>10cm² or less</Size><SupplierCode>40192</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109264</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>419571</ARTG></ARTGs><Note>The PL benefit is limited to use of the device for procedures related to dura defect repair in spinal and neurosurgical procedures only.</Note><MinimumBenefit>320</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB118</BillingCode><Name>Neuropatch Dura Substitute</Name><Description>Polyurethane</Description><Size>1.5 x 3cm</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109264</GroupID><ARTGs><ARTG>138310</ARTG></ARTGs><MinimumBenefit>64</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH722</BillingCode><Name>TissuePatchDural 100*100</Name><Description>Self adhesive dural sealant</Description><Size>100*100mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109265</GroupID><ARTGs><ARTG>377573</ARTG></ARTGs><Note>The PL benefit is limited to use of the device for procedures related to dura defect repair in spinal and neurosurgical procedures only.</Note><MinimumBenefit>921</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ166</BillingCode><Name>Neodura Dural Repair Patch</Name><Description>absorbable dural repair patch made of degradable PLLA &amp; Gelatin</Description><Size>10 to 50cm2</Size><SupplierCode>40192</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109266</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>419571</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>477</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK496</BillingCode><Name>DuraMatrix</Name><Description>Resorbable Collagen Dura Substitute Membrane</Description><Size>2" x 2" (5cm x 5cm)</Size><SupplierCode>40329</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109266</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>367947</ARTG><ARTG>154606</ARTG><ARTG>367948</ARTG></ARTGs><MinimumBenefit>477</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK493</BillingCode><Name>DuraMatrix</Name><Description>Resorbable Collagen Dura Substitute Membrane</Description><Size>1" x 3" (2.5cm x 7.5cm)</Size><SupplierCode>40329</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109266</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>367948</ARTG><ARTG>154606</ARTG><ARTG>367947</ARTG></ARTGs><MinimumBenefit>477</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI081</BillingCode><Name>Durepair</Name><Description>Dura Substitute, Collagen</Description><Size>1"-2" x 2"-3"</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109266</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>134482</ARTG></ARTGs><MinimumBenefit>477</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG040</BillingCode><Name>DuraGen</Name><Description>Collagen dural graft matrix</Description><Size>2.5cm x 7.5cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109266</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>158829</ARTG></ARTGs><MinimumBenefit>477</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG042</BillingCode><Name>DuraGen Suturable</Name><Description>Collagen dural graft matrix</Description><Size>2.5cm x 7.5cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109266</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>158826</ARTG></ARTGs><MinimumBenefit>477</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB357</BillingCode><Name>Lyoplant Onlay</Name><Description>Biological Onlay &amp; Suturable Dura Substitute</Description><Size>5 x 5cm and 2.5 x 7.5cm</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109266</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>264832</ARTG></ARTGs><MinimumBenefit>477</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG044</BillingCode><Name>DuraGen Plus</Name><Description>Collagen dural graft matrix</Description><Size>5cm x 5cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109266</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>158825</ARTG></ARTGs><MinimumBenefit>477</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG045</BillingCode><Name>DuraGen Suturable</Name><Description>Collagen dural graft matrix</Description><Size>5cm x 5cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109266</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>158826</ARTG></ARTGs><MinimumBenefit>477</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG041</BillingCode><Name>DuraGen Plus</Name><Description>Collagen dural graft matrix</Description><Size>2.5cm x 7.5cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109266</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>158825</ARTG></ARTGs><MinimumBenefit>477</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG043</BillingCode><Name>DuraGen</Name><Description>Collagen dural graft matrix</Description><Size>5cm x 5cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109266</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>158829</ARTG></ARTGs><MinimumBenefit>477</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB363</BillingCode><Name>Neuropatch Dura Substitute</Name><Description>Polyurethane</Description><Size>Medium</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109266</GroupID><ARTGs><ARTG>138310</ARTG></ARTGs><MinimumBenefit>426</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IJ023</BillingCode><Name>Regenerative Dural Repair Patch (ReDuraTM)</Name><Description>Absorbable synthetic patch with biomimetic design.</Description><Size>Medium</Size><SupplierCode>40241</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109266</GroupID><ARTGs><ARTG>363114</ARTG></ARTGs><Note>The the PL benefit is limited to use of the device for procedures related to dura defect repair in spinal and neurosurgical procedures only.</Note><MinimumBenefit>426</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC753</BillingCode><Name>Durepair</Name><Description>Dura Substitute, Collagen</Description><Size>3" x 3"</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109267</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>134482</ARTG></ARTGs><MinimumBenefit>944</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ168</BillingCode><Name>Neodura Dural Repair Patch</Name><Description>Absorbable dural repair patch made of degradable PLLA &amp; Gelatin</Description><Size>50 to 100cm2</Size><SupplierCode>40192</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109267</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>419571</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>944</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB358</BillingCode><Name>Lyoplant Onlay</Name><Description>Biological Onlay &amp; Suturable Dura Substitute</Description><Size>7.5 x 7.5cm</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109267</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>264832</ARTG></ARTGs><MinimumBenefit>944</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG048</BillingCode><Name>DuraGen Suturable</Name><Description>Collagen dural graft matrix</Description><Size>7.5cm x 7.5cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109267</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>158826</ARTG></ARTGs><MinimumBenefit>944</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB113</BillingCode><Name>Neuropatch Dura Substitute</Name><Description>Polyurethane</Description><Size>Large</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109267</GroupID><ARTGs><ARTG>138310</ARTG></ARTGs><MinimumBenefit>709</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG046</BillingCode><Name>DuraGen</Name><Description>Collagen dural graft matrix</Description><Size>7.5cm x 7.5cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109267</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>158829</ARTG></ARTGs><MinimumBenefit>944</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG047</BillingCode><Name>DuraGen Plus</Name><Description>Collagen dural graft matrix</Description><Size>7.5cm x 7.5cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109267</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>158825</ARTG></ARTGs><MinimumBenefit>944</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK495</BillingCode><Name>Dura Matrix</Name><Description>Resorbable Collagen Dura Substitute Membrane</Description><Size>3" x 3" (7.5cm x 7.5cm)</Size><SupplierCode>40329</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109267</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>367947</ARTG><ARTG>367948</ARTG><ARTG>154606</ARTG></ARTGs><MinimumBenefit>944</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IJ024</BillingCode><Name>Regenerative Dural Repair Patch (ReDuraTM)</Name><Description>Absorbable synthetic patch with biomimetic design</Description><Size>Large</Size><SupplierCode>40241</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109267</GroupID><ARTGs><ARTG>363114</ARTG></ARTGs><Note>The the PL benefit is limited to use of the device for procedures related to dura defect repair in spinal and neurosurgical procedures only.</Note><MinimumBenefit>709</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB015</BillingCode><Name>Neuro-Patch</Name><Description>Polyesterurethane</Description><Size>12 x 14cm</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109268</GroupID><ARTGs><ARTG>138310</ARTG></ARTGs><MinimumBenefit>591</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IJ025</BillingCode><Name>Regenerative Dural Repair Patch (ReDuraTM)</Name><Description>Absorbable synthetic patch with biomimetic design.</Description><Size>Extra Large</Size><SupplierCode>40241</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109268</GroupID><ARTGs><ARTG>363114</ARTG></ARTGs><Note>The the PL benefit is limited to use of the device for procedures related to dura defect repair in spinal and neurosurgical procedures only.</Note><MinimumBenefit>591</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB359</BillingCode><Name>Lyoplant Onlay</Name><Description>Biological Onlay &amp; Suturable Dura Substitute</Description><Size>10 x 12.5cm</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109268</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>264832</ARTG></ARTGs><MinimumBenefit>1592</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ167</BillingCode><Name>Neodura Dural Repair Patch</Name><Description>Absorbable dural repair patch made of degradable PLLA &amp; Gelatin</Description><Size>Greater than 100cm2</Size><SupplierCode>40192</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109268</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>419571</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>1592</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK494</BillingCode><Name>DuraMatrix</Name><Description>Resorbable Collagen Dura Substitute Membrane</Description><Size>4" x 5" (10cm x 12.5cm), 5” x 7” (12.5cm x 17.5cm)</Size><SupplierCode>40329</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109268</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>154606</ARTG><ARTG>159826</ARTG><ARTG>367947</ARTG><ARTG>367948</ARTG></ARTGs><Note>The PL benefit is limited to use of the device for procedures related to dura defect repair in spinal and neurosurgical procedures only.</Note><MinimumBenefit>1592</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC754</BillingCode><Name>Durepair</Name><Description>Dura Substitute, Collagen</Description><Size>4" x 5"</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109268</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>134482</ARTG></ARTGs><MinimumBenefit>1592</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG059</BillingCode><Name>DURAGEN PLUS</Name><Description>Collagen Dural Graft Matrix</Description><Size>10cm x 12.5cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109268</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>158825</ARTG></ARTGs><MinimumBenefit>1592</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG051</BillingCode><Name>DuraGen Suturable</Name><Description>Collagen dural graft matrix</Description><Size>10cm x 12.5cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109268</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>158826</ARTG></ARTGs><MinimumBenefit>1592</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG060</BillingCode><Name>DURAGEN PLUS</Name><Description>Collagen Dural Graft Matrix</Description><Size>12.5cm x 17.5cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109268</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>158825</ARTG></ARTGs><MinimumBenefit>1592</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG049</BillingCode><Name>DuraGen</Name><Description>Collagen Dural graft matrix</Description><Size>10cm x 12.5cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109268</GroupID><Suffix>Biological</Suffix><ARTGs><ARTG>158829</ARTG></ARTGs><MinimumBenefit>1592</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG142</BillingCode><Name>DuraSeal Xact Spinal Dural Sealant</Name><Description>Xact Dural Sealant for spine.  Packaged in sterile single use disposable tray.</Description><Size>3ml</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109269</GroupID><ARTGs><ARTG>233759</ARTG></ARTGs><MinimumBenefit>629</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG141</BillingCode><Name>Duraseal Dural Sealant</Name><Description>DuraSeal is a Synthetic, absorbable, Polyethylene Glycon, hydrogel sealant used as an adjunct to sutured dural repair to achieve watertight closure.</Description><Size>5ml of hydrogel sealant</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109270</GroupID><ARTGs><ARTG>233618</ARTG></ARTGs><MinimumBenefit>580</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW660</BillingCode><Name>Adherus AutoSpray</Name><Description>Hydrogel sealant with automatic applicator.</Description><Size>6mL</Size><SupplierCode>40329</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109270</GroupID><ARTGs><ARTG>202972</ARTG></ARTGs><MinimumBenefit>580</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW659</BillingCode><Name>ADHERUS Dural Sealant</Name><Description>Dural sealant</Description><Size>6ml</Size><SupplierCode>40329</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109270</GroupID><ARTGs><ARTG>202972</ARTG></ARTGs><MinimumBenefit>580</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH719</BillingCode><Name>TissuePatchDural 50* 25</Name><Description>Self adhesive dural sealant</Description><Size>50*25mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109272</GroupID><ARTGs><ARTG>377573</ARTG></ARTGs><Note>The PL benefit is limited to use of the device for procedures related to dura defect repair in spinal and neurosurgical procedures only.</Note><MinimumBenefit>446</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH723</BillingCode><Name>TissuePatchDural 100*25</Name><Description>Self adhesive dural sealant</Description><Size>100*25mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109272</GroupID><ARTGs><ARTG>377573</ARTG></ARTGs><Note>The PL benefit is limited to use of the device for procedures related to dura defect repair in spinal and neurosurgical procedures only.</Note><MinimumBenefit>446</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH720</BillingCode><Name>TissuePatchDural 50 * 50</Name><Description>Self adhesive dural sealant</Description><Size>50*50mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109272</GroupID><ARTGs><ARTG>377573</ARTG></ARTGs><Note>The PL benefit is limited to use of the device for procedures related to dura defect repair in spinal and neurosurgical procedures only.</Note><MinimumBenefit>446</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX343</BillingCode><Name>HEMOPATCH SEALING HAEMOSTAT</Name><Description>HEMOPATCH is an absorbable collagen pad intended for sealing and hemostasis.  HEMOPATCH is indicated as a hemostatic device and surgical sealant for procedures in  which control of bleeding or leakage of other body fluids or air by conventional surgical  techniques is either ineffective or impractical. HEMOPATCH may be used to close dural  defects following traumatic injury, excision, retraction or shrinkage of the dura mater.</Description><Size>Medium 4.5cm X 4.5cm  ( 3 pads per box)  Large 4.5cm X 9cm  (3 pads per box)</Size><SupplierCode>39947</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109272</GroupID><ARTGs><ARTG>360130</ARTG></ARTGs><Note>The prosthesis is only to be used in a surgical procedure described in item 39612, 39615, 39641, 39710 and 39712 in Group T8 of the Regulations.</Note><MinimumBenefit>446</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH721</BillingCode><Name>TissuePatchDural 50*100</Name><Description>Self adhesive dural sealant</Description><Size>50*100mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107784</SubCategoryID><GroupID>109272</GroupID><ARTGs><ARTG>377573</ARTG></ARTGs><Note>The PL benefit is limited to use of the device for procedures related to dura defect repair in spinal and neurosurgical procedures only.</Note><MinimumBenefit>446</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC529</BillingCode><Name>Lumboperitoneal Shunt</Name><Description>CSF Lumboperitoneal Catheter System; Lumbar Catheter Kit</Description><Size>84cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109274</GroupID><ARTGs><ARTG>140359</ARTG></ARTGs><MinimumBenefit>407</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI525</BillingCode><Name>CSF-Lumboperitoneal Shunt</Name><Description>T-Tube and K-Tube</Description><Size>Length: 87cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109274</GroupID><ARTGs><ARTG>134740</ARTG></ARTGs><MinimumBenefit>407</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB322</BillingCode><Name>Aesculap-Miethke gravitational shunt (with catheter)</Name><Description>Single valve, (anti-siphon) gravitational shunt, titanium construction (MRI safe to 3 tesla), with incorporated distal catheter, supplied sterile</Description><Size>23mm long , 4.6mm diameter, 5cmH2O - 40cmH2O, Catheter - di=1.2mm, do=2.5mm, 1200mm long</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109274</GroupID><Suffix>Antisyphon function</Suffix><ARTGs><ARTG>181718</ARTG><ARTG>375142</ARTG></ARTGs><MinimumBenefit>1221</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG172</BillingCode><PriorBillingCodes><PriorBillingCode>JJ855</PriorBillingCode></PriorBillingCodes><Name>Codman-Medos Non-programmable Valve System</Name><Description>Lumbar/peritoneal catheter, James and Holter designs</Description><Size>25-80cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109274</GroupID><ARTGs><ARTG>149300</ARTG><ARTG>150123</ARTG></ARTGs><MinimumBenefit>407</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG023</BillingCode><Name>Cordis Omnishunt System</Name><Description>Silicone and Synthetic ruby</Description><Size>Very low to very high pressures</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109274</GroupID><ARTGs><ARTG>151644</ARTG></ARTGs><MinimumBenefit>407</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG031</BillingCode><Name>Ventricular Catheters</Name><Description>Silicon Ventricular Catheter</Description><Size>15cm - 25cm, optional flanges or right angle or endoscopic tip. ID 1.3mm, OD 2.5mm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Proximal</Suffix><ARTGs><ARTG>150579</ARTG></ARTGs><MinimumBenefit>167</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI165</BillingCode><Name>ARES Antibiotic-Impregnated Catheter</Name><Description>ARES antibiotic-impregnated ventricular catheter</Description><Size>23cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Antibiotics</Suffix><ARTGs><ARTG>245273</ARTG></ARTGs><MinimumBenefit>424</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI166</BillingCode><Name>ARES antibiotic -impregnated catheter</Name><Description>ARES antibiotic-impregnated peritoneal catheter</Description><Size>120cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Antibiotics</Suffix><ARTGs><ARTG>245274</ARTG></ARTGs><MinimumBenefit>424</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG164</BillingCode><PriorBillingCodes><PriorBillingCode>JJ263</PriorBillingCode></PriorBillingCodes><Name>ACCU-FLO Intracranial Pressure shunt</Name><Description>ACCU-FLO barium ventricular catheter, packaged sterile, silicone rubber</Description><Size>One size only</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Proximal</Suffix><ARTGs><ARTG>150088</ARTG></ARTGs><MinimumBenefit>167</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG157</BillingCode><PriorBillingCodes><PriorBillingCode>JJ218</PriorBillingCode></PriorBillingCodes><Name>HOLTER Intracranial Pressure Shunt</Name><Description>HOLTER Ventricular Catheter, packaged sterile, silicone rubber</Description><Size>3 - 7cm and 15cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Proximal</Suffix><ARTGs><ARTG>150090</ARTG></ARTGs><MinimumBenefit>167</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG179</BillingCode><Name>Codman Ventricular Catheter with Bactiseal Silicone </Name><Description>Silicone ventricular catheter, antibiotic impregnated</Description><Size>14cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Antibiotics</Suffix><ARTGs><ARTG>343683</ARTG></ARTGs><MinimumBenefit>424</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG025</BillingCode><Name>Right Angle Ventricular Catheter</Name><Description>Silicone, integral right angle</Description><Size>3-11cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Proximal</Suffix><ARTGs><ARTG>151660</ARTG></ARTGs><MinimumBenefit>167</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG014</BillingCode><Name>Heyer Schulte Portnoy Flanged Ventricular Catheter</Name><Description>Composition - silicone with tantalum markings</Description><Size>Length 18cm, outer diameter 8mm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Proximal</Suffix><ARTGs><ARTG>163262</ARTG></ARTGs><MinimumBenefit>167</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC638</BillingCode><Name>Peritoneal Catheter PSM range with Bioglide</Name><Description>Translucent silicone elastomer with Barium impregnated stripe.  Catheter surface bonded with Hydrogel.</Description><Size>60-90cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Distal, Coating</Suffix><ARTGs><ARTG>130410</ARTG></ARTGs><MinimumBenefit>202</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG180</BillingCode><Name>Codman Peritoneal Catheter with Bactiseal Silicone</Name><Description>Silicone peritoneal catheter, antibiotic impregnated</Description><Size>120cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Antibiotics</Suffix><ARTGs><ARTG>343684</ARTG></ARTGs><MinimumBenefit>424</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC584</BillingCode><Name>CSF - Distal Catheters</Name><Description>Non metallic and latex free, Models 43418,43103,43111,43209,43522,43551,25024</Description><Size>Distal cardiac/peritoneal catheters ID 1.3mm OD 2.5mm Length 90cm, ID 1.2mm, OD 2.1mm, Length 58cm, 90cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Distal</Suffix><ARTGs><ARTG>140357</ARTG><ARTG>130410</ARTG><ARTG>140360</ARTG></ARTGs><MinimumBenefit>167</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC639</BillingCode><Name>Ventricular Catheter PSM range with Bioglide</Name><Description>Translucent silicone elastomer with Barium impregnated stripe. Catheter surface bonded with Hydrogel.</Description><Size>15-23cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Proximal, Coating</Suffix><ARTGs><ARTG>141102</ARTG></ARTGs><MinimumBenefit>220</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI167</BillingCode><Name>ARES antibiotic-impregnated catheter kit</Name><Description>ARES antibiotic catheter kit includes ventricular and peritoneal catheter</Description><Size>23 - 120cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Antibiotics, Distal, Proximal</Suffix><ARTGs><ARTG>245275</ARTG></ARTGs><MinimumBenefit>609</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG155</BillingCode><Name>Codman Ventricular Catheter and Codman Peritoneal Catheter with Bactiseal Silicone</Name><Description>Silicone antibiotic impregnated catheter kit</Description><Size>Kit</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Antibiotics, Distal, Proximal</Suffix><ARTGs><ARTG>343682</ARTG></ARTGs><MinimumBenefit>609</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG161</BillingCode><PriorBillingCodes><PriorBillingCode>JJ227</PriorBillingCode></PriorBillingCodes><Name>Codman Medos Straight Ventricular Catheter</Name><Description>14cm, packaged sterile, silicone rubber</Description><Size>14cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Proximal</Suffix><ARTGs><ARTG>150085</ARTG></ARTGs><MinimumBenefit>167</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI122</BillingCode><Name>CSF Ventricular Catheter PSM range</Name><Description>Ventricular catheter, non metallic latex free. Barium impregnated, include stainless steel stylet.</Description><Size>1.3 - 35cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Proximal</Suffix><ARTGs><ARTG>141100</ARTG></ARTGs><MinimumBenefit>167</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG011</BillingCode><Name>Shunt</Name><Description>Peritoneal</Description><Size>90 - 120cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Distal</Suffix><ARTGs><ARTG>151659</ARTG></ARTGs><MinimumBenefit>167</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG021</BillingCode><Name>Peritoneal Catheter</Name><Description>Peritoneal Catheters</Description><Size>Length: 91cm, F7.  OD: 2.1mm; ID:1.1mm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Distal</Suffix><ARTGs><ARTG>151659</ARTG></ARTGs><MinimumBenefit>167</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG010</BillingCode><Name>Shunt</Name><Description>Components - catheter: Atrial</Description><Size>55cm - 60cm, Low - High pressure range</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Distal</Suffix><ARTGs><ARTG>151659</ARTG></ARTGs><MinimumBenefit>167</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG163</BillingCode><PriorBillingCodes><PriorBillingCode>JJ261</PriorBillingCode></PriorBillingCodes><Name>ACCU-FLO Intracranial Pressure shunt</Name><Description>ACCU-FLO catheter, packaged sterile, silicone rubber</Description><Size>91cm in length</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Distal</Suffix><ARTGs><ARTG>150089</ARTG></ARTGs><MinimumBenefit>167</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG174</BillingCode><PriorBillingCodes><PriorBillingCode>JJ857</PriorBillingCode></PriorBillingCodes><Name>HOLTER Intracranial Pressure Shunt</Name><Description>HOLTER distal peritoneal catheter/Salmon, packaged sterile, silicone</Description><Size>90cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Distal</Suffix><ARTGs><ARTG>149299</ARTG></ARTGs><MinimumBenefit>167</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB329</BillingCode><Name>Miethke Peritoneal Catheter</Name><Description>Peritoneal catheter, barium impregnated, radio-opaque silicon
2) Peritoneal catheter with integrated barium strip</Description><Size>d 1.2mm od =2.5mm; 600,900 1200mm long</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Distal</Suffix><ARTGs><ARTG>181747</ARTG></ARTGs><MinimumBenefit>167</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG162</BillingCode><PriorBillingCodes><PriorBillingCode>JJ229</PriorBillingCode></PriorBillingCodes><Name>Codman Medos Peritoneal Catheter</Name><Description>85cm, packaged sterile, silicone rubber</Description><Size>85cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Distal</Suffix><ARTGs><ARTG>149295</ARTG></ARTGs><MinimumBenefit>167</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB331</BillingCode><Name>Miethke Ventricular catheter with deflector</Name><Description>Ventricular catheters (with deflector) are used to drain CSF out of the ventricle. All catheters are made of radiopaque silicone. The deflectors allow 90 degree deflection of the ventricular catheter in the burrhole without kinking the catheter. All deflectors are made of titanium. The deflectors are adjustable on the catheter, have suture fixation holes and are radiopaque.</Description><Size>Ventricular catheter with deflector:
Inside diameter 1.2mm, Outside diameter 2.5mm.
FV075P: Ventricular catheter 180mm, graduated.
Deflector: Large.
FV078P: Ventricular catheter 250mm, graduated.
Deflector: Large.
Ventricular catheter with deflector (for pediatric application):
Inside diameter 1.2mm, Outside diameter 2.5mm.
FV076P: Ventricular catheter 180mm, graduated.
Deflector: Small.</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Proximal</Suffix><ARTGs><ARTG>196110</ARTG></ARTGs><MinimumBenefit>167</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG020</BillingCode><Name>Atrial Catheter </Name><Description>Components - catheter: Atrial Atrial Catheters  Hydrocephalux Valve Accessories</Description><Size>Length: 46cm, F7.  OD: 2.1mm; ID:1.1mm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Distal</Suffix><ARTGs><ARTG>151659</ARTG></ARTGs><MinimumBenefit>167</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG012</BillingCode><Name>Shunt</Name><Description>Ventricular</Description><Size>14.5cm - 23cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Proximal</Suffix><ARTGs><ARTG>163262</ARTG></ARTGs><MinimumBenefit>167</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG030</BillingCode><Name>Cardiac/Peritoneal Catheters</Name><Description>SiliconDistal Catheter, ID 1.3mm, OD 2.5mm</Description><Size>90cm, barium impregnated silicone catheter, closed or open ended, with or without slits</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Distal</Suffix><ARTGs><ARTG>150579</ARTG></ARTGs><MinimumBenefit>167</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB336</BillingCode><Name>Miethke Ventricular Catheter with stylet</Name><Description>Ventricluar catheters (with stylet) are used to drain CSF out of the ventricle. All catheters are made of radiopaque silicone.</Description><Size>Inside diameter 1.2mm, Outside diameter 2.5mm.
FV074P: 180mm, graduated.
FV077P: 250mm, graduated.</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Proximal</Suffix><ARTGs><ARTG>196110</ARTG></ARTGs><MinimumBenefit>167</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC857</BillingCode><Name>Small Lumen Peritoneal Catheter</Name><Description>CSF Distal Catheter</Description><Size>ID - 0.7mm OD - 2.5mm Length - 120cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109275</GroupID><Suffix>Distal</Suffix><ARTGs><ARTG>130410</ARTG></ARTGs><MinimumBenefit>167</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG156</BillingCode><PriorBillingCodes><PriorBillingCode>JJ164</PriorBillingCode></PriorBillingCodes><Name>Siphonguard CSF Control Device</Name><Description>PET shell anti-siphon device for shunt</Description><Size>One size only</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109276</GroupID><ARTGs><ARTG>165962</ARTG></ARTGs><MinimumBenefit>794</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB327</BillingCode><Name>Aesculap-Miethke Shunt Burr hole port</Name><Description>Titanium, (MRI safe 3 tesla), radio-opaque with low overall height for easy and safe positioning of ventricular catheter. Allows CSF extraction and drug injection by syringe through silicone dome. Solid Titanium base ensures syringes will not penetrate, supplied sterile.</Description><Size>Radio- opaque titanium. 14mm diameter, 4.8mm height; 20/9.5mm diameter, 5.65mm height. For catheters - id =1.2mm, od =2.5mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109277</GroupID><ARTGs><ARTG>181719</ARTG></ARTGs><MinimumBenefit>338</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG008</BillingCode><Name>Heyer-Schulte Ommaya CSF Reservoir</Name><Description>Standard, side-inlet, convertible, mini</Description><Size>1.5 - 2.5cm and mini</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109277</GroupID><ARTGs><ARTG>161176</ARTG></ARTGs><MinimumBenefit>338</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB326</BillingCode><Name>Aesculap-Miethke Shunt inline Flushing reservoir</Name><Description>Titanium, (MRI safe 3 tesla), radio- opaque with low overall height for easy and safe positioning of ventricular catheter. Allows CSF extraction and drug injection by syringe through silicone dome. Solid Titanium base ensures syringes will not penetrate.</Description><Size>Radio-opaque titanium. 14mm diameter,4.8mmheight; 20mm diameter, 5.65mm height. For catheters - id = 1.2mm,od = 2.5mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109277</GroupID><ARTGs><ARTG>181719</ARTG></ARTGs><MinimumBenefit>338</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC534</BillingCode><Name>Pressure valve (anti-siphon device or  flushing valve or flush pump)</Name><Description>Neonatal Reservior, CSF Lumbo Peritoneal</Description><Size>2 - 90cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109277</GroupID><ARTGs><ARTG>129650</ARTG></ARTGs><MinimumBenefit>338</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB333</BillingCode><Name>Miethke Port / Reservoir</Name><Description>The ports / reservoirs are all made of titanium and are radiopaque. They have a low overall height for easy and safe positioning and fixation of the ventricular catheter. They allow CSF extraction and drug injection by inserting a syringe through the silicone dome. The solid titanium base prevents penetration with a syringe needle. There are 6 different types: Burrhole port, CSF port, Burrhole reservoir, Sprung reservoir, Flushing reservoir, Control reservoir.</Description><Size>Burrhole port:
FV030T: Diameter 20mm, Height 5.65mm.
FV040T: Diameter 14mm, Height 4.8mm (for pediatric application).
CSF port:
FV060T: Diameter 20mm, Height 5.65mm.
Burrhole reservoir:
FV028T: Diameter 20mm, Height 5.65mm.
FV029T: Diameter 20mm, Height 5.65mm with adjustable connector.
FV039T: Diameter 14mm, Height 4.8mm (for pediatric application).
Sprung reservoir:
FV043T: Diameter 20mm, Height 5.65mm.
Flushing reservoir:
FV033T: Diameter 20mm, Height 5.65mm.
FV035T: Diameter 14mm, Height 4.8mm (for pediatric application).
Control reservoir:
FV047T: Diameter 20mm, Height 5.65mm.</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109277</GroupID><ARTGs><ARTG>181719</ARTG></ARTGs><MinimumBenefit>338</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG013</BillingCode><Name>Shunt</Name><Description>Reservoir</Description><Size>Standard, Large</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109277</GroupID><ARTGs><ARTG>151646</ARTG></ARTGs><MinimumBenefit>338</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG033</BillingCode><Name>Reservoirs</Name><Description>Shunt component</Description><Size>9mm to 25mm, with or without convertible outlet port, burr hole or flat bottom style</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109277</GroupID><ARTGs><ARTG>163539</ARTG></ARTGs><MinimumBenefit>338</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI018</BillingCode><Name>Reservoir</Name><Description>CSF Reservoir, Port, Neonatal, Snap assembly</Description><Size>Various</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109277</GroupID><ARTGs><ARTG>145332</ARTG><ARTG>129650</ARTG><ARTG>145336</ARTG></ARTGs><MinimumBenefit>338</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG173</BillingCode><PriorBillingCodes><PriorBillingCode>JJ856</PriorBillingCode></PriorBillingCodes><Name>Burr Hole Button Reservoirs</Name><Description>Various ventriculostomy reservoirs</Description><Size>Standard, dome, flat profile and large</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109277</GroupID><ARTGs><ARTG>140900</ARTG><ARTG>149298</ARTG><ARTG>149297</ARTG></ARTGs><MinimumBenefit>338</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB330</BillingCode><Name>Miethke Reservoir with integrated catheter</Name><Description>The reservoirs are all made of titanium and are radiopaque. They have a low overall height for easy and safe positioning and fixation of the ventricular catheter. They allow CSF extraction and drug injection by inserting a syringe through the silicone dome. The solid titanium base prevents penetration with a syringe needle.
The reservoirs come with integrated catheters. There are 4 different types of reservoirs with integrated catheters: Burrhole reservoir, sprung reservoir, flushing reservoir and control reservoir.</Description><Size>Burrhole reservoir: 
FV027T - Diameter 20mm, Height 5.65mm, with integrated catheter 600mm. 
FV054T - Diameter 14mm, Height 4.8mm, with integrated catheter 200mm (pediatric).
Sprung reservoir: 
FV044T - Diameter 20mm, Height 5.65mm, with integrated catheter 600mm.
Flushing reservoir: 
FV034T - Diameter 20mm, Height 5.65mm, with integrated 600mm.
FV081T - Diameter 14mm, Height 4.8mm, with integrated catheter 600mm (pediatric).
Control reservoir: 
FV048T - Diameter 20mm, Height 5.65mm, with integrated catheter 600mm.</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109277</GroupID><Suffix>Integrated Catheter</Suffix><ARTGs><ARTG>181719</ARTG></ARTGs><MinimumBenefit>451</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB323</BillingCode><Name>Aesculap-Miethke SHUNTASSISTANT</Name><Description>Anti-siphon gravitational unit to treat standing pressure over drainage in conjunction with existing shunts in children and adults, titanium construction (MRI safe to 3 tesla).</Description><Size>19.5mm long and 23.7mm long , 4.0mm diameter and 4.6mm diameter, 10cmH2O and 15-35cmH2O. Straight and u-shaped.</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109279</GroupID><ARTGs><ARTG>181718</ARTG><ARTG>375141</ARTG></ARTGs><MinimumBenefit>794</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER612</BillingCode><Name>Alpha Omega NeuroProbe Microelectrodes</Name><Description>Alpha Omega Neuroprobe family of microtargeting electrodes; shielded, Sonus  shielded or unshielded, various configurations, sterile</Description><Size>Length: 240-300 mm  Microtip length: 2.5-27 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109283</GroupID><ARTGs><ARTG>346530</ARTG></ARTGs><MinimumBenefit>1145</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI073</BillingCode><Name>Medtronic MicroTargeting Electrodes</Name><Description>Microelectrodes used for intra-operative recording of neuronal activity for DBS</Description><Size>Various</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109283</GroupID><ARTGs><ARTG>133619</ARTG></ARTGs><MinimumBenefit>1145</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER647</BillingCode><PriorBillingCodes><PriorBillingCode>SJ198</PriorBillingCode></PriorBillingCodes><Name>MicroTargeting Electrodes</Name><Description>Microtargeting mono- and bipolar- electrodes</Description><Size>100-300mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109283</GroupID><ARTGs><ARTG>161735</ARTG></ARTGs><MinimumBenefit>1145</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI445</BillingCode><Name>Neurostimulation System - Extensions</Name><Description>1 x 8 Extension Kit Model 37081</Description><Size>20, 40 &amp; 60cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109288</GroupID><ARTGs><ARTG>426912</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>1362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC941</BillingCode><Name>Pocket Adaptors for Spinal Cord Stimulation</Name><Description>Pocket Adaptors for Spinal Cord Stimulation (Single and Dual Channel)</Description><Size>12.9cm, 25.5cm and 27.4cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109288</GroupID><ARTGs><ARTG>165114</ARTG></ARTGs><MinimumBenefit>1362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ160</BillingCode><Name>ANS Spinal Cord Stimulation System (SCS)</Name><Description>Lead Extensions - in addition to 3341, 3342, 3343, 3382 and 3383, additional model 3346 - Dual Quad Extension and 3386 - single octrode extension</Description><Size>60cm length</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109288</GroupID><ARTGs><ARTG>126078</ARTG><ARTG>126001</ARTG></ARTGs><MinimumBenefit>1362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC734</BillingCode><Name>Quadripolar Stretch-Coil Extensions</Name><Description>Model 37082 Bifurcated, Silver and Silicone Rubber</Description><Size>20cm - 60cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109288</GroupID><ARTGs><ARTG>239412</ARTG></ARTGs><MinimumBenefit>1362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ358</BillingCode><Name>Axium Neurostimulator System - Lead Extension Kit</Name><Description>Lead extension kit.</Description><Size>1 size (1 presentation)</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109288</GroupID><ARTGs><ARTG>203096</ARTG><ARTG>301410</ARTG><ARTG>333448</ARTG></ARTGs><MinimumBenefit>1362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER007</BillingCode><Name>Nevro Spinal Cord Stimulation System (SCSS) - Lead Extension Kit</Name><Description>The lead extender is intended to be used when the implant site for the Implantable Pulse Generator is too far from the stimulation site to directly connect the stimulation lead.</Description><Size>Length: 15cm-60cm, in increments of 5cm</Size><SupplierCode>40067</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109288</GroupID><ARTGs><ARTG>185993</ARTG></ARTGs><MinimumBenefit>1362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC733</BillingCode><Name>Quadripolar Stretch-Coil Extensions</Name><Description>Model 37083 Single, Silver and Silicone Rubber</Description><Size>20cm - 60cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109288</GroupID><ARTGs><ARTG>239412</ARTG></ARTGs><MinimumBenefit>1362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UY004</BillingCode><Name>Evoke 12C Lead Extension Kit - 55cm</Name><Description> A 12 contact lead extension.</Description><Size>55cm</Size><SupplierCode>40224</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109288</GroupID><ARTGs><ARTG>336571</ARTG></ARTGs><MinimumBenefit>1362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS169</BillingCode><Name>Precision SCS Splitter</Name><Description>Lead extension for connection of multiple leads</Description><Size>Multiple Configurations</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109288</GroupID><ARTGs><ARTG>167101</ARTG><ARTG>167102</ARTG><ARTG>197908</ARTG></ARTGs><MinimumBenefit>1362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WW023</BillingCode><PriorBillingCodes><PriorBillingCode>ER130</PriorBillingCode></PriorBillingCodes><Name>Nevro Spinal Cord Stimulation System (SCSS) - Pocket Adaptor Kit - M8</Name><Description>The Pocket Adaptor is intended to be used when replacing a previously implanted Pulse Generator with the Nevro Implantable Pulse Generator. The Pocket Adaptor interfaces the Nevro Implantable Pulse Generator to another manufacturer's previously implanted compatible lead or lead extension</Description><Size>Length of 10cm to 60cm, in increments of 1cm</Size><SupplierCode>40398</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109288</GroupID><ARTGs><ARTG>204062</ARTG></ARTGs><MinimumBenefit>1362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS111</BillingCode><Name>Precision SCS Lead Extensions</Name><Description>Lead Extensions</Description><Size>25cm to 55cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109288</GroupID><ARTGs><ARTG>128679</ARTG></ARTGs><MinimumBenefit>1362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WW024</BillingCode><PriorBillingCodes><PriorBillingCode>ER102</PriorBillingCode></PriorBillingCodes><Name>Nevro Spinal Cord Stimulation System (SCSS) - Pocket Adaptor Kit - S8</Name><Description>The Pocket Adaptor is intended to be used when replacing a previously implanted Pulse Generator with the Nevro Implantable Pulse Generator. The Pocket Adaptor interfaces the Nevro Implantable Pulse Generator to another manufacturer's previously implanted compatible lead or lead extension.</Description><Size>Length of 10cm to 60cm, in increments of 1cm.</Size><SupplierCode>40398</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109288</GroupID><ARTGs><ARTG>199081</ARTG></ARTGs><MinimumBenefit>1362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS158</BillingCode><Name>Precision Connector M1</Name><Description>Lead extension for Precision SCS System</Description><Size>35. 55. 70 cm length</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109288</GroupID><ARTGs><ARTG>162422</ARTG></ARTGs><MinimumBenefit>1362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS323</BillingCode><Name>Precision M8 Adaptor</Name><Description>Designed to connect a Precision IPG or Precision Spectra IPG to another manufacturer's previously implanted compatible lead or lead extension</Description><Size>15cm - 55cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109288</GroupID><ARTGs><ARTG>281250</ARTG></ARTGs><MinimumBenefit>1362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC313</BillingCode><Name>Synchro Med II Pump</Name><Description>Model No's 8637-20 &amp; 8637-40, Composition - Titanium</Description><Size>20 ml &amp; 40 ml</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107788</SubCategoryID><GroupID>109290</GroupID><Suffix>Variable Flow Rate</Suffix><ARTGs><ARTG>389968</ARTG></ARTGs><MinimumBenefit>14666</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI450</BillingCode><Name>Medtronic myPTM™ Patient Programmer</Name><Description>Patient Programmer for SynchroMed™ II</Description><Size>One size</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107788</SubCategoryID><GroupID>109291</GroupID><ARTGs><ARTG>358310</ARTG></ARTGs><MinimumBenefit>1354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC944</BillingCode><Name>8835 Personal Therapy Manager for Synchromed Pumps</Name><Description>Personal Therapy Manager for SynchroMed II implantable infusion pumps</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107788</SubCategoryID><GroupID>109291</GroupID><ARTGs><ARTG>151719</ARTG></ARTGs><MinimumBenefit>1354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI048</BillingCode><Name>Intrathecal catheter accessory</Name><Description>Tunnelling rods - Stainless steel</Description><Size>38-60cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107788</SubCategoryID><GroupID>109293</GroupID><ARTGs><ARTG>121281</ARTG></ARTGs><MinimumBenefit>147</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI028</BillingCode><Name>Medtronic Ascenda Component Accessory Kits</Name><Description>Accessories for implantable drug pumps

The Ascenda Kit consists of single-use aids integral for implanting the Intrathecal Catheter (App 028), which are only suitable for use with the patient in whom the intrathecal catheter is implanted.

Kit includes:
- Anchor with anchor dispenser
- Anchor removal tool
- Catheter connector with 2 attached coils.

The Ascenda provides better stabilization and reduced catheter dislodgement due to a newly designed anchor and dispensing tool.</Description><Size>One size</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107788</SubCategoryID><GroupID>109293</GroupID><ARTGs><ARTG>133523</ARTG><ARTG>133763</ARTG></ARTGs><MinimumBenefit>147</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CB012</BillingCode><Name>LVIS Intraluminal Support Device</Name><Description>Self-expanding intracranial vascular stent</Description><Size>Diameters: 2.5, 3.0, 3.5, 4.0, 4.5, 5.5mm  Lengths: 8-67mm</Size><SupplierCode>39993</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109297</GroupID><ARTGs><ARTG>194409</ARTG></ARTGs><MinimumBenefit>6769</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PN022</BillingCode><Name>ACCLINO Flex Plus Stent</Name><Description>Acclino Flex Plus Stent is a self-expanding lasercut Nitinol stent for aneurysm neck bridging in case of stent assisted coiling procedures. It is intended for use with embolisation materials for the treatment of intracranial aneurysms. It provides an increased range and is suitable for vessel diameters from 1.5 to 6.0 mm. For an easy handling all sizes from 3.0  - 5.5 mm are deliverable through microcatheters with 0.0165 -   0.017  ID. This allows a sequential stent and coil placement without the changing of the microcatheter. The 6.5 mm diameter devices are deliverable through  microcatheters with 0.021   ID.</Description><Size>Diameter: 3.0 - 6.5mm    Length: 15 - 35 mm</Size><SupplierCode>40107</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109297</GroupID><ARTGs><ARTG>281032</ARTG></ARTGs><MinimumBenefit>6769</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW567</BillingCode><Name>Neuroform ATLAS Stent System</Name><Description>The Neuroform Atlas (Atlas) Stent System is intended to be used for stent assisted embolization for intracranial aneurysm therapy. The purpose of the stent is to retain the occlusive devices within the aneurysm. Occlusive devices can be delivered prior to stent placement or after stent placement. The Atlas Stent System consists of a self-expanding, sterile, nitinol stent preloaded over a delivery wire inside an introducer sheath.  The sheath and delivery wire are used to transfer the stent into a 0.0165 to 0.017 inch internal diameter microcatheter.  After transferring the stent, the sheath is removed from the proximal end of the delivery wire. The delivery wire is then used to advance the stent to the distal end of the microcatheter. The microcatheter and stent system are repositioned as a unit to ensure the stent is located across the aneurysm. The stent is deployed by stabilizing the delivery wire and withdrawing the microcatheter. The Neuroform Atlas stent cannot be repositioned or captured once deployed.</Description><Size>Stent Diameter (mm): 3.0, 4.0, 4.5
Stent Length (mm): 15, 21, 24, 30</Size><SupplierCode>40329</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109297</GroupID><ARTGs><ARTG>278675</ARTG></ARTGs><MinimumBenefit>6769</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW470</BillingCode><Name>Wingspan Stent System</Name><Description>Wingspan Self Expanding Nitonol Stent and delivery catheter</Description><Size>Stent diameters: 2.5mm to 4.5mm; Stent lengths: 9.0mm to 20.0mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109297</GroupID><ARTGs><ARTG>128926</ARTG><ARTG>130061</ARTG></ARTGs><MinimumBenefit>6769</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PN023</BillingCode><Name>ACCERO Stent</Name><Description>ACCERO Stent is a highly visible,braided self-expanding stent with BlueXide® surface technology.The self-expanding braided stent is characterised by an excellent opening behaviour,  superior wall apposition and a very smooth surface. It is intended for use with embolization materials in the treatment of intracranial aneurysms. Accero’s full range of sizes can be delivered through a small 0.0170” microcatheter and can be resheathed up to 95%.    </Description><Size>Stent Diameter (mm): 2.5, 3.0, 3.5,4.0, 4.5           Stent Length (mm): 10, 15, 20, 25</Size><SupplierCode>40107</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109297</GroupID><ARTGs><ARTG>321603</ARTG></ARTGs><MinimumBenefit>6769</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ME209</BillingCode><Name>Leo+</Name><Description>Leo+ Stent</Description><Size>D 2.0mm L 12mm, 18mm, 25mm.
D 2.5mm L 12mm, 18mm, 25mm, 30mm, 35mm.
D 3.0mm L 12mm, 18mm, 25mm, 35mm 
D 3.5mm L 12mm, 18mm, 25mm, 30mm, 35mm, 50mm.
D 4.5mm L 15mm, 20mm, 25mm, 30mm, 40mm, 50mm, 75mm.
D 5.5mm L 25mm, 30mm, 35mm, 50mm, 60mm, 75mm.</Size><SupplierCode>40363</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109297</GroupID><ARTGs><ARTG>197947</ARTG></ARTGs><MinimumBenefit>6769</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS196</BillingCode><Name>Solitaire</Name><Description>Solitaire Neurovascular Remodelling Device is a self-expanding, fully retrievable device which can be delivered and deployed by a single operator.</Description><Size>Diameter: 3-6mm
Length: 15-40mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109297</GroupID><ARTGs><ARTG>155038</ARTG></ARTGs><MinimumBenefit>6769</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PN014</BillingCode><Name>Penumbra Smart Coil</Name><Description>The Penumbra Smart Coil System is comprised of the The Penumbra Smart Coil, a platinum embolization coil attached to a composite delivery pusher with a radiopaque positioning marker and the Penumbra Smart Coil Detachment Handle.</Description><Size>Standard: Diameter 3-18mm, Length 3-60cm;
Soft: Diameter 1-14mm, Length 2-45cm;
Extra Soft: Diameter 1-6mm, Length 1-20cm;
Helical Extra Soft: Diameter 1-6mm, Length 1-20cm.</Size><SupplierCode>40107</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109298</GroupID><ARTGs><ARTG>242752</ARTG></ARTGs><MinimumBenefit>1043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ME226</BillingCode><Name>Optima Coil System</Name><Description>Implantable embolization Coil comprised of platinum-tungsten alloy attached to a proximal stainless steel hypo-tube and distal body coil delivery pusher with a radiopaque distal positioning marker and a proximal fluorosafe marker.</Description><Size>Various sizes as attached.</Size><SupplierCode>40363</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109298</GroupID><ARTGs><ARTG>302253</ARTG></ARTGs><MinimumBenefit>1043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS193</BillingCode><Name>Axium Detachable Coil System</Name><Description>Platinum alloy coils (including coils enlaced with PGLA filaments and Nylon Fibers)  attached to a composite implant delivery pusher with a radiopaque positioning marker.  The proximal end of the pusher is loaded into the Actuator which detaches the coil.</Description><Size>Diameter:  1.5 - 25mm; Length:  1 - 50cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109298</GroupID><ARTGs><ARTG>149398</ARTG><ARTG>194132</ARTG><ARTG>162494</ARTG><ARTG>162495</ARTG></ARTGs><MinimumBenefit>1043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CB010</BillingCode><Name>Hydrocoils</Name><Description>Framing and filling coils with Hydrogel.</Description><Size>Diam: 1-24mm  Length: 1-50cm</Size><SupplierCode>39993</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109298</GroupID><ARTGs><ARTG>137933</ARTG></ARTGs><MinimumBenefit>1043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI240</BillingCode><Name>Axium Prime Detachable Coil - Extra Soft</Name><Description>Platinum alloy embolization coil attached to a composite implant delivery pusher with a radiopaque positioning marker and hand-held Instant Detacher, which when activated, mechanically detaches the coil from the delivery pusher tip.</Description><Size>3D Shape: diameter 1 to 3.5 mm;  length 2 to 10 cm; Volume 1.34 to 6.70 mm3
Helical Shape: diameter 1 to 3 mm;  length 1 to 10 cm; Volume 0.67  to 6.70 mm3</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109298</GroupID><ARTGs><ARTG>287418</ARTG></ARTGs><MinimumBenefit>1043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CB011</BillingCode><Name>Microplex Coils</Name><Description>Framing and filling coils</Description><Size>Diam: 1-24mm
Length: 1-68cm</Size><SupplierCode>39993</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109298</GroupID><ARTGs><ARTG>137934</ARTG></ARTGs><MinimumBenefit>1043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ217</BillingCode><Name>Target Detachable Coils – Target Tetra</Name><Description>Detachable Platinum Coils </Description><Size>Coil diameter: 1.5-4.5mm, Coil Length: 2-10cm</Size><SupplierCode>40329</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109298</GroupID><ARTGs><ARTG>170214</ARTG></ARTGs><MinimumBenefit>1043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RQ086</BillingCode><Name>Numen Coil Embolization System</Name><Description>The Medical Device consists of an implant coil attached to a delivery wire (pusher) within an introducer sheath. It is intended to endovascularly obstruct or occlude blood flow in vascular abnormalities of the neurovascular and peripheral vessels</Description><Size>Coil Length (cm)- 1.0-70.0.  Coil Secondary Diameter (mm)- 1.0-24.0 </Size><SupplierCode>40089</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109298</GroupID><ARTGs><ARTG>413431</ARTG></ARTGs><MinimumBenefit>1043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PN004</BillingCode><Name>Penumbra Coil System / Penumbra Complex Soft Coil 400</Name><Description>Fill configuration coil is used to fill empty space within the frame coil. The stiffness allows for a traumatic interaction with the aneurysm wall and primary packing of the occlusion site (aneurysm).</Description><Size>Diameters: 3-24mm
Lengths: 6-57cm</Size><SupplierCode>40107</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109298</GroupID><ARTGs><ARTG>182354</ARTG></ARTGs><MinimumBenefit>1043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PN003</BillingCode><Name>Penumbra Coil System / Penumbra Complex Standard Coil 400</Name><Description>Frame configuration coil, three-dimensional complex shape, stiffest coil within the system, first coil to be placed, frames area of embolisation and holds subsequent coils within this zone.</Description><Size>Diameters: 3-24mm
Lengths: 6-57cm</Size><SupplierCode>40107</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109298</GroupID><ARTGs><ARTG>182354</ARTG></ARTGs><MinimumBenefit>1043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PN005</BillingCode><Name>Penumbra Coil System / Penumbra J Soft Coil 400</Name><Description>Finish Coil Implant (J Soft) fills small empty pockets remaining within the occlusion site. The J shaped tip and stiffness allows the coils to manoeuvre and fill the remaining pockets after use of the primary Fill Coils.</Description><Size>Lengths: 1-15cm</Size><SupplierCode>40107</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109298</GroupID><ARTGs><ARTG>182354</ARTG></ARTGs><MinimumBenefit>1043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PN006</BillingCode><Name>Penumbra Coil System / Penumbra Curve Extra Soft 400</Name><Description>The Soft Finish Coil Implant (Curve Extra Soft) is used for final packing of the aneurysm. The serpentine shape and the lowest stiffness allow the coils to manoeuvre and fill any remaining pockets after use of the other coil types.</Description><Size>Diameters: 2-4mm
Lengths: 1-20cm</Size><SupplierCode>40107</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109298</GroupID><ARTGs><ARTG>182354</ARTG></ARTGs><MinimumBenefit>1043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PN009</BillingCode><Name>Penumbra Complex Extra Soft Coil 400</Name><Description>The Soft Finish Coil Implants (Complex Extra Soft) are used for final packing of the aneurysm. The coil combines the shape of the complex standard coil, with the lowest stiffness of the Curve Extra Soft coil. The Soft Finish Coil Implants are available in varying diameters and lengths to accommodate physician need.</Description><Size>Secondary diameters: 2-4mm; Lengths: 2-10mm</Size><SupplierCode>40107</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109298</GroupID><ARTGs><ARTG>182354</ARTG></ARTGs><MinimumBenefit>1043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW467</BillingCode><Name>Target Detachable Coils</Name><Description>Detachable Platinum coils</Description><Size>Coil Diameter: 1mm to 24mm  Coil Length: 1cm to 50cm</Size><SupplierCode>40329</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109298</GroupID><ARTGs><ARTG>170214</ARTG></ARTGs><MinimumBenefit>1043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JZ001</BillingCode><Name>Wallaby Avenir Coil System</Name><Description>Platinum alloy coils attached to an implant delivery pusher which delivers the coil to the treatment site.  The pusher has a platinum iridium marker band to visualise coil position within a standard microcatheter which also has a radiopaque marker.</Description><Size>• 18-System Complex Framing Coils    Diameter: 6mm – 25mm    Length: 16cm – 60cm    • 10-System Complex Framing Coils   Diameter: 2mm – 10mm    Length: 2cm – 34cm    • 10-System Helical Filling Coils   Diameter: 3mm – 10mm    Length: 4cm – 30cm    • 10-System Complex Finishing Coils   Diameter: 1mm – 5mm    Length: 2cm – 10cm    • 10-System Helical Finishing Coils   Diameter: 1mm – 6mm    Length: 1cm – 10cm</Size><SupplierCode>40390</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109298</GroupID><ARTGs><ARTG>389092</ARTG></ARTGs><MinimumBenefit>1043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS353</BillingCode><Name>Promus PREMIER BTK</Name><Description>Everolimus-Eluting Platinum Chromium Stent System</Description><Size>Diameter 2.5-4mm, Length 20-38mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109304</GroupID><ARTGs><ARTG>302114</ARTG></ARTGs><MinimumBenefit>2042</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC289</BillingCode><Name>Zilver PTX</Name><Description>The Zilver PTX Drug Eluting Peripheral Stent is a self-expanding stent made of nitinol and coated with the drug Paclitaxel.  The stent is preloaded in a 6.0 French delivery catheter.</Description><Size>6French: 5, 6, 7, 8 mm diameters in 20, 30, 40, 60, 80, 100, 120, 140mm lengths</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109304</GroupID><ARTGs><ARTG>279510</ARTG></ARTGs><MinimumBenefit>2042</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI060</BillingCode><Name>Endurant II AAA Abdominal Tube</Name><Description>Endurant II Endoluminal Stent Graft System - Abdominal Tube</Description><Size>Proximal diameter: 23 to 36mm; Distal diameter: 23 to 36mm; Covered length: 70mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109310</GroupID><ARTGs><ARTG>202471</ARTG></ARTGs><MinimumBenefit>4378</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC998</BillingCode><Name>Endurant II AAA Aorto-Uni-Iliac</Name><Description>Endurant II Endoluminal Stent Graft System - AUI</Description><Size>Proximal diameter: 23 to 36mm; Distal daimeter: 14mm; Covered length: 102mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109311</GroupID><ARTGs><ARTG>197539</ARTG></ARTGs><MinimumBenefit>9206</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JY006</BillingCode><Name>E-tegra Aorto-Uni-Iliac</Name><Description>E-tegra Stent Graft System - AUI</Description><Size>Length (covered): 105mm  Diameter (proximal): 23-36mm  Diameter (distal): 13mm</Size><SupplierCode>40391</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109311</GroupID><ARTGs><ARTG>388371</ARTG></ARTGs><MinimumBenefit>9206</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT276</BillingCode><Name>GORE EXCLUDER Iliac Branch Endoprosthesis</Name><Description>The GORE EXCLUDER IBE provides an endovascular option for treatment allowing preservation of perfusion to the internal iliac, versus occlusion and covering the internal iliac or open surgical alternatives. The The GORE EXCLUDER IBE consists of two components (Iliac Branch Component: 1 of 2).</Description><Size>CEB231010 - Internal Iliac Diameter:  6.50-9mm
CEB231210 - Internal Iliac Diameter: 10-11mm
CEB231410 - Internal Iliac Diameter: 12 - 13.5mm</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109313</GroupID><ARTGs><ARTG>232968</ARTG></ARTGs><MinimumBenefit>6769</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC233</BillingCode><Name>Zenith Branch Endovascular Graft - Iliac Bifurcation</Name><Description>Bifurcated branch vessel stent graft with openings to connect the common iliac, sidebranch, and external iliac segments. Made of stainless steel and nitinol z-stents and woven polyester, mounted on H&amp;LB one shot delivery system</Description><Size>Common iliac lengths 45 or 61mm, external iliac lengths 41 or 58mm and distal cuff diameters 10 or 12mm</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109313</GroupID><ARTGs><ARTG>138930</ARTG></ARTGs><MinimumBenefit>6769</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC263</BillingCode><Name>Zenith Fenestrated AAA Endovascular Graft with Flexor</Name><Description>Proximal Fenestrated body with Flexor sheath</Description><Size>1 or 2 internal stents, 24 - 36mm Diameter, 73 - 129mm Length</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109314</GroupID><ARTGs><ARTG>138797</ARTG></ARTGs><MinimumBenefit>7726</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU005</BillingCode><Name>Anaconda Endovascular Graft System</Name><Description>Iliac Leg, Ultrathin woven polyester, nitinol ring stents, tantalum markers</Description><Size>8 - 23mm</Size><SupplierCode>40450</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109316</GroupID><ARTGs><ARTG>172404</ARTG><ARTG>173321</ARTG></ARTGs><MinimumBenefit>2986</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JY004</BillingCode><Name>E-tegra Iliac Extension</Name><Description>E-tegra Stent Graft System - Iliac Extension</Description><Size>Diameter (distal): 10-27mm    Diameter (proximal): 13-27    Length (usable): 50mm    Length (total): 80mm</Size><SupplierCode>40391</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109316</GroupID><ARTGs><ARTG>388373</ARTG></ARTGs><MinimumBenefit>2986</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JY003</BillingCode><Name>E-tegra Contralateral Leg</Name><Description>E-tegra Stent Graft System - Contralateral Leg</Description><Size>Diameter (Proximal): 15mm    Diameter (Distal): 10-25mm    Length (Useable): 50-105mm    Length (Total): 80-135mm</Size><SupplierCode>40391</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109316</GroupID><ARTGs><ARTG>388370</ARTG></ARTGs><MinimumBenefit>2986</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU041</BillingCode><Name>Anaconda Endovascular Graft System</Name><Description>Flared iliac limb, Ultrathin woven polyester, nitinol ring stents, tantalum markers</Description><Size>Diameter: Proximal end 10-17mm, distal end 12-23mm: Length 80-130mm</Size><SupplierCode>40450</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109316</GroupID><ARTGs><ARTG>172404</ARTG><ARTG>173321</ARTG></ARTGs><MinimumBenefit>2986</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC330</BillingCode><Name>Zenith Alpha Spiral-Z Endovascular Leg</Name><Description>Iliac leg graft</Description><Size>Distal Diameters: 9-24mm.  Graft lengths: 42-125mm.</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109316</GroupID><ARTGs><ARTG>229923</ARTG></ARTGs><MinimumBenefit>2986</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC996</BillingCode><Name>Endurant II AAA Contralateral Iliac Limb</Name><Description>Endurant II Endoluminal Stent Graft System - Contralateral Iliac Limb</Description><Size>Proximal diameter: 16mm; Distal diameter: 10 to 28mm; Covered length: 156mm, 199mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109316</GroupID><Suffix>L (long length, &gt;150mm)</Suffix><ARTGs><ARTG>197541</ARTG></ARTGs><MinimumBenefit>3926</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU004</BillingCode><Name>Anaconda Endovascular Graft System</Name><Description>Iliac Extension Cuff. Ultrathin woven polyester, nitinol ring stents, tantalum markers

</Description><Size>8 - 18mm

</Size><SupplierCode>40450</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109316</GroupID><ARTGs><ARTG>172404</ARTG><ARTG>173321</ARTG></ARTGs><MinimumBenefit>2986</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT188</BillingCode><Name>EXCLUDER AAA Endovascular Prostheses</Name><Description>AAA Stent Graft Nitinol &amp; ePTFE Two piece system (2/2) Contralateral Limb</Description><Size>Diameters: 12, 14.5, 23, 27mm
Lenghts: 10, 12, 14cm
Diameters: 16, 18, 20mm
Lenghts: 9.5, 11.5, 13.5cm</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109316</GroupID><ARTGs><ARTG>158680</ARTG></ARTGs><MinimumBenefit>2986</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC286</BillingCode><Name>Zenith® Spiral-Z AAA lliac Legs with Z-Trak™ Introduction System</Name><Description>Zenith® Spiral-Z AAA lliac Leg</Description><Size>Proximal Diameter - 13mm
Distal Diameter - 9mm to 24 mm
Working Length - 39 mm to 122 mm</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109316</GroupID><ARTGs><ARTG>184456</ARTG></ARTGs><MinimumBenefit>2986</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT190</BillingCode><Name>Excluder AAA Endovascular Prostheses</Name><Description>Abdominal Stent Graft Nitinol &amp; ePTFE - Iliac Extender</Description><Size>Diameters: 10, 12, 14.5mm
Lengths: 7cm</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109316</GroupID><ARTGs><ARTG>158682</ARTG></ARTGs><MinimumBenefit>2986</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JW010</BillingCode><PriorBillingCodes><PriorBillingCode>DO014</PriorBillingCode></PriorBillingCodes><Name>InCraft AAA Stent-Graft System - Iliac Limb/Extension</Name><Description>Contralateral/Ipsilateral lliac limbs and extensions</Description><Size>10-24mm diameter, 80-140mm length</Size><SupplierCode>40402</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109316</GroupID><ARTGs><ARTG>231895</ARTG></ARTGs><MinimumBenefit>2986</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT277</BillingCode><Name>GORE EXCLUDER Iliac Branch Endoprosthesis</Name><Description>The GORE EXCLUDER IBE provides an endovascular option for treatment allowing for preservation of perfusion to the internal iliac, versus occlusion and covering the internal iliac or open surgical procedures. 
The GORE EXCLUDER IBE consists of two components (Internal Iliac Component: 2 of 2).</Description><Size>HGB 161007 - Internal Iliac Diameter: 6.5 - 9mm
HGB 161207 - Internal Iliac Diameter: 10-11mm
HGB 161407 - Internal Iliac Diameter: 12 - 13.5mm</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109316</GroupID><ARTGs><ARTG>232968</ARTG></ARTGs><MinimumBenefit>2986</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC994</BillingCode><Name>Endurant II AAA Contralateral Iliac Limb</Name><Description>Endurant II Endoluminal Stent Graft System - Contralateral Iliac Limb</Description><Size>Proximal diameter: 16mm; Distal diameter: 10 to 28mm; Covered length: 82mm; 93mm; 124mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109316</GroupID><ARTGs><ARTG>197541</ARTG></ARTGs><MinimumBenefit>2986</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC995</BillingCode><Name>Endurant II AAA Iliac Extension</Name><Description>Endurant II AAA Iliac Extension</Description><Size>Proximal diameter: 10 to 28mm; Distal diameter: 10 to 28mm; Covered length: 82mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109316</GroupID><ARTGs><ARTG>197654</ARTG></ARTGs><MinimumBenefit>2986</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU057</BillingCode><Name>Anaconda AAA Stent Graft System</Name><Description>Ultrathin woven polyester, nitinol ring stents, tantalum markers (longer legs lengths &gt;150mm).

Long limbs have not got ARTG, but the Anaconda Stent Graft System does with regular limbs (ARTG173321 and 172404).

The Anaconda AAA Stent Graft System is a device support structure that expands and stays in place inside a blood carrying vessel for isolated iliac aneurysm repair and a component of the  AAA stent graft system.  It is delivered to the intended landing zone by a delivery system, where the stent is expanded to provide support for the vessel   The stent graft remains in place as a permanent implant.

The patient is hospitalised and undergoing invasive surgery of implantation of the stent graft.</Description><Size>Tapered Legs
Outer Diameter (Proximal 12mm; Distal 10mm) x  Length 150mm
Outer Diameter (Proximal 12mm; Distal 10mm) x  Length 170mm

Flared Legs
Outer Diameter (Proximal 12mm; Distal 13mm) x  Length 150mm
Outer Diameter (Proximal 12mm; Distal 13mm) x  Length 170mm
Outer Diameter (Proximal 12mm; Distal 15mm) x  Length 150mm
Outer Diameter (Proximal 12mm; Distal 15mm) x  Length 170mm
Outer Diameter (Proximal 12mm; Distal 17mm) x  Length 150mm
Outer Diameter (Proximal 12mm; Distal 17mm) x  Length 170mm
Outer Diameter (Proximal 12mm; Distal 19mm) x  Length 150mm
Outer Diameter (Proximal 12mm; Distal 19mm) x  Length 170mm 
Outer Diameter (Proximal 12mm; Distal 21mm) x  Length 150mm
Outer Diameter (Proximal 12mm; Distal 21mm) x  Length 170mm 
Outer Diameter (Proximal 12mm; Distal 23mm) x  Length 150mm
Outer Diameter (Proximal 12mm; Distal 23mm) x  Length 170mm 

Straight Legs
Outer Diameter 12mm x  Length 160mm
Outer diameter 12mm x  Length 180mm</Size><SupplierCode>40450</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109316</GroupID><Suffix>L (long length, &gt;150mm)</Suffix><ARTGs><ARTG>172404</ARTG></ARTGs><MinimumBenefit>3926</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC203</BillingCode><Name>Talent Occluder System</Name><Description>Nitinol stents attached to polyester graft sealed both ends</Description><Size>Standard Sizes, 8 - 24mm x 31 - 35mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109317</GroupID><ARTGs><ARTG>197552</ARTG></ARTGs><MinimumBenefit>2306</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB027</BillingCode><Name>Vascular Uni - Graft - Bifurcated</Name><Description>Vascular graft</Description><Size>12x7 to 12x12</Size><SupplierCode>40020</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109321</GroupID><ARTGs><ARTG>142665</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU014</BillingCode><Name>Gelsoft Plus Graft</Name><Description>Bifurcated, Polyester, Knitted</Description><Size>12mmx6mmx45cm to 24mmx12mmx45cm</Size><SupplierCode>40450</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109321</GroupID><ARTGs><ARTG>125679</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GX020</BillingCode><Name>Maquet InterVascular Bifurcated Vascular Grafts</Name><Description>Bifurcated Vascular Grafts</Description><Size>Diameter – 12mmx6mm – 24mmx12mm  Length - 50cm </Size><SupplierCode>39943</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109321</GroupID><ARTGs><ARTG>145507</ARTG><ARTG>145515</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT006</BillingCode><Name>Gore-Tex Stretch Bifurcated Graft</Name><Description>Stretch Bifurcated Graft with Thin Walled Limbs (ePTFE)</Description><Size>12x6mm to 24x12mm 40-50cm long</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109321</GroupID><ARTGs><ARTG>143264</ARTG><ARTG>11169</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU013</BillingCode><Name>Gelweave Graft</Name><Description>Bifurcated, Polyester, Woven</Description><Size>12mmx 6mmx 45 cm to 24mmx12mm x 45cm</Size><SupplierCode>40450</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109321</GroupID><ARTGs><ARTG>125606</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU018</BillingCode><Name>Gelsoft Plus Graft</Name><Description>Axillo-bifemoral, Polyester, Knitted, Externally reinforced</Description><Size>8x8mm/100x60cm; 8x7mm/90x40cm; 10x8mm/90x40cm</Size><SupplierCode>40450</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109322</GroupID><ARTGs><ARTG>125679</ARTG></ARTGs><MinimumBenefit>1760</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT216</BillingCode><Name>Gore-Tex Axillobifemoral Vascular Graft</Name><Description>Stretch vascular graft with removable rings (ePTFE)</Description><Size>Diameter 8mm x 90cm 40cm</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109322</GroupID><ARTGs><ARTG>143248</ARTG></ARTGs><MinimumBenefit>1760</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GX022</BillingCode><Name>Intergard Knitted</Name><Description>Knitted Axillobifemoral Radially Supported</Description><Size>Diameter - 8x6x6mm - 10x8x8mm  Total body/branch length 100cm - 55cm   Radially Supported length 20-60cm  </Size><SupplierCode>39943</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109322</GroupID><ARTGs><ARTG>145509</ARTG></ARTGs><MinimumBenefit>1760</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GX021</BillingCode><PriorBillingCodes><PriorBillingCode>MQ027</PriorBillingCode></PriorBillingCodes><Name>Intergard W</Name><Description>Woven Aortic Arch</Description><Size>Body Diameter 20mm - 36mm  Limbs Diameter 8 - 10mm</Size><SupplierCode>39943</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109322</GroupID><ARTGs><ARTG>145513</ARTG><ARTG>145514</ARTG></ARTGs><MinimumBenefit>1760</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER172</BillingCode><Name>LifeSpan ePTFE vascular grafts-tapered or end modified-regular or thin wall, 40-70 cm</Name><Description>LifeSpan ePTFE vascular grafts-unsupported, tapered or end modified, 4-7 mm dia x 40-70 cm long  </Description><Size>4-7 mm dia x 40-70 cm long; </Size><SupplierCode>40067</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109323</GroupID><ARTGs><ARTG>216528</ARTG></ARTGs><MinimumBenefit>770</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT273</BillingCode><Name>Standard Wall Grafts</Name><Description>Standard Wall Grafts Stretch Tapered (ePTFE)</Description><Size>Diameter 4-6mm &amp; 4-7mm, Length 45 48cm</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109323</GroupID><ARTGs><ARTG>137804</ARTG></ARTGs><MinimumBenefit>770</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GX024</BillingCode><PriorBillingCodes><PriorBillingCode>MQ012</PriorBillingCode></PriorBillingCodes><Name>Advantra PTFE Vascular Graft</Name><Description>Tapered Trilaminate PTFE Graft with Graft Deployment System</Description><Size>4mm - 8mm diameter, 10 - 40cm lengths</Size><SupplierCode>39943</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109323</GroupID><ARTGs><ARTG>279716</ARTG></ARTGs><MinimumBenefit>770</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA256</BillingCode><Name>Bard Vascular Graft</Name><Description>PTFE graft</Description><Size>6-10mm diameter, 40 - 80cm length
4mm - 8mm diameter, 10cm - 50cm length
7 &amp; 8mm diameter. 50, 60, 70, 80cm lengths</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109323</GroupID><ARTGs><ARTG>134452</ARTG></ARTGs><MinimumBenefit>770</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GX023</BillingCode><PriorBillingCodes><PriorBillingCode>MQ013</PriorBillingCode></PriorBillingCodes><Name>Advantra PTFE Vascular Graft with Graft Deployment System</Name><Description>Trilaminate PTFE. Vascular Access Graft</Description><Size>4mm - 8mm diameter. 50 - 80cm length</Size><SupplierCode>39943</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109323</GroupID><Suffix>ID (immediate dialysis)</Suffix><ARTGs><ARTG>279716</ARTG></ARTGs><MinimumBenefit>1878</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER173</BillingCode><Name>LifeSpan ePTFE vascular grafts-supported, tapered or end modified 50-80 cm</Name><Description>LifeSpan ePTFE vascular grafts-supported, end modified or tapered, regular or thin wall, 4-7 mm dia x 50-80 cm length; spiral length 5-70 cm</Description><Size>4-7 mm dia x 50-80 cm length; spiral length 5-70 cm</Size><SupplierCode>40067</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109323</GroupID><Suffix>R (ringed)</Suffix><ARTGs><ARTG>216528</ARTG></ARTGs><MinimumBenefit>770</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT214</BillingCode><Name>Gore-Tex Intering Vascular Graft</Name><Description>Internally radially supported vascular graft (ePTFE)</Description><Size>4-6 tapered diameter 38cm radial support length 45cm length; 4-7 tapered diameter 38cm radial support length 45cm length; 6mm diameter 40cm radial support length 40cm length</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109323</GroupID><Suffix>R (ringed)</Suffix><ARTGs><ARTG>143262</ARTG></ARTGs><MinimumBenefit>770</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB026</BillingCode><Name>Vascular Uni - Graft - Tapered</Name><Description>Vascular graft</Description><Size>12x6 to 24x12</Size><SupplierCode>40020</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109323</GroupID><ARTGs><ARTG>142665</ARTG></ARTGs><MinimumBenefit>770</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS424</BillingCode><Name>Ranger/Ranger SL Paclitaxel Coated Balloon Catheter</Name><Description>Peripheral angioplasty balloon catheter, drug-eluting  </Description><Size>Balloon Length: 30-200 mm; Diameter: 2.00 - 8.00 mm; </Size><SupplierCode>39966</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107795</SubCategoryID><GroupID>109326</GroupID><ARTGs><ARTG>300173</ARTG><ARTG>300172</ARTG></ARTGs><MinimumBenefit>1245</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT255</BillingCode><Name>Passeo-18 Lux</Name><Description>Paclitaxel releasing PTA Balloon Catheter</Description><Size>Length   40, 80, 120mm     Diameter   4F:2, 2.5, 3, 3.5, 4mm   5F:5, 6, 7mm</Size><SupplierCode>39967</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107795</SubCategoryID><GroupID>109326</GroupID><ARTGs><ARTG>275026</ARTG></ARTGs><MinimumBenefit>1245</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI507</BillingCode><Name>IN.PACT Admiral Paclitaxel-Coated PTA Balloon Catheter</Name><Description>The FreePac™ drug coating on the balloon of the IN.PACT Admiral DCB consists of the drug paclitaxel and the excipient urea. </Description><Size>The IN.PACT Admiral DCB variations are: Balloon Diameter: 4 -12mm; Balloon Length: 40 to 250 mm; Catheter Usable Length: 40 to 130 cm.  </Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107795</SubCategoryID><GroupID>109326</GroupID><ARTGs><ARTG>228876</ARTG></ARTGs><MinimumBenefit>1245</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ268</BillingCode><Name>Lutonix Drug Coated Balloon PTA Catheter</Name><Description>The Lutonix Drug Coated Balloon PTA Catheter consists of an over the wire catheter with a drug coated balloon fixed at the distal tip. The balloon is coated with a specialized formulation that includes the drug, paclitaxel. There are three different Models available depending on guidewire compatibility.</Description><Size>Balloon Length (mm)*: 20-300 Catheter Length (cm)*: 75-150 Balloon Diameter (mm)*: 2-12   (*Range across all three models)</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107795</SubCategoryID><GroupID>109326</GroupID><ARTGs><ARTG>364691</ARTG><ARTG>231258</ARTG><ARTG>231530</ARTG></ARTGs><MinimumBenefit>1245</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VA001</BillingCode><Name>Venous Valve Ring</Name><Description>Dacron/silicone variable diameter ring</Description><Size>52mmx15mmx0.09 mm</Size><SupplierCode>40046</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107796</SubCategoryID><GroupID>109327</GroupID><ARTGs><ARTG>64017</ARTG></ARTGs><MinimumBenefit>921</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JW013</BillingCode><PriorBillingCodes><PriorBillingCode>DO017</PriorBillingCode></PriorBillingCodes><Name>OPTEASE retrievable vena cava filter</Name><Description>OPTEASE is a laser cut nitinol vena cava filter, used to treat patients at high risk of pulmonary embolisation</Description><Size>Suitable for vessels up to 30mm</Size><SupplierCode>40402</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107797</SubCategoryID><GroupID>109328</GroupID><ARTGs><ARTG>186230</ARTG></ARTGs><MinimumBenefit>2059</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC329</BillingCode><Name>Cook Celect Platinum Vena Cava Filter</Name><Description>The Cook Celect Platinum Vena Cava Filter is made of a biocompatible cobalt chromium alloy.  Platinum markers are located on the end of the primary legs for increased radiopacity.</Description><Size>Length: 49mm
Diameter: 30mm</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107797</SubCategoryID><GroupID>109328</GroupID><ARTGs><ARTG>219274</ARTG><ARTG>219275</ARTG><ARTG>219276</ARTG></ARTGs><MinimumBenefit>2059</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CB019</BillingCode><Name>Option ELITE Vena Cava Filter</Name><Description>The Option ELITE Vena Cava Filter is designed for the prevention of recurrent pulmonary embolism via percutaneous delivery in the inferior vena cava.</Description><Size>Suitable for vessels up to 32mm</Size><SupplierCode>39993</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107797</SubCategoryID><GroupID>109328</GroupID><ARTGs><ARTG>283794</ARTG><ARTG>284696</ARTG></ARTGs><MinimumBenefit>2059</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IZ001</BillingCode><Name>ALN Vena Cava Filter</Name><Description>The ALN Vena Cava Filter is implanted into the SVC via the femoral, brachial and jugular vein to prevent pulmonary emboli (PEs).</Description><Size>One size, diameter up to 32mm</Size><SupplierCode>40223</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107797</SubCategoryID><GroupID>109328</GroupID><ARTGs><ARTG>184700</ARTG><ARTG>185255</ARTG><ARTG>184695</ARTG><ARTG>184696</ARTG><ARTG>184697</ARTG><ARTG>184698</ARTG><ARTG>184699</ARTG></ARTGs><MinimumBenefit>2059</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA010</BillingCode><Name>Bard Inferior Vena Cava Filter</Name><Description>Nitinol self expanding vena cava filter</Description><Size>For IVC with a diameter less than or equal to 28mm diameter</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107797</SubCategoryID><GroupID>109328</GroupID><ARTGs><ARTG>198865</ARTG><ARTG>150739</ARTG><ARTG>150742</ARTG><ARTG>198866</ARTG></ARTGs><MinimumBenefit>2059</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS192</BillingCode><Name>Spider FX Embolic Protection Device</Name><Description>The Spider FX is a rapid exchange device percutaneously delivered distal embolic protection device with components designed to capture and remove debris from vessels during interventional procedures in the vasculature.</Description><Size>Filter:  3.0 - 7.0mm; Capture Wire:  190 and 320cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107797</SubCategoryID><GroupID>109329</GroupID><ARTGs><ARTG>151258</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ449</BillingCode><Name>Emboshield</Name><Description>Embolic Protection Device, including delivery system, device specific procedural wire, filter for capturing embolic matter and retrieval system</Description><Size>Large and small. Two wire lengths: 190cm for Monorail system and 315cm for Over the wire</Size><SupplierCode>40062</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107797</SubCategoryID><GroupID>109329</GroupID><ARTGs><ARTG>168012</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VD006</BillingCode><Name>ROBIN Neuroprotection System</Name><Description>The ROBIN Neuroprotection System is an emboli capture guidewire intended to collect embolic material during carotid artery angioplasty procedures including stent placement. The device consists of a nitinol "filtering basket" structure, attached to a guidewire.</Description><Size>Filtering Basket Diameter: 4-8mm  Guidewire Length: 170cm, 300cm</Size><SupplierCode>40269</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107797</SubCategoryID><GroupID>109329</GroupID><ARTGs><ARTG>321802</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JW004</BillingCode><PriorBillingCodes><PriorBillingCode>DO008</PriorBillingCode></PriorBillingCodes><Name>Angioguard RX Emboli Capture Guidewire System</Name><Description>Distal protection device and delivery system</Description><Size>Length 180cm, Diameter 0.014"; basket sizes 4mm, 5mm, 6mm, 7mm and 8mm</Size><SupplierCode>40402</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107797</SubCategoryID><GroupID>109329</GroupID><ARTGs><ARTG>116900</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS085</BillingCode><Name>Filterwire EZ</Name><Description>Embolic Protection Device</Description><Size>Vessel compatibility 3.5mm - 5.5mm and delivery system lengths up to 300cm.</Size><SupplierCode>39966</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107797</SubCategoryID><GroupID>109329</GroupID><ARTGs><ARTG>167933</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS364</BillingCode><Name>Sentinel Cerebral Protection System</Name><Description>The device Sentinel Cerebral Protection System (Sentinel) is percutaneously delivered to capture and remove debris dislodged during endovascular procedures. The system utilises an embolic filter delivered to the brachiocephalic artery (Proximal Filter), and a second embolic filter delivered to the left common carotid artery (Distal Filter). The Sentinel Cerebral Protection System consists of 6 French catheter, with deployable proximal and distal filters, articulating sheath and integral handle assembly.</Description><Size>Proximal filter 15mm, Distal filter 7-10mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107797</SubCategoryID><GroupID>109329</GroupID><Suffix>Multi filter</Suffix><ARTGs><ARTG>319101</ARTG></ARTGs><MinimumBenefit>3288</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DL003</BillingCode><PriorBillingCodes><PriorBillingCode>MB026</PriorBillingCode></PriorBillingCodes><Name>WIRION Embolic Protection System</Name><Description>Temporary arterial embolic protection system</Description><Size>Blood vessel diameter: 3.5 - 6.0mm
Filter unit length: 22.5mm
Pore size: 120μ
Crossing profile: 3.2F
Guide catheter/Sheath: 6F
Delivery catheter length: 145cm
Retrieval catheter length: 146cm</Size><SupplierCode>39987</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107797</SubCategoryID><GroupID>109329</GroupID><ARTGs><ARTG>280883</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JW008</BillingCode><PriorBillingCodes><PriorBillingCode>DO012</PriorBillingCode></PriorBillingCodes><Name>EXOSEAL (TM) Vascular Closure Device</Name><Description>Vascular Closure Device</Description><Size>5 - 7F</Size><SupplierCode>40402</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107798</SubCategoryID><GroupID>109330</GroupID><ARTGs><ARTG>176723</ARTG></ARTGs><MinimumBenefit>290</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JW015</BillingCode><PriorBillingCodes><PriorBillingCode>DO025</PriorBillingCode></PriorBillingCodes><Name>MYNX Control Vascular Closure Device</Name><Description>The MYNX CONTROL Vascular Closure Device is designed to achieve femoral artery hemostasis via delivery of an extravascular, water-soluble synthetic  hydrogel sealant, using a balloon catheter in conjunction with a standard procedural sheath. The sealant is made of a polyethylene glycol (PEG) material which expands upon contact with subcutaneous fluids to seal the  arteriotomy. The sealant is resorbed by the body within 30 days. A 10 ml locking syringe is used for balloon inflation and deflation.</Description><Size>5F, 6/7F</Size><SupplierCode>40402</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107798</SubCategoryID><GroupID>109330</GroupID><ARTGs><ARTG>333853</ARTG></ARTGs><MinimumBenefit>290</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU067</BillingCode><Name>Angio-Seal VAscular Closure Device - VIP</Name><Description>Angio-Seal Haemostatic Puncture Closure Device, Model VIP Platform</Description><Size>6F and 8F</Size><SupplierCode>40450</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107798</SubCategoryID><GroupID>109330</GroupID><ARTGs><ARTG>306829</ARTG><ARTG>128525</ARTG></ARTGs><MinimumBenefit>290</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ459</BillingCode><Name>Perclose ProStyle Suture Mediated Closure and Repair System </Name><Description>Suture-Mediated Closure and Repair System</Description><Size>One size</Size><SupplierCode>40062</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107798</SubCategoryID><GroupID>109330</GroupID><ARTGs><ARTG>300736</ARTG></ARTGs><MinimumBenefit>290</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ452</BillingCode><PriorBillingCodes><PriorBillingCode>AY033</PriorBillingCode></PriorBillingCodes><Name>Proglide</Name><Description>Suture Mediated Closure Device</Description><Size>5 - 8 French</Size><SupplierCode>40062</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107798</SubCategoryID><GroupID>109330</GroupID><ARTGs><ARTG>300736</ARTG></ARTGs><MinimumBenefit>290</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ463</BillingCode><PriorBillingCodes><PriorBillingCode>AY017</PriorBillingCode></PriorBillingCodes><Name>Starclose</Name><Description>6 Fr Exchange Sheath, Dilator, Guidewire, implantable nitinol clip pre-mounted on a Clip Applier</Description><Size>6 Fr</Size><SupplierCode>40062</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107798</SubCategoryID><GroupID>109330</GroupID><ARTGs><ARTG>240055</ARTG></ARTGs><MinimumBenefit>290</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JW005</BillingCode><PriorBillingCodes><PriorBillingCode>DO009</PriorBillingCode></PriorBillingCodes><Name>Mynx Vascular Closure Device</Name><Description>Water-soluble synthetic sealant made of a polyethylene glycol (PEG) The sealant is resorbed by the body within 30 days</Description><Size>5F, 6/7F</Size><SupplierCode>40402</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107798</SubCategoryID><GroupID>109330</GroupID><ARTGs><ARTG>201265</ARTG></ARTGs><MinimumBenefit>290</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU061</BillingCode><Name>FemoSeal Vascular Closure System</Name><Description>Haemostatic Puncture Closure Device</Description><Size>One Size</Size><SupplierCode>40450</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107798</SubCategoryID><GroupID>109330</GroupID><ARTGs><ARTG>263892</ARTG><ARTG>304029</ARTG></ARTGs><MinimumBenefit>290</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ451</BillingCode><PriorBillingCodes><PriorBillingCode>AY034</PriorBillingCode></PriorBillingCodes><Name>Prostar</Name><Description>Suture Mediated Closure Device - Closure of Large holes</Description><Size>Up to 24 French</Size><SupplierCode>40062</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107798</SubCategoryID><GroupID>109330</GroupID><Suffix>L (Large)</Suffix><ARTGs><ARTG>300736</ARTG></ARTGs><MinimumBenefit>608</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC044</BillingCode><Name>PVA Embolisation particles</Name><Description>Embolisation &amp; Occlusion</Description><Size>Particle Size Ranges (microns) 50-100, 100-200, 200-300,300-500, 500-700, 700-1000, 1000-1500, 1500-2000, 2000-2800</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109331</GroupID><ARTGs><ARTG>216797</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS374</BillingCode><PriorBillingCodes><PriorBillingCode>DE294</PriorBillingCode></PriorBillingCodes><Name>Bead Block</Name><Description>Polyvinyl Alcohol hydrogel microspheres in pre-loaded syringe</Description><Size>2ml- (100 - 300, 300 - 500, 500 - 700, 700 - 900, 900 - 1200 microns</Size><SupplierCode>39966</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109331</GroupID><ARTGs><ARTG>271535</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS034</BillingCode><Name>Contour PVA</Name><Description>Polyvinyl Alcohol (PVA) embolization particles spherical-shaped PVA</Description><Size>Up to 1200 micron, volume up to 2ml.</Size><SupplierCode>39966</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109331</GroupID><ARTGs><ARTG>392004</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OW012</BillingCode><Name>Bearing nsPVA</Name><Description>Bearing nsPVA are non-bioabsorbable embolization particles used for the embolization of peripheral hypervascularized tumors, including leiomyoma and
peripheral arteriovenous malformations (AVMs).</Description><Size>45-150 microns
150-250 microns
250-355 microns
355-500 microns
500-710 microns
710-1000 microns
1000-1180 microns</Size><SupplierCode>40178</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109331</GroupID><ARTGs><ARTG>285716</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IZ002</BillingCode><Name>EOS Endoluminal Occlusion System</Name><Description>EOS is made of self-expandable Nitinol flat wire, serving as a supportive scaffold with significant radial strength, covered by impermeable ePTFE membrane for achievement of immediate occlusion of a peripheral vessel. This implant is pre-loaded on a delivery catheter with 2 deployment handles. This System will be inserted through a standard guide catheter (not included) up to the targeted segment.</Description><Size>3 to 5 mm of vessel diameter (6.1 mm diameter unconstrained)
4.5 to 8 mm of vessel diameter (9.1 mm diameter unconstrained)
7.5 to 11 mm of vessel diameter (12.2 mm diameter unconstrained)</Size><SupplierCode>40223</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109334</GroupID><ARTGs><ARTG>229075</ARTG></ARTGs><MinimumBenefit>1268</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PN020</BillingCode><PriorBillingCodes><PriorBillingCode>PN016</PriorBillingCode></PriorBillingCodes><Name>POD Packing Coil</Name><Description>POD Packing coil is a soft shapeless coil up to 60cm in length designed to pack very densely behind POD to occlude arteries and veins throughout the peripheral vasculature.</Description><Size>15cm, 30cm, 45cm, 60cm lengths</Size><SupplierCode>40107</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109334</GroupID><ARTGs><ARTG>235149</ARTG></ARTGs><MinimumBenefit>1268</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PN024</BillingCode><Name>Penumbra POD Occlusion Device</Name><Description>The Peripheral Occlusion Device (POD) is compromised of a specifically designed platinum enbolisation coil with varied diameter and is attache to a composite pusher with a radiopaque positioning marker. The distal Anchor segment has a larger diameter to secure the coil in a straight or fast flowing vessel. The proximal segment has a softer and smaller diameter to ensure occlusion and stasis of the vessel. The device is transferred into the microcatheter and advanced under fluoroscopic guidance. The device may be fully deployed prior to detachment. the detachment handle is attached and advanced over the proximal ned of the delivery pusher and the the device is detached by using the retraction button on the handle for accurate placement</Description><Size>20cm Length - 3mm diameter  30cm Length - 3.25 - 4mm diameter  30cm Length - 4-5mm diameter  50cm Length - 5-6mm diameter  60cm Length - 6-8mm diameter  60cm Length - 8-10mm diameter  60cm Length - 10-12mm diameter  60cm Length - 12-14mm diameter</Size><SupplierCode>40107</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109334</GroupID><ARTGs><ARTG>235149</ARTG></ARTGs><MinimumBenefit>1268</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DL006</BillingCode><Name>IMPEDE Embolization Plug</Name><Description>The IMPEDE Embolization Plug is a pushable embolization device comprised of a self-expanding porous Shape Memory Polymer (SMP) Plug and a proximal platinum/iridium markerband or distal pre-shaped helical Anchor Coil comprised of nitinol and platinum, and a proximal platinum marker band..  The device is supplied pre-loaded in an Introducer with the SMP Plug in a crimped state. It is designed to be delivered to the target vessel using a guidewire through a standard catheter/sheath. Upon deployment in the target vessel and exposure to an aqueous environment and body temperature, the SMP Plug will self-expand to embolize the target vessel.  The IMPEDE Embolization Plug System is packaged as a single unit and is provided sterile, non-pyrogenic, and is intended for single use only.  </Description><Size>5mm, 6 mm, 7mm, 8 mm, 10mm, 12 mm</Size><SupplierCode>39987</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109334</GroupID><Suffix>Microcatheter</Suffix><ARTGs><ARTG>386855</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PN025</BillingCode><Name>Penumbra POD Packing Coil</Name><Description>Platinum coil designed in a WAVE shape to behave like a liquid to compliment the Plug effect of the POD and pack densely, reducing reliance on thrombus formation. This packing coil does not have the traditional 3D shape formation of other coils so only has a measurement of length</Description><Size>5cm length  15cm length  30cm length  45cm length  60cm length</Size><SupplierCode>40107</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109334</GroupID><ARTGs><ARTG>235149</ARTG></ARTGs><MinimumBenefit>1268</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ266</BillingCode><Name>AMPLATZER Vascular Plug - II</Name><Description>The AMPLATZER Vascular Plug II is a self-expandable, multi-lobed cylindraical device made from a nitinol wire mesh.</Description><Size>3mm-22mm Diameter, 6mm-18mm Plug Length</Size><SupplierCode>40062</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109334</GroupID><Suffix>ids (integral delivery system)</Suffix><ARTGs><ARTG>156560</ARTG><ARTG>345217</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI185</BillingCode><Name>MVP Microvascular Plug System</Name><Description>MVP Microvascular Plug can be delivered through a microcatheter to enable rapid occlusion.</Description><Size>Unconstrained device diameter (mm): 5.3, 6.5, 9.2, &amp; 13.0</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109334</GroupID><Suffix>Microcatheter</Suffix><ARTGs><ARTG>332241</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ268</BillingCode><Name>Amplatzer Vascular Plug III</Name><Description>AVP III is a self-expanding, Nitinol mesh occlusion device.</Description><Size>Size: (mm): 4, 6, 8, 10, 10, 12, 12, 14, 14  Long Axis (mm): 4, 6, 8, 10, 10, 12, 12, 14, 14 Length (mm): 6.5</Size><SupplierCode>40062</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109334</GroupID><ARTGs><ARTG>169352</ARTG></ARTGs><MinimumBenefit>1268</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ265</BillingCode><Name>Amplatzer Vascular Plug</Name><Description>Self expandable nitinol wire mesh</Description><Size>Diameter 4mm - 16mm, Length 7 &amp; 8mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109334</GroupID><ARTGs><ARTG>114855</ARTG><ARTG>345216</ARTG></ARTGs><MinimumBenefit>1268</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ269</BillingCode><Name>AMPLATZER Vascular Plug 4</Name><Description>The AMPLATZER Vascular Plug 4 (AVP4) is a self-expanding, Nitinol mesh occlusion device. The Device has a radiopaque marker band at each end and a micro screw attachment at one end for attaching to the delivery wire. The AVP4 fits through a 0.038 guidewire compatible diagnostic catheter allowing the use of the same catheter throughout the procedure rather than having to exchange the diagnostic catheter for a second delivery catheter to place a plug.</Description><Size>4mm 4 diameter 10.0 length  5mm 5 diameter 10.5 length  6mm 6 diameter 11.0 length  7mm 7 diameter 12.5 length  8mm 8 diameter 13.5 length</Size><SupplierCode>40062</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109334</GroupID><ARTGs><ARTG>345218</ARTG><ARTG>168673</ARTG></ARTGs><MinimumBenefit>1268</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI208</BillingCode><Name>Onyx 6ml Kit</Name><Description>DMSO Liquid Embolic Material</Description><Size>6ml Kit</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109335</GroupID><ARTGs><ARTG>151837</ARTG></ARTGs><MinimumBenefit>7265</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS190</BillingCode><Name>Onyx</Name><Description>DSMO/Liquid Embolic Material</Description><Size>18, 20, 34 (formulations)</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109335</GroupID><ARTGs><ARTG>151837</ARTG></ARTGs><MinimumBenefit>2076</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ME229</BillingCode><Name>SQUID LIQUID EMBOLIC AGENT</Name><Description>SQUID is a non-adhesive, liquid embolic agent consisting of an ethylene vinyl alcohol (EVOH ) copolymer dissolved in DMSO (dimethyl sulfoxide), and suspended micronized tantalum powder to provide contrast for visualisation under fluoroscopy.  The SQUID Liquid Embolic System consists of a vial of SQUID, a vial of DMSO, two SQUID delivery syringes, one DMSO delivery syringe, two syringe adapters and 8 stickers to identify the vials of SQUID.  A SQUID-compatible delivery micro-catheter, the use of which is indicated for the neurovascular system (Sonic, Balt catheters) is used to access the embolization site.  The adapter is an interface between the SQUID delivery syringe and the delivery catheter.</Description><Size>12, 12LD, 18, 18LD formulations</Size><SupplierCode>40363</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109335</GroupID><ARTGs><ARTG>262852</ARTG><ARTG>262853</ARTG></ARTGs><MinimumBenefit>2076</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS191</BillingCode><Name>Onyx System</Name><Description>DSMO Liquid Embolic Material</Description><Size>500 Formulation</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109335</GroupID><Suffix>ids (integral delivery system)</Suffix><ARTGs><ARTG>151837</ARTG></ARTGs><MinimumBenefit>4468</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA282</BillingCode><Name>PowerHohn 5 Fr Single Lumen, Basic Kit</Name><Description>PowerHohn 5 Fr Single Lumen, Basic Kit</Description><Size>5 Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109337</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>309587</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA184</BillingCode><Name>Peripherally Inserted Central Catheter</Name><Description>Power Injectable PICC, Single Lumen</Description><Size>3Fr - 6Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109337</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>286035</ARTG><ARTG>286034</ARTG><ARTG>286036</ARTG><ARTG>155226</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA212</BillingCode><Name>Peripherally Inserted Central Catheter</Name><Description>Valved, Power Injectable PICC, Single Lumen</Description><Size>4Fr - 6Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109337</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>191603</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA129</BillingCode><Name>Groshong Peripherally Inserted Central Catheter</Name><Description>Closed-Ended PICC, Single Lumen</Description><Size>3Fr - 5Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109337</GroupID><Suffix>cu (cuffed)</Suffix><ARTGs><ARTG>42589</ARTG></ARTGs><MinimumBenefit>146</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA220</BillingCode><Name>Groshong Peripherally Inserted Central Catheter</Name><Description>Closed-Ended, Power Injectable PICC, Single Lumen</Description><Size>5Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109337</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>198806</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX061</BillingCode><Name>Arrow Pressure Injectable Midline</Name><Description>The Arrow Pressure Injectable Midline Catheter is a peripherally inserted intravenous catheter manufactured with medical grade, flexible polyurethane. The Arrow Midline is designed with a non-tapered catheter body and softens in-situ to be less traumatic to the vessel.   The Arrow Pressure Injectable Midline Catheter is indicated for peripheral access to the venous system for intravenous therapy, blood sampling, infusion, and pressure injection of contrast media. The maximum pressure of pressure injector equipment used with the Arrow Pressure Injectable Midline Catheter may not exceed 300 psi. The maximum pressure injection flow rate for the specific lumen being used for pressure injection is printed on the extension line hub.  </Description><Size>Single Lumen Pressure Injectable Midline, 4Fr, 20cm</Size><SupplierCode>40451</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109337</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>371714</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX036</BillingCode><Name>Arrow single lumen pressure injectable peripherally inserted central catheter (PICC) sets</Name><Description>Single lumen pressure injectable peripherally inserted central catheter (PICC) sets</Description><Size>3, 4, Fr single lumen Pressure Injectable PICCs various Pressure Injection rates, various lengths.</Size><SupplierCode>40451</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109337</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>278735</ARTG><ARTG>148784</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA268</BillingCode><Name>PowerGlide Pro</Name><Description>Single lumen, power injectable percutaneous catheter</Description><Size>18 - 22 Gauge</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109337</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>228968</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MS069</BillingCode><Name>BioFlo Midline</Name><Description>Percutaneous Catheter, Single Lumen, Power Injectable</Description><Size>Length: 20 cm  French Size: 3Fr - 5Fr</Size><SupplierCode>39931</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109337</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>312726</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA125</BillingCode><Name>Groshong Central Venous Catheter</Name><Description>Closed-Ended CVC, Single Lumen</Description><Size>5.5Fr - 9.5Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109337</GroupID><Suffix>cu (cuffed)</Suffix><ARTGs><ARTG>42589</ARTG></ARTGs><MinimumBenefit>146</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA049</BillingCode><Name>Hickman/Broviac Catheters</Name><Description>Open-Ended CVC, Single Lumen</Description><Size>2.7Fr - 9.6Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109337</GroupID><Suffix>cu (cuffed)</Suffix><ARTGs><ARTG>145469</ARTG><ARTG>145466</ARTG></ARTGs><MinimumBenefit>146</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA296</BillingCode><Name>PowerHickman, 8 Fr Single Lumen, Intermediate Kit with SureCuff  Airguard(5 cm)</Name><Description>PowerHickman, 8 Fr Single Lumen, Intermediate Kit with SureCuff Airguard(5 cm)</Description><Size>8Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109337</GroupID><Suffix>cu, pi</Suffix><ARTGs><ARTG>309586</ARTG></ARTGs><MinimumBenefit>146</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA291</BillingCode><Name>PowerHickman Single Lumen Microinducer with SureCuff (2cm &amp; 5 cm) with AirGuard</Name><Description>PowerHickman, 8 Fr Single Lumen, MicroIntroducer Kit with SureCuff (2 cm &amp; 5 cm)</Description><Size>8 Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109337</GroupID><Suffix>cu, pi</Suffix><ARTGs><ARTG>309584</ARTG><ARTG>309585</ARTG></ARTGs><MinimumBenefit>146</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MS074</BillingCode><PriorBillingCodes><PriorBillingCode>ER134</PriorBillingCode></PriorBillingCodes><Name>Single Lumen Peripherally Inserted Central Catheter</Name><Description>Power injectable with Pressure Activated Safely Valve (PASV) technology</Description><Size>3F x55cm, 4F x 55cm, 5F x 55cm</Size><SupplierCode>39931</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109337</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>203831</ARTG><ARTG>179150</ARTG><ARTG>175080</ARTG><ARTG>178780</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA273</BillingCode><Name>PowerMidline</Name><Description>Single lumen, power injectable percutaneous catheter</Description><Size>3Fr-4Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109337</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>228968</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA292</BillingCode><Name>PowerLine Single Lumen MicroIntroducer Kit</Name><Description>PowerLine 5 Fr Single Lumen, Polyurethane Catheter with Surecuff, MicroIntroducer Kit</Description><Size>5 Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109337</GroupID><Suffix>cu, pi</Suffix><ARTGs><ARTG>309588</ARTG></ARTGs><MinimumBenefit>146</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX027</BillingCode><Name>Arrow Peripherally Inserted Central Catheterisation Sets  </Name><Description>Range of Polyurethane single lumen peripherally inserted central catheters with or without stylet</Description><Size>4 Fr, range of lengths</Size><SupplierCode>40451</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109337</GroupID><ARTGs><ARTG>148782</ARTG><ARTG>148784</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX026</BillingCode><Name>Arrow Peripherally Inserted Central Catheterisation Sets</Name><Description>Range of Polyurethane single lumen peripherally inserted central catheters with or without stylet</Description><Size>3 Fr, range of lengths</Size><SupplierCode>40451</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109337</GroupID><ARTGs><ARTG>148782</ARTG><ARTG>148784</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MS078</BillingCode><Name>Peripherally Inserted Central Catheter, Single Lumen</Name><Description>Peripherally Inserted Central Catheter, Single Lumen, Anti-Thrombogenic Catheter  Material, Power Injectable</Description><Size>3Fr - 5Fr</Size><SupplierCode>39931</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109337</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>203831</ARTG><ARTG>215411</ARTG><ARTG>215419</ARTG><ARTG>215418</ARTG><ARTG>203832</ARTG><ARTG>215412</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX030</BillingCode><Name>ARROWg+ard Blue Single Lumen Central Venous Catheters</Name><Description>A polyurethane central venous catheter with Blue FlexTip (of various lengths, sizes and lumen configurations) with antimicrobial impregnation (chlorhexidine and silver sulphadiazine) on the external surface of the polyurethane catheter body.</Description><Size>CS-24301 - 16g x 20cm, Single Lumen, Adult
CS-24306E-16g x 16cm, Single Lumen Adult
CS-24701 - 14g x 20cm, Single Lumen Adult
CS-24706E -14g x 16cm, Single Lumen, Adult</Size><SupplierCode>40451</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109337</GroupID><Suffix>A (Anti-infective Agent Coating)</Suffix><ARTGs><ARTG>156637</ARTG></ARTGs><MinimumBenefit>71</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA308</BillingCode><Name>PowerGlide Pro™ Midline Cannula with Cue™ Needle Tracking</Name><Description>Single lumen, power injectable percutaneous catheter </Description><Size>Basic kits: 22G x 8 cm, 20G x 8 cm, 22G x 10 cm, 18G x 8 cm, 18G x 10 cm   </Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109337</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>317521</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA302</BillingCode><Name>Provena™ Midline Catheter</Name><Description>The Provena™ Midline Catheters are intended to be inserted into a patient's vascular system to sample blood, administer fluids and power injection of contrast media. The unique feature of Provena™ Midline Catheters is that they are configured with a smaller outer diameter with minimal reduction to the intraluminal area assisting in providing the optimal catheter to vein ratio, whilst still enabling good flow rates to ensure the therapy delivery is uncompromised.</Description><Size>3Fr single lumen</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109337</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>317521</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MS075</BillingCode><Name>Peripherally Inserted Central Catheter (PICC)</Name><Description>Peripherally Inserted Central Catheter, Single Lumen, Power Injectable </Description><Size>4Fr - 5Fr</Size><SupplierCode>39931</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109337</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>203832</ARTG><ARTG>215418</ARTG><ARTG>215419</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA289</BillingCode><Name>PowerHickman, 9.5 Fr Dual Lumen, Intermediate Kit with SureCuff (5 cm) &amp; Airguard</Name><Description>PowerHickman, 9.5 Fr Dual Lumen, Intermediate Kit with SureCuff (5 cm) &amp; Airguard</Description><Size>9.5 Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>cu, pi</Suffix><ARTGs><ARTG>309586</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA295</BillingCode><Name>PowerHickman, 9.5 Fr Multi Lumen, MicroIntroducer Kit with SureCuff (2 &amp;5 cm)</Name><Description>PowerHickman, 9.5 Fr Dual Lumen, MicroIntroducer Kit with SureCuff (2 &amp; 5 cm)</Description><Size>9.5 Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>cu, pi</Suffix><ARTGs><ARTG>309584</ARTG><ARTG>309585</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA294</BillingCode><Name>PowerLine Multi Lumen without Airguard Intermediate Kit</Name><Description>PowerLine 6 Fr Multi Lumen, Polyurethane Catheter with Surecuff, Intermediate Kit</Description><Size>6 Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>cu, pi</Suffix><ARTGs><ARTG>309589</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA293</BillingCode><Name>PowerLine Multi Lumen MicroIntroducer Kit</Name><Description>PowerLine 5-6 Fr Multi Lumen, Polyurethane Catheter with Surecuff, MicroIntroducer Kit</Description><Size>5-6Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>cu, pi</Suffix><ARTGs><ARTG>309588</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA126</BillingCode><Name>Groshong Central Venous Catheter</Name><Description>Closed-Ended CVC, Multiple Lumen</Description><Size>5.5Fr - 9.5 Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>cu (cuffed)</Suffix><ARTGs><ARTG>42589</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA209</BillingCode><Name>HemoStar Long Term Haemodialysis Catheter</Name><Description>Dialysis Catheter, Multiple Lumen</Description><Size>14.5Fr - 16Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>cu (cuffed)</Suffix><ARTGs><ARTG>170529</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA051</BillingCode><Name>Hickman/Leonard Catheters</Name><Description>Open-Ended CVC, Multiple Lumen</Description><Size>7Fr - 12.5Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>cu (cuffed)</Suffix><ARTGs><ARTG>145468</ARTG><ARTG>145469</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA298</BillingCode><Name>PowerPICC SOLO²™ HF 5 French Triple Lumen Basic</Name><Description>A peripherally inserted central catheter made from specially formulated and processed medical grade materials. Each PowerPICC SOLO²™ catheter has a kink resistant, reverse tapered design. PowerPICC SOLO²™ is packaged in a tray with accessories for reliable long (greater than 30 days) or short (less than 30 days) term vascular access.    The PowerPICC SOLO²™ catheter valve controls the flow of fluids to provide clamp-free infusion therapy. Positive pressure into the catheter (gravity, pump, syringe) will open the valve, allowing fluid infusion. When negative pressure (aspiration) is applied, the valve opens allowing for the withdrawal of blood into a syringe.</Description><Size>5 French Triple Lumen</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>325434</ARTG></ARTGs><MinimumBenefit>131</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX031</BillingCode><Name>ARROWg+ard Four &amp; Five Lumen Central Venous Catheters</Name><Description>A polyurethane central catheter with Blue FlexTip (of various lengths, sizes and lumen configurations) with antimicrobial impregnation (chlorhexidine and silver sulphadiazine) on the external surface of the polyurethane catheter material</Description><Size>CS-22854E - 8.5 Fr x 16cm, Quad Lumen
CS-25854E - 8.5Fr x 20cm, Quad Lumen
CS-22855 - 8.5 x 16cm, Five Lumen
CS-25855 - 8.5Fr x 20cm, Five Lumen</Size><SupplierCode>40451</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>A (Anti-infective Agent Coating)</Suffix><ARTGs><ARTG>156637</ARTG></ARTGs><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX034</BillingCode><Name>ARROWg+ard Blue Plus Double &amp; Triple Lumen Central Venous Catheters</Name><Description>Double &amp; Triple  Lumen Central Venous Catheters (of various lengths sizes and lumen configurations) with antimicrobial impregnation on: 1. The external indwelling surface of catheter material (chlorhexidine and silver sulphadiazine) 2. The entire internal fluid pathway including catheter, extension-lines and hubs (chlorhexidine acetate)</Description><Size>CS-45802E - 8 Fr x 20cm, Dual Lumen CS-46702E - 7Fr x 20cm, Dual Lumen CS-47702E - 7Fr x 20cm, Dual Lumen CS-42703E - 7Fr x 16cm, Triple Lumen CS-45703E - 7Fr x 20cm, Triple Lumen</Size><SupplierCode>40451</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>A (Anti-infective Agent Coating)</Suffix><ARTGs><ARTG>157350</ARTG></ARTGs><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA283</BillingCode><Name>PowerHohn 6 Fr Multi Lumen, Basic Kit</Name><Description>PowerHohn 6 Fr Dual Lumen, Basic Kit</Description><Size>6 Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>309587</ARTG></ARTGs><MinimumBenefit>131</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA290</BillingCode><Name>PowerLine Multi Lumen Airguard Intermediate Kit</Name><Description>PowerLine 6 Fr Multi Lumen, Polyurethane Catheter with Surecuff, AirGuard, Intermediate Kit</Description><Size>6 Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>cu, pi</Suffix><ARTGs><ARTG>309590</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX056</BillingCode><Name>Arrow Pressure Injectable Multi-Lumen Central Venous Catheterisation Kit</Name><Description>7F x 20CM Pressure Injectable Central Venous Catheter with Insertion Kit</Description><Size>7F x 20CM</Size><SupplierCode>40451</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>142543</ARTG></ARTGs><MinimumBenefit>131</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MS080</BillingCode><PriorBillingCodes><PriorBillingCode>MS072</PriorBillingCode><PriorBillingCode>MS073</PriorBillingCode></PriorBillingCodes><Name>Peripherally Inserted Central Catheter, Multiple Lumen</Name><Description>Power injectable with Pressure Accivated Safety Valve (PASV) technology</Description><Size>5Fr x 55cm (Dual Lumen), 6Fr x 55cm (Dual Lumen), 6Fr x 55cm (Triple Lumen)</Size><SupplierCode>39931</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>203831</ARTG><ARTG>175080</ARTG><ARTG>179150</ARTG><ARTG>203830</ARTG><ARTG>178780</ARTG></ARTGs><MinimumBenefit>131</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MS076</BillingCode><Name>Peripherally Inserted Central Catheter (PICC)</Name><Description>Peripherally Inserted Central Catheter, Multiple Lumen, Power Injectable</Description><Size>5Fr - 6Fr</Size><SupplierCode>39931</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>215418</ARTG><ARTG>215419</ARTG><ARTG>203832</ARTG></ARTGs><MinimumBenefit>131</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MS071</BillingCode><Name>BioFlo Midline</Name><Description>Percutaneous Catheter, Dual Lumen, Power Injectable</Description><Size>Length: 20 cm  French Size: 5Fr</Size><SupplierCode>39931</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>312726</ARTG></ARTGs><MinimumBenefit>131</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MS077</BillingCode><Name>Peripherally Inserted Central Catheter, Multiple Lumen</Name><Description>Peripherally Inserted Central Catheter, Single Lumen, Anti-Thrombogenic Catheter Material, Power Injectable</Description><Size>5Fr - 6Fr</Size><SupplierCode>39931</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>203832</ARTG><ARTG>215418</ARTG><ARTG>215419</ARTG><ARTG>203831</ARTG><ARTG>215411</ARTG><ARTG>215412</ARTG></ARTGs><MinimumBenefit>131</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA300</BillingCode><Name>PowerPICC SOLO²™ HF 5 French Triple Lumen Radiology</Name><Description>A peripherally inserted central catheter made from specially formulated and processed medical grade materials. Each PowerPICC SOLO²™ catheter has a kink resistant, reverse tapered design. PowerPICC SOLO²™ is packaged in a tray with accessories for reliable long (greater than 30 days) or short (less than 30 days) term vascular access.    The PowerPICC SOLO²™ catheter valve controls the flow of fluids to provide clamp-free infusion therapy. Positive pressure into the catheter (gravity, pump, syringe) will open the valve, allowing fluid infusion. When negative pressure (aspiration) is applied, the valve opens allowing for the withdrawal of blood into a syringe.  </Description><Size>5 French Triple Lumen with 70cm Nitinol Guidewire  5 French Triple Lumen with 135cm Nitinol Guidewire</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>325434</ARTG></ARTGs><MinimumBenefit>131</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA183</BillingCode><Name>Peripherally Inserted Central Catheter</Name><Description>Power Injectable PICC, Multiple Lumen</Description><Size>4Fr - 6Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>286039</ARTG><ARTG>286036</ARTG><ARTG>286037</ARTG><ARTG>286034</ARTG><ARTG>286038</ARTG><ARTG>155226</ARTG><ARTG>286035</ARTG></ARTGs><MinimumBenefit>131</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX062</BillingCode><Name>Arrow Pressure Injectable Midline</Name><Description>The Arrow Pressure Injectable Midline Catheter is a peripherally inserted intravenous catheter manufactured with medical grade, flexible polyurethane. The Arrow Midline is designed with a non-tapered catheter body and softens in-situ to be less traumatic to the vessel.   The Arrow Pressure Injectable Midline Catheter is indicated for peripheral access to the venous system for intravenous therapy, blood sampling, infusion, and pressure injection of contrast media. The maximum pressure of pressure injector equipment used with the Arrow Pressure Injectable Midline Catheter may not exceed 300 psi. The maximum pressure injection flow rate for the specific lumen being used for pressure injection is printed on the extension line hub.  </Description><Size>Double Lumen Pressure Injectable  Midline, 5Fr , 20cm </Size><SupplierCode>40451</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>371714</ARTG></ARTGs><MinimumBenefit>131</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX035</BillingCode><Name>Arrow multi lumen pressure injectable peripherally inserted central catheter (PICC) sets</Name><Description>Arrow multi lumen pressure injectable PICC (peripherally inserted central catheter) sets</Description><Size>4, 5, 6Fr multi lumen Pressure Injectable PICCs various Pressure Injection rates, various lengths. Double &amp; triple Lumen configurations.</Size><SupplierCode>40451</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>148784</ARTG><ARTG>180279</ARTG><ARTG>278735</ARTG></ARTGs><MinimumBenefit>131</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX043</BillingCode><Name>Pressure Injectable ARROWg+ard® Blue Plus Antimicrobial Multi-Lumen Central Venous Catheters</Name><Description>Pressure Injectable Multi Lumen Central Venous Catheters (of various lengths sizes and lumen configurations) with antimicrobial impregnation of the internal and external catheter with Chlorhexidine and Silver Sulphadiazine.</Description><Size>CS42703HP: 16cm x 7Fr Triple Lumen Catheter
CS45703HP: 20cm x 7Fr Triple Lumen Catheter
CS42854HP: 16cm x 8.5Fr Quad Lumen Catheter
CS45854HP: 20cm x 8.5Fr Quad Lumen Catheter</Size><SupplierCode>40451</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>A (Anti-infective Agent Coating), pi (power injection)</Suffix><ARTGs><ARTG>177098</ARTG></ARTGs><MinimumBenefit>131</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX032</BillingCode><Name>ARROWg+ard Blue Double &amp; Triple Lumen Central Venous Catheters</Name><Description>A polyurethane central venous catheter with Blue FlexTip (of various lengths, sizes and lumen configurations) with antimicrobial impregnation (chlorhexidine and silver sulphadiazine) on the external surface of the polyurethane catheter material</Description><Size>CS-24402 - 4Fr x 13cm, Dual Lumen CS-22502 -5Fr x 5cm, Dual Lumen CS-25402 - 4Fr x 8cm, Dual Lumen CS-25502 - 5Fr x 12cm, Dual Lumen
CS-22702E - 7Fr x 16cm, Double Lumen CS-26702 - 7Fr x 20cm, Double Lumen CS-27702E - 7Fr x 20cm, Double Lumen CS-25553 - 5.5Fr x 8cm, Triple Lumen CS-22703E - 7Fr x 16cm, Triple Lumen CS-26553 -5.5Fr x 13cm, Triple Lumen CS-24703E - 7Fr x 30cm, Triple Lumen
CS-25703E - 7Fr x 20cm, Triple Lumen</Size><SupplierCode>40451</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>A (Anti-infective Agent Coating)</Suffix><ARTGs><ARTG>156637</ARTG></ARTGs><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX033</BillingCode><Name>ARROWg+ard Blue Plus QUAD Lumen Central Venous Catheters</Name><Description>Central Venous Catheters (of various lengths, sizes and lumen configurations with antimicrobial impregnation on: 1. The external indwelling surface of catheter material (chorhexidine and silver sulphadiazine) 2. The entire internal fluid pathway including catheter, extension-lines and hubs (chlorhexidine acetate)</Description><Size>CS-42854E - 8.5Fr x 16cm, Quad Lumen CS-45854E - 8.5Fr x 20cm, Quad Lumen</Size><SupplierCode>40451</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>A (Anti-infective Agent Coating)</Suffix><ARTGs><ARTG>157350</ARTG></ARTGs><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA299</BillingCode><Name>PowerPICC SOLO²™ HF 5 French Triple Lumen 3CG</Name><Description>PowerPICC SOLO²™ HF 5-Fr Triple Lumen 3CG comes with a Sherlock 3CG stylet which is made of specifically formulated materials designed to aid in the placement of peripherally inserted central catheters. The stylet material provides internal reinforcement to aid in catheter placement. The Sherlock 3CG stylet may be used with the Sherlock 3CG Tip Confirmation System (TCS) to provide catheter tip placement information during the procedure.    The Sherlock 3CG stylet, Sherlock 3CG TCS system, and the Site~Rite 8 Ultrasound System, include a comprehensive, integrated set of PICC placement tools such as vein location, lumen size visualisation, needle guided vein access, catheter tip orientation, catheter tip depth, catheter tip placement using ECG, and ECG placement documentation. In most instances, this removes the need for confirming PICC tip placement through radiological methods.   </Description><Size>5 French Triple Lumen</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>325434</ARTG></ARTGs><MinimumBenefit>131</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA303</BillingCode><Name>Provena™ Midline Catheter</Name><Description>The Provena™ Midline Catheters are intended to be inserted into a patient's vascular system to sample blood, administer fluids and power injection of contrast media. The unique feature of Provena™ Midline Catheters is that they are configured with a smaller outer diameter with minimal reduction to the intraluminal area assisting in providing the optimal catheter to vein ratio, whilst still enabling good flow rates to ensure the therapy delivery is uncompromised.</Description><Size>4Fr dual lumen  </Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>317521</ARTG></ARTGs><MinimumBenefit>131</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA213</BillingCode><Name>Peripherally Inserted Central Catheter</Name><Description>Valved, Power Injectable PICC, Multiple Lumen</Description><Size>4Fr-6Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>191603</ARTG></ARTGs><MinimumBenefit>131</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA274</BillingCode><Name>PowerMidline</Name><Description>Multiple lumen, power injectable percutaneous catheter</Description><Size>4Fr - 5Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>228968</ARTG></ARTGs><MinimumBenefit>131</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX028</BillingCode><Name>Arrow Peripherally Inserted Central Catheterisation Sets</Name><Description>Range of Polyurethane double lumen peripherally inserted central catheters with or without stylet</Description><Size>4 and 5 Fr, range of lengths</Size><SupplierCode>40451</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><ARTGs><ARTG>148782</ARTG><ARTG>148784</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA130</BillingCode><Name>Groshong Peripherally Inserted Central Catheter</Name><Description>Closed-Ended PICC, Multiple Lumen</Description><Size>3Fr - 5Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109338</GroupID><ARTGs><ARTG>42589</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA140</BillingCode><Name>Haemodialysis Catheters</Name><Description>Dialysis Catheter, Multiple Lumen</Description><Size>12.5Fr - 16FR</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109339</GroupID><Suffix>cu (cuffed)</Suffix><ARTGs><ARTG>117986</ARTG><ARTG>156250</ARTG><ARTG>107195</ARTG><ARTG>145482</ARTG><ARTG>170529</ARTG><ARTG>277925</ARTG></ARTGs><MinimumBenefit>267</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX054</BillingCode><Name>Arrow-Clark(TM) VectorFlow(TM) Chronic Haemodialysis Catheter</Name><Description>The Arrow-Clark VectorFlow Catheter is indicated for use in attaining long-term vascular access for hemodialysis and apheresis.</Description><Size>15Fr x 19cm, 15Fr x 23cm, 15Fr x 27cm, 15Fr x 31cm, 15Fr x 42cm, 15Fr x 55cm,</Size><SupplierCode>40451</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109339</GroupID><Suffix>cu (cuffed)</Suffix><ARTGs><ARTG>289583</ARTG><ARTG>289730</ARTG></ARTGs><MinimumBenefit>267</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI238</BillingCode><Name>Palindrome™ Precision Catheter</Name><Description>Haemodialysis catheter presented in a kit assembly including insertion stylets</Description><Size>14.5 Fr; 19cm-55cm (implant length); 36-72cm overall length with side slots,  symmetric tip</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109339</GroupID><Suffix>cu (cuffed)</Suffix><ARTGs><ARTG>270192</ARTG><ARTG>270194</ARTG></ARTGs><MinimumBenefit>267</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TK006</BillingCode><Name>Medcomp Long Term Catheter sets for Haemodialysis</Name><Description>HemoFlow HFS-Carbothane with cuff</Description><Size>14.5 French   24,28,32 &amp; 36cm lengths</Size><SupplierCode>40452</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109339</GroupID><Suffix>cu (cuffed)</Suffix><ARTGs><ARTG>145174</ARTG></ARTGs><MinimumBenefit>267</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KA018</BillingCode><Name>Palindrome</Name><Description>Haemodialysis catheter</Description><Size>14.5Fr, 15 Fr, 16Fr; 19, 23, 28, 33, 55cm Insertion Lengths, with 36, 40, 45, 50, 72cm Overall length, with side slots, symmetric tip</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109339</GroupID><Suffix>cu (cuffed)</Suffix><ARTGs><ARTG>184449</ARTG><ARTG>217352</ARTG></ARTGs><MinimumBenefit>267</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TK005</BillingCode><Name>Medcomp Long Term Catheter sets for Haemodialysis</Name><Description>ASH, TESIO-BioFlex with cuff</Description><Size>10, 14 French   24,28,32 &amp; 36cm lengths</Size><SupplierCode>40452</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109339</GroupID><Suffix>cu (cuffed)</Suffix><ARTGs><ARTG>145174</ARTG></ARTGs><MinimumBenefit>267</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MS070</BillingCode><Name>BioFlo DuraMax</Name><Description>Percutaneous Catheter for Haemodialysis, Dual Lumen, Cuffed</Description><Size>French Size: 15.5 Fr   Catheter Length: 20 - 55 cm  Tip-to-Cuff Length: 15 - 50 cm</Size><SupplierCode>39931</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109339</GroupID><Suffix>cu (cuffed)</Suffix><ARTGs><ARTG>283676</ARTG><ARTG>283677</ARTG><ARTG>283678</ARTG><ARTG>283680</ARTG><ARTG>283679</ARTG></ARTGs><MinimumBenefit>267</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA215</BillingCode><Name>Haemodialysis Catheter</Name><Description>Power Injectable, Triple Lumen Haemodialysis Catheter</Description><Size>13Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109339</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>141187</ARTG></ARTGs><MinimumBenefit>169</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ123</BillingCode><PriorBillingCodes><PriorBillingCode>BX352</PriorBillingCode></PriorBillingCodes><Name>GamCath Dolphin Protect HighFlow Haemodialysis Catheter Kit</Name><Description>GamCath HighFlow Dolphin Protect Catheters are single-use,   sterile Polyurethane vascular access Catheters with Dolphin Protect   (CareBioBac) Coating for adult patients used by health professionals.   GamCath Dolphin Protect catheters are intended for the short-term   (up to 30 days) modification of subclavian, jugular or femoral veins   to obtain vascular access and for the short-term (up to 30 days)   treatment by extracorporeal blood purification methods such   as apheresis, autotransfusion, hemodialysis, hemofiltration,   hemodiafiltration, plasmapheresis or extracorporeal carbon dioxide   removal in combination with extracorporeal blood purification devices   and their accessories.  </Description><Size>11.5F to 13F  guage. Available in 150mm to 250mm Straight and curved configurations. </Size><SupplierCode>40484</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109339</GroupID><Suffix>A (Anti-infective Agent Coating)</Suffix><ARTGs><ARTG>401852</ARTG></ARTGs><MinimumBenefit>128</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA211</BillingCode><Name>Haemodialysis Catheters</Name><Description>Haemodialysis Catheters, multiple lumen</Description><Size>11Fr - 13.5Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109339</GroupID><ARTGs><ARTG>141187</ARTG></ARTGs><MinimumBenefit>103</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI242</BillingCode><Name>Mahurkar Elite High Flow Dual Lumen Catheter Kit</Name><Description>Mahurkar Elite High Flow Dual Lumen Catheter Kit</Description><Size>13.5 Fr, 13cm-30cm, Straight/Curved/PreCurved Exten.</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109339</GroupID><ARTGs><ARTG>180135</ARTG></ARTGs><MinimumBenefit>103</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI229</BillingCode><Name>Mahurkar Elite Triple Lumen Catheter Kit</Name><Description>Triple Lumen Catheter  Straight/Curved/Pre-Curved Exten.</Description><Size>12Fr, 12.5Fr; 13-30 cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109339</GroupID><ARTGs><ARTG>180135</ARTG></ARTGs><MinimumBenefit>103</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VD003</BillingCode><Name>Balton Dialysis Catheter</Name><Description>The Balton Dialysis Catheter is a multiple lumen percutaneous catheter intended for obtaining access to a large blood vessel for haemodialysis.</Description><Size>Length: 7-30cm  Lumen type: Double Lumen Cannula,Triple Lumen Cannual</Size><SupplierCode>40269</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109339</GroupID><ARTGs><ARTG>313280</ARTG></ARTGs><MinimumBenefit>103</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI241</BillingCode><Name>Mahurkar Elite Subclavian Dual Lumen Catheter Kit</Name><Description>Acute haemodialysus, short term vascular access. Catheters constructed of radiopaque polyurethane. Tips are made of polyvinyl chloride and are more radiopaque than the rest of the catheter.</Description><Size>10 Fr-12Fr, 13cm-30 cm, Straight/Curved/PreCurved Exten.</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109339</GroupID><ARTGs><ARTG>180135</ARTG></ARTGs><MinimumBenefit>103</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ124</BillingCode><PriorBillingCodes><PriorBillingCode>BX338</PriorBillingCode><PriorBillingCode>BX338</PriorBillingCode></PriorBillingCodes><Name>GamCath High Flow Catheter Kit</Name><Description>GamCath High Flow Catheter is a polyurethane, kidney elliptical multi lumen, staggered tipped catheter kit, which ensures flows up to 430ml/min</Description><Size>11.5fr and 13fr guage.  Available in 150mm, 175mm, 200mm and 250mm length and straight and curved configuration.</Size><SupplierCode>40484</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109339</GroupID><ARTGs><ARTG>120507</ARTG></ARTGs><MinimumBenefit>103</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX029</BillingCode><Name>ARROWg+ard Blue Haemodialysis Catheters</Name><Description>Haemodialysis Catheters (of various lengths, sizes and lumen configurations) with antimicrobial impregnation (chlorhexidine and silver sulphadiazine) on the external surface of the polyurethane catheter material.</Description><Size>CS-22122 - 12Fr 16cm, Dual Lumen CS-22123 – 12Fr 16cm, Triple Lumen CS-25122 – 12Fr x 20cm, Dual Lumen CS-22142CF – 14Fr x 15cm, Dual Lumen, Curved, Firm CS-22142F – 14Fr x 15cm, Dual Lumen Firm CS-25122 – 12Fr x 20cm, Double Lumen CS-25123 – 12Fr x 20cm, Triple Lumen CS- 25142CF – 14Fr x 20cm, Double Lumen, Curve, Firm CS-25142F – 14Fr x 20cm, Double Lumen, Firm CS-26142F – 14Fr x 25cm, Double Lumen, Firm  CU-22122 – 12Fr x 16cm, Double Lumen, Curved CU-23122 – 12Fr x 13cm, Double Lumen, Curved CU-25122 – 12Fr x 20cm, Double Lumen, Curved, Dueal Lumen CS-22142CF - 14Fr x 15cm, Dual Lumen, Curved, Firm CS-22142F - 14Fr x 15cm, Dual Lumen Firm CS-25122 - 12Fr x 20cm</Size><SupplierCode>40451</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109339</GroupID><Suffix>A (Anti-infective Agent Coating)</Suffix><ARTGs><ARTG>158708</ARTG></ARTGs><MinimumBenefit>128</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA181</BillingCode><Name>PowerPort</Name><Description>Titanium or MRI implantable port, Open-ended Catheter, Single Chamber</Description><Size>6Fr - 8Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109340</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>170347</ARTG><ARTG>149028</ARTG></ARTGs><MinimumBenefit>510</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA057</BillingCode><Name>Groshong Subcutaneous Ports</Name><Description>Titanium or MRI Implatable Port, Closed-Ended Catheter, Single Chamber</Description><Size>7Fr - 8 Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109340</GroupID><ARTGs><ARTG>157391</ARTG><ARTG>157393</ARTG><ARTG>156248</ARTG><ARTG>157399</ARTG><ARTG>157396</ARTG></ARTGs><MinimumBenefit>399</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA221</BillingCode><Name>Implanted infusion Port</Name><Description>Titanium or MRI Implanted Port, Open-Ended Catheter, Single Chamber</Description><Size>6Fr - 9.6Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109340</GroupID><ARTGs><ARTG>157395</ARTG><ARTG>157398</ARTG><ARTG>157402</ARTG><ARTG>157397</ARTG><ARTG>157401</ARTG><ARTG>157403</ARTG><ARTG>157392</ARTG><ARTG>156249</ARTG><ARTG>157394</ARTG><ARTG>157400</ARTG></ARTGs><MinimumBenefit>399</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JF002</BillingCode><Name>HealthPORT  Venous Access Port</Name><Description>HEALTHPORT Venous   Polysufone/Titanium Implantable Venous Access Systems, for mid and long term intermittent or continuous central venous infusion. Come with Silicon or Polyurethane catheter in multiple French sizes. Kits include Port chamber, Catheter, Connector, Huber needle 22G, Luer connector, Peel-away dilator-introducer, Introducer needle 18G, J-Guidewire 0.89mm, Stainless Steel Tunneler</Description><Size>5-8 Fr</Size><SupplierCode>39937</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109340</GroupID><ARTGs><ARTG>385351</ARTG></ARTGs><MinimumBenefit>399</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA208</BillingCode><Name>PowerPort with Groshong Catheter</Name><Description>Titanium or MRI implantable Port, Closed-Ended Catheter, Single Chamber</Description><Size>8Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109340</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>170345</ARTG><ARTG>170346</ARTG></ARTGs><MinimumBenefit>510</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MS079</BillingCode><Name>Power Injectable Infusion Port</Name><Description>Single Chamber, MRI Conditional, Vascular Access Port with Vortex Technology</Description><Size>Catheter (French Size): 5Fr - 8Fr, Catheter (Length): 45 cm - 63 cm, Port Body (Height): 10.8 mm - 13.0 mm, Port Septum (Diameter): 10.2 mm - 12.7 mm</Size><SupplierCode>39931</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109340</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>378931</ARTG><ARTG>378932</ARTG><ARTG>378930</ARTG></ARTGs><MinimumBenefit>510</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FK007</BillingCode><Name>Ambix Intraport CP Powerflow &amp; Ambix Intraport T Powerflow</Name><Description>Ambix Intraport® systems are completely implantable catheter systems.  They consist of a casing, a medicine compartment with a silicone membrane and a catheter which can be connected to the port casing.</Description><Size>Port: 8086012 Ambix Intraport CP Powerflow
Material: PEEK casing with aluminium oxide ceramic medicine compartment
Diameter of port base: 30mm
Port Weight: 7.8/7.6g
Port filling volume: 0.21/0.25ml
Port: 8086442
Material: Titanium
Diameter of port: 30mm
Port Height: 13.8mm
Port weight: 12.6g
Port filling volume: 0.56ml</Size><SupplierCode>40376</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109340</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>222676</ARTG><ARTG>222677</ARTG></ARTGs><MinimumBenefit>510</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SI053</BillingCode><Name>PORT-A-CATH Single Lumen</Name><Description>PORT-A-CATH® Polysulfone/Titanium Implantable Venous Access Systems, Single Lumen with Multiple French sizes</Description><Size>6 - 10 fr</Size><SupplierCode>40340</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109340</GroupID><ARTGs><ARTG>154989</ARTG><ARTG>154982</ARTG><ARTG>169403</ARTG><ARTG>154988</ARTG><ARTG>175617</ARTG><ARTG>175621</ARTG></ARTGs><MinimumBenefit>399</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SI054</BillingCode><Name>POWER PORT-A-CATH Single Lumen</Name><Description>PORT-A-CATH® POWER PAC Polysulfone/Titanium Implantable Venous Access Systems, Single Lumen with Multiple French sizes</Description><Size>6 -10 fr</Size><SupplierCode>40340</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109340</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>161541</ARTG><ARTG>161540</ARTG><ARTG>175619</ARTG></ARTGs><MinimumBenefit>510</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TK008</BillingCode><Name>Pro-Fuse CT Power Injectable Infusion Port</Name><Description>Power injectable implantable infusion port, open-ended catheter, single chamber, MRI compatible</Description><Size>5F - 8F</Size><SupplierCode>40452</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109340</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>159639</ARTG></ARTGs><MinimumBenefit>510</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB366</BillingCode><Name>Celsite Safety Venous Access Port</Name><Description>Celsite Safety is a venous access port that is implanted and is intended to be used for any condition that requires mid to long-term intermittent or continuous central venous infusions.</Description><Size>Standard: 33 x 26mm x 13.7mm: Septum 13.0mm
Small: 29 x 22mm x 11.3mm: Septum 10.8mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109340</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>285508</ARTG><ARTG>286710</ARTG></ARTGs><MinimumBenefit>510</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JF001</BillingCode><Name>HealthPORT Power Venous Access Port</Name><Description>HealthPORT Power Venous Polysufone/Titanium Implantable Venous Access Systems, for mid and long term intermittent or continuous central venous infusion. Come with Silicon or Polyurethane catheter in multiple French sizes. Kits include Port chamber, Catheter, Connector, Huber needle 22G, Luer connector, Peel-away dilator-introducer, Introducer needle 18G, J-Guidewire 0.89mm, Stainless Steel Tunneler  For Power Injection</Description><Size>5-8 Fr</Size><SupplierCode>39937</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109340</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>385351</ARTG></ARTGs><MinimumBenefit>510</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MS016</BillingCode><Name>Smart Port CT</Name><Description>Power-Injectable, Single Chamber, Titanium, Vascular Access Port with Vortex Technology</Description><Size>Detached or Pre-Attached Catheter: 6.6 Fr - 9.6 Fr</Size><SupplierCode>39931</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109340</GroupID><Suffix>pi (power injection)</Suffix><ARTGs><ARTG>235097</ARTG><ARTG>169838</ARTG><ARTG>235099</ARTG><ARTG>235098</ARTG></ARTGs><MinimumBenefit>510</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MS014</BillingCode><Name>Vortex Implantable Port</Name><Description>Implantable access device for administration of medications, fluids, etc. and for blood sampling</Description><Size>Catheter Size (Fr): 6.6 - 9.6</Size><SupplierCode>39931</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109340</GroupID><ARTGs><ARTG>155910</ARTG></ARTGs><MinimumBenefit>399</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB170</BillingCode><Name>Celsite Access Port for pain relief</Name><Description>Composition - polysulphone.  Kit includes tunnelling rod, filter, connectors, needles, syringe, tuohy needle</Description><Size>Diameter of septum:11.7mm.  Height: 11.5mm.  Dimension: 25.8 x 37.8mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109340</GroupID><ARTGs><ARTG>133738</ARTG></ARTGs><MinimumBenefit>399</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MS015</BillingCode><Name>Injection/Infusion Ports Sterile</Name><Description>Plastic/titanium, dual lumen</Description><Size>10, 10.5, 12F</Size><SupplierCode>39931</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109341</GroupID><ARTGs><ARTG>155909</ARTG></ARTGs><MinimumBenefit>636</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA059</BillingCode><Name>Dual Lumen Subcutaneous Ports</Name><Description>Silicone, Polyurethane or ChronoFlex Open-ended Catheter</Description><Size>7 - 10 French Catheter</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109341</GroupID><ARTGs><ARTG>157389</ARTG><ARTG>157390</ARTG><ARTG>156247</ARTG></ARTGs><MinimumBenefit>636</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SI055</BillingCode><Name>PORT-A-CATH Double Lumen</Name><Description>PORT-A-CATH® Polysulfone/Titanium Implantable Venous Access Systems.  Dual Lumen with Multiple French sizes</Description><Size>7-10Fr</Size><SupplierCode>40340</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107800</SubCategoryID><GroupID>109341</GroupID><ARTGs><ARTG>175618</ARTG><ARTG>175620</ARTG></ARTGs><MinimumBenefit>636</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KA002</BillingCode><Name>Paediatric Peritoneal Catheter</Name><Description>Paediatric Peritoneal Dialysis Catheters - includes catheter options: Tenckhoff, Curl Cath, Swan Neck</Description><Size>31cm to 42cm length</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107801</SubCategoryID><GroupID>109344</GroupID><ARTGs><ARTG>179006</ARTG></ARTGs><MinimumBenefit>158</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KA006</BillingCode><Name>Curl Cath Peritoneal Catheter</Name><Description>Curl Cath Peritoneal Dialysis Catheters - includes a variety of catheter lengths and cuff placements </Description><Size>57cm to 62cm length</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107801</SubCategoryID><GroupID>109344</GroupID><ARTGs><ARTG>179006</ARTG><ARTG>178936</ARTG></ARTGs><MinimumBenefit>158</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KA001</BillingCode><Name>Tenckhoff Peritoneal Catheters</Name><Description>Tenckhoff Peritoneal Dialysis Catheters - includes a variety of catheter lengths and cuff placements </Description><Size>41cm to 47cm length</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107801</SubCategoryID><GroupID>109344</GroupID><ARTGs><ARTG>178936</ARTG><ARTG>179006</ARTG></ARTGs><MinimumBenefit>158</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI319</BillingCode><PriorBillingCodes><PriorBillingCode>KA004</PriorBillingCode><PriorBillingCode>KA005</PriorBillingCode></PriorBillingCodes><Name>Swan Neck Peritoneal Catheter</Name><Description>Swan Neck Peritoneal Dialysis Catheters - includes catheter options: Tenckhoff, Curl Cath and Presternal</Description><Size>43cm to 113cm length</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107801</SubCategoryID><GroupID>109344</GroupID><ARTGs><ARTG>179006</ARTG></ARTGs><MinimumBenefit>158</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK515</BillingCode><Name>Nasal Sheet (Strut).</Name><Description>Nasal Sheet (Strut). Model 9536</Description><Size>Nasal Sheet (Strut): 40 x 9 x 1.1mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><ARTGs><ARTG>257016</ARTG></ARTGs><MinimumBenefit>144</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UI002</BillingCode><Name>BIOMODEL</Name><Description>3D CT Based Patient Specific biomodels generated from Patient’s CT scan to   replicate patient particular anatomical contours</Description><Size>Custom - made. Patient specific</Size><SupplierCode>40421</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109360</GroupID><ARTGs><ARTG>292561</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UI004</BillingCode><Name>OMF Model</Name><Description>A custom made patient-specific and single-use aid, intended to be used in dental and craniomaxillofacial surgical procedures</Description><Size>Patient specific</Size><SupplierCode>40421</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109360</GroupID><ARTGs><ARTG>322576</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HI002</BillingCode><Name>DDN Biomodel</Name><Description>Custom made biomodel for use with the Neoss Implant System (NJ001)</Description><Size>The device is custom made so the size will vary.</Size><SupplierCode>40245</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109360</GroupID><ARTGs><ARTG>336209</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HI005</BillingCode><Name>DDN Biomodel</Name><Description>Custom made biomodel for use with the STRAUMANN Implant System (SB024), (SB009), (SB015), (SB023), (SB008), (SB012), (SB018)</Description><Size>The device is custom made so the size will vary.</Size><SupplierCode>40245</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109360</GroupID><ARTGs><ARTG>336209</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ311</BillingCode><Name>Stryker Patient-Matched TMJ – Anatomic Biomodel</Name><Description>The anatomical bone model (biomodel) is produced from a computer tomography (CT) scan of the patient’s mandible and maxilla and intended to be used by the surgeon as an anatomical reference in planning and performing the implantation of the prosthesis.</Description><Size>Patient Specific</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109360</GroupID><ARTGs><ARTG>427023</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ050</BillingCode><Name>Lyka-Smith Anatomical Biomodel</Name><Description>Three-dimensional anatomical biomodel</Description><Size>The device is custom made so the size will vary</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109360</GroupID><ARTGs><ARTG>293845</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ046</BillingCode><Name>OrthoTin Anatomic Biomodel</Name><Description>Anatomic Biomodel</Description><Size>The device is custom so the size will vary</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109360</GroupID><ARTGs><ARTG>293845</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW651</BillingCode><Name>VSP Orthognathics Bundle (Custom Biomodel and Implants)</Name><Description>VSP Orthognathics Bundle (Custom Biomodel and Implants - Plates and Screws)</Description><Size>Custom</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109360</GroupID><ARTGs><ARTG>200615</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT004</BillingCode><Name>UNIQOS Patient Specific Anatomical Biomodel</Name><Description>Patient specific antomical biomodel</Description><Size>Custom-Patient Specific</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109360</GroupID><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ001</BillingCode><PriorBillingCodes><PriorBillingCode>AT076</PriorBillingCode><PriorBillingCode>AT076</PriorBillingCode></PriorBillingCodes><Name>Anatomics Biomodel</Name><Description>A patient-specific, 3D printed  biomodel intended to assist the surgeon during pre- and intraoperative procedural planning.</Description><Size>The device is custom made so the size will vary.</Size><SupplierCode>40481</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109360</GroupID><ARTGs><ARTG>288564</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OG004</BillingCode><Name>The OMX Solutions Biomodel</Name><Description>CT Based Patient Specific Anatomical Biomodel</Description><Size>The device is patient specific so size will vary</Size><SupplierCode>40126</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109360</GroupID><ARTGs><ARTG>276753</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY779</BillingCode><Name>ProPlan</Name><Description>Patient Specific Craniofacial Anatomical Biomodel</Description><Size>Custom</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109360</GroupID><ARTGs><ARTG>276733</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW544</BillingCode><Name>Stryker Anatomical Biomodel for Mandible</Name><Description>Patient Specific Craniofacial Anatomical Biomodel</Description><Size>Custom</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109360</GroupID><ARTGs><ARTG>218563</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW652</BillingCode><Name>VSP Reconstruction Maxillofacial Case Bundle</Name><Description>VSP Reconstruction Maxillofacial Case Bundle (Includes Skull Model)</Description><Size>Custom</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109360</GroupID><ARTGs><ARTG>200615</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW546</BillingCode><Name>Stryker Anatomical Biomodel for PEEK</Name><Description>Patient Specific Craniofacial Anatomical Biomodel</Description><Size>Custom</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109360</GroupID><ARTGs><ARTG>218563</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW412</BillingCode><Name>Chins</Name><Description>Extended chin implants: Round RZ (Models 8313 - 8315) and extended square RZ (Models 8316, 8318). Two piece chin design (Models 8320 - 8322). Single piece chin design, contoured (Models 7520 - 7522). Additional chin shapes (Models 6341 - 6344) Contoured t</Description><Size>Extended chin Implants design RZ round small: 45 x 47 x 3mm, medium 45 x 47 x 5mm, large 45 x 47 x 7mm; Extneded Chin Implants square small 45 x 47 x3mm; Medium 45 x 47 x 5mm; Large 45 x 47 x 7mm; Two piece design small 46 x 33 x 5mm; Medium 56 x 36 x 7mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109361</GroupID><ARTGs><ARTG>257033</ARTG></ARTGs><MinimumBenefit>189</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY782</BillingCode><Name>SynPOR</Name><Description>Porous Polyethylene Chin Implant</Description><Size>4-9mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109361</GroupID><Suffix>Complex</Suffix><ARTGs><ARTG>190454</ARTG></ARTGs><MinimumBenefit>626</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE806</BillingCode><PriorBillingCodes><PriorBillingCode>VL003</PriorBillingCode></PriorBillingCodes><Name>Su-Por Chin Two Piece Anatomical contour.</Name><Description>An implantable device intended to support, contour, and provide structure for the chin. Made of high density polyethylene material with an interconnecting pore structure that supports tissue ingrowth. The device is available in various shapes and can be cut by the surgeon to meet the patient's specific needs.</Description><Size>3mm, 5mm, 7mm, 9mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109361</GroupID><Suffix>Complex</Suffix><ARTGs><ARTG>335454</ARTG></ARTGs><MinimumBenefit>626</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK512</BillingCode><Name>Malar Shape</Name><Description>Porus Polyethylene. Design RZ malar shapes, super petite and petite, left and right (Models 9501 - 9504). Design M malar shapes, left and right (Models 9507 - 9512). Additional malar shapes, extended contoured left and right (Models 9513 - 9518) Contoured</Description><Size>Design RZ malar shapes: super petite left and right 50 x 19 x 3mm, Design RZ malar shapes petite left and right 50 x 19 x 5mm. Design malar shapes: small left and right  64 x 19 x 3mm, left and right medium 64 x 19 x 4.5mm, Left and right large 64 x 19 x </Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109364</GroupID><ARTGs><ARTG>187184</ARTG><ARTG>257037</ARTG></ARTGs><MinimumBenefit>322</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NR007</BillingCode><Name>Branemark Titanium Fixture</Name><Description>Zygomaticus Fixture</Description><Size>30, 35, 37.5, 40, 42.5, 45, 47.5, 50, 52.5mm Length</Size><SupplierCode>40132</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109370</GroupID><ARTGs><ARTG>97382</ARTG></ARTGs><MinimumBenefit>780</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB024</BillingCode><Name>Straumann Zygomatic Implant, ZAGA Round and ZAGA Flat</Name><Description>Titanium zygomatic implant, round or flat</Description><Size>4.3mm diameter, 30mm - 60mm length</Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109370</GroupID><ARTGs><ARTG>330842</ARTG></ARTGs><MinimumBenefit>780</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IC002</BillingCode><Name>Southern Zygomatic and Oncology Implants</Name><Description>Zygomatic Titanium dental implants with 45 or 55 degree angulation</Description><Size>4 to 6mm diameter, 27 to 52.5mm length</Size><SupplierCode>40338</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109370</GroupID><ARTGs><ARTG>146307</ARTG></ARTGs><MinimumBenefit>780</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GZ001</BillingCode><Name>JD Zygoma Dental Implants</Name><Description>Titanium Dental Implants</Description><Size>3.9mm to 4.3mm (diameter), 30mm to 60mm (height)</Size><SupplierCode>40479</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109370</GroupID><ARTGs><ARTG>334160</ARTG></ARTGs><MinimumBenefit>780</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ132</BillingCode><Name>OsseoFrame</Name><Description>The MAXONIQ OsseoFrame is a subperiosteal, titanium (Ti64), patient-specific surgical
implant individually designed from a 3D Computed Tomography (CT) or Cone Beam CT
(CBCT) scan provided to MAXONIQ by the referring surgeon. The OsseoFrame is
fixated to alveolar bone of the maxilla or mandible to fit the natural contours. An
OsseoFrame is comprised of a baseplate with holes for screw fixation and transmucosal
connectors for dental prosthesis attachment. The OsseoFrame is intended to be used on
the alveolar bone of the mandible or maxilla to provide a stable and permanent platform for
fixation of the dental prosthesis. The OsseoFrame is indicated to restore oral function
and facial aesthetics in edentulous patients missing 3 or more adjacent teeth with atrophic
jaws, low sinus floors or who have undergone partial jaw resection. The OsseoFrame
may also be beneficial for patients who cannot tolerate removable dentures and desire a
fixed solution; who cannot tolerate complex bone graft surgery to support dental implants;
or if they want replacement teeth immediately after surgery. The dental prosthesis is
supplied separately and is to be fitted by surgeon, a restorative dentist or a prosthodontist.
The OsseoFrame may be supplied with a biomodel and a surgical guide, both these items
have separate Prosthesis Listings.</Description><Size>The OsseoFrame may be supplied as either a 2 post, 3 post or 4 post variant of the prosthesis. Effectively, these size variants are designed for partial overdentures (2 and 3 post variants) or a 4 post variant for full arch restoration. The 4 post, full arch variant is designed to treat a fully edentulous patient, whilst the 2 and 3 post variants are designed to treat patients missing 3 or more teeth. The clinician and prosthodontist will determine the appropriate number of posts for an individual patient.</Size><SupplierCode>40126</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109372</GroupID><ARTGs><ARTG>286266</ARTG></ARTGs><MinimumBenefit>3254</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM030</BillingCode><Name>Synovis Coupler</Name><Description>High Density polyethylene (ring); Stainless Steel (pins)</Description><Size>Diameter 1-4mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107808</SubCategoryID><GroupID>109378</GroupID><ARTGs><ARTG>95596</ARTG></ARTGs><MinimumBenefit>609</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM274</BillingCode><Name>FlowCOUPLER</Name><Description>High Density polyethylene (ring); Stainless Steel (pins) with preattached probe</Description><Size>2.0mm, 2.5mm, 3.0mm, 3.5mm, 4.0mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107808</SubCategoryID><GroupID>109378</GroupID><Suffix>with Doppler probe</Suffix><ARTGs><ARTG>243832</ARTG></ARTGs><MinimumBenefit>990</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL005</BillingCode><Name>Storz (Coburn) Intraocular Lens  121UV; L122UV PMMA Anterior Chamber Lens</Name><Description>PMMA Anterior Chamber Intraocular lens 1 piece</Description><Size>13.75mm length. 6.0mm optic size, diopter range 3-30d. L122UV: 6.0mm optic, 13.75mm length, power range; 5.0 to 30.0 Diopters</Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107638</SubCategoryID><GroupID>108461</GroupID><SubGroupID>109704</SubGroupID><ARTGs><ARTG>97880</ARTG></ARTGs><MinimumBenefit>126</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EG009</BillingCode><Name>Artisan Anterior Chamber Intraocular Lens</Name><Description>Aphakia Model
Composition: PMMA</Description><Size>5.00mm Optic Diameter x 8.5 in overall length</Size><SupplierCode>40068</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107638</SubCategoryID><GroupID>108461</GroupID><SubGroupID>109704</SubGroupID><Suffix>ifc</Suffix><ARTGs><ARTG>92476</ARTG></ARTGs><MinimumBenefit>203</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL003</BillingCode><Name>MTA2UO - MTA6UO</Name><Description>PMMA</Description><Size>+5 to +30 D</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107638</SubCategoryID><GroupID>108461</GroupID><SubGroupID>109704</SubGroupID><ARTGs><ARTG>144332</ARTG></ARTGs><MinimumBenefit>126</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EG012</BillingCode><Name>Artisan Anterior Chamber IOL</Name><Description>Phakic Intraocular Lens Myopic / Hyperopic</Description><Size>5.00mm Optic Diameter x 8.5 in overall length;</Size><SupplierCode>40068</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107638</SubCategoryID><GroupID>108462</GroupID><SubGroupID>109705</SubGroupID><ARTGs><ARTG>92476</ARTG></ARTGs><MinimumBenefit>552</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EG020</BillingCode><Name>Artisan Toric (Custom) T2</Name><Description>AC Iris clip IOL Toric</Description><Size>5.00mm Optic Diameter x 7.5 Overall</Size><SupplierCode>40068</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107638</SubCategoryID><GroupID>108462</GroupID><SubGroupID>109705</SubGroupID><Suffix>t2, ifc</Suffix><ARTGs><ARTG>92476</ARTG></ARTGs><MinimumBenefit>1180</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EG019</BillingCode><Name>Artisan Toric (Custom) T1</Name><Description>AC Iris clip IOL Toric</Description><Size>5.00mm Optic Diameter x 7.5 Overall</Size><SupplierCode>40068</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107638</SubCategoryID><GroupID>108462</GroupID><SubGroupID>109705</SubGroupID><Suffix>t1, ifc</Suffix><ARTGs><ARTG>92476</ARTG></ARTGs><MinimumBenefit>934</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EG010</BillingCode><Name>Artiflex Anterior Chamber Intraocular Lens</Name><Description>Optic: Hydrophobic Polysiloxane. Haptic: PMMA</Description><Size>6mm optic diameter x 8.5 in overall length</Size><SupplierCode>40068</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107638</SubCategoryID><GroupID>108462</GroupID><SubGroupID>109706</SubGroupID><ARTGs><ARTG>92476</ARTG></ARTGs><MinimumBenefit>565</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL026</BillingCode><Name>Akreos AO Micro Incision Lens</Name><Description>Micro Incision, posterior chamber, foldable acrylic, aphakic, anterior &amp; posterior edge modification, preloaded, with aberration control, intraocular lens</Description><Size>6mm optic overall diameter 11.0mm(10D-15D), 10.7mm (15.50-22D), 10.5mm (22.50-30D)</Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109707</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>98915</ARTG></ARTGs><MinimumBenefit>270</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ286</BillingCode><Name>AT TORBI 719M High Cyl</Name><Description>HIGH CYLINDER BITORIC - ZEISS Micro Incision Aspheric (aberration neutral) IOL: Foldable square edged, single piece IOL for capsular bag fixation</Description><Size>Spherical Equivalent (SE) -4.0 to +32.0 D, 0.5 D increments Cylinder +7.0 to +12.0 D, 0.5 D increments Optic size: 6.0mm, Overall length: 11.0mm</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109707</SubGroupID><Suffix>at, t2</Suffix><ARTGs><ARTG>151348</ARTG></ARTGs><MinimumBenefit>751</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ287</BillingCode><Name>AT TORBI 719MP (Standard Range)</Name><Description>Bitoric, preloaded, micro incision, aspheric (aberration neutral), foldable, square-edged,
single-piece IOL for capsular bag fixation</Description><Size>Spherical Equivalent (SE) -8.0 to +28.0 D, 0.5 D increments Cylinder +1.0 to +4.0 D, 0.5 D increments Optic size: 6.0mm, Overall length: 11.0mm</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109707</SubGroupID><Suffix>at, pl, t1</Suffix><ARTGs><ARTG>151348</ARTG></ARTGs><MinimumBenefit>549</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ288</BillingCode><Name>AT TORBI 719M (Standard Range)</Name><Description>STANDARD RANGE BITORIC - ZEISS Micro Incision Aspheric (aberration neutral) IOL: Foldable, square-edged, single piece IOL for capsular bag fixation</Description><Size>Spherical Equivalent (SE) Diopter range: Sph -4.0 to +32.0D, 0.5D increments, Cylinder (cyl) +1.0 to 6.5D, 0.5 D increments, Optic size: 6.0mm, Overall length: 11.0mm</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109707</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>151348</ARTG></ARTGs><MinimumBenefit>534</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CZ040</BillingCode><Name>CT SPHERIS 209M</Name><Description>Micro incision, Spherical aberrated, foldable square-edged single-piece intraocular lens for capsular bag fixation.</Description><Size>Diopter range :0.00 to + 32.0. Optic Size : 6mm  Overall Length  : 11mm</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109707</SubGroupID><ARTGs><ARTG>151348</ARTG></ARTGs><MinimumBenefit>232</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TW012</BillingCode><PriorBillingCodes><PriorBillingCode>EG016</PriorBillingCode></PriorBillingCodes><Name>ARTIS PL E</Name><Description>Preloaded Intraocular lens</Description><Size>0 to 35D</Size><SupplierCode>40417</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109707</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>226270</ARTG></ARTGs><MinimumBenefit>270</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG015</BillingCode><Name>Rayner C-flex Advance Aspheric IOL</Name><Description>Mini incision pre-loaded  aspheric IOL</Description><Size>Power range +8.0 - +34.0 dioptres in 0.5 increments</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109707</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>220612</ARTG></ARTGs><MinimumBenefit>270</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CZ037</BillingCode><Name>CT ASPHINA 509MP</Name><Description>Preloaded, micro incision, aspheric (aberration correcting), foldable square-edged single-piece intraocular lens for capsular bag fixation</Description><Size>Diopter range: 0.0 to + 32.0D; Optic Size: 6.0mm; Overall length: 11.0mm</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109707</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>134490</ARTG></ARTGs><MinimumBenefit>270</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CZ028</BillingCode><Name>CT ASPHINA 409MP</Name><Description>Preloaded, micro incision, aspheric (aberration neutral), foldable square-edged single piece intraocular lens for capsular bag fixation.</Description><Size>Diopter range: 0.0 to 32.0D; Optic size: 6.0mm; Overall length: 11.0mm</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109707</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>151348</ARTG></ARTGs><MinimumBenefit>270</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CZ017</BillingCode><Name>CT ASPHINA 509M</Name><Description>ZEISS Micro Incision Aspheric (aberration correcting) IOL: Foldable, square-edged, single piece IOL for capsular bag fixation</Description><Size>6mm Optic, 11mm overall diameter. Diopter range 0.0 to +32.0D (0.5D steps from 10.0 to 30.0D, 1.0D outside this range)</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109707</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>151348</ARTG></ARTGs><MinimumBenefit>263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TW011</BillingCode><PriorBillingCodes><PriorBillingCode>EG015</PriorBillingCode></PriorBillingCodes><Name>ARTIS T PL</Name><Description>Preloaded Toric Intraocular lens</Description><Size>+18 to +25D / C +1.50D</Size><SupplierCode>40417</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109707</SubGroupID><Suffix>at, pl, t1</Suffix><ARTGs><ARTG>226270</ARTG></ARTGs><MinimumBenefit>549</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CZ016</BillingCode><Name>CT ASPHINA 409M</Name><Description>ZEISS Micro Incision Aspheric (aberration neutral) IOL: Foldable, square-edged, single piece IOL for capsular bag fixation</Description><Size>6mm optic, 11mm overall diameter. Diopter range 0.0 to +32.0D (0.5D steps from 10.0 to 30.0D, 1.0D outside this range)</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109707</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>151348</ARTG></ARTGs><MinimumBenefit>263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CZ031</BillingCode><Name>AT TORBI 709MP (Standard Range)</Name><Description>Bitoric, preloaded, micro incision, aspheric (aberration neutral), foldable, square-edged, single-piece IOL for capsular bag fixation</Description><Size>Diopter range: Sph -10.0 to 32.0, Cyl +1.0 to 6.5
Optic size: 6.0mm, Overall length: 11.0mm</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109707</SubGroupID><Suffix>at, pl, t1</Suffix><ARTGs><ARTG>151348</ARTG></ARTGs><MinimumBenefit>549</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CZ020</BillingCode><Name>AT TORBI 709M</Name><Description>STANDARD RANGE BITORIC - ZEISS Micro Incision Aspheric (abberation neutral) IOL: Foldable, square-edged, single piece IOL for capsular bag fixation</Description><Size>6mm optic, 11mm overall diameter. Diopter range: Sph -10.0 to +32.0D, Cyl +1.0 to 6.5D (all 0.5D steps)</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109707</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>151348</ARTG></ARTGs><MinimumBenefit>534</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CZ027</BillingCode><Name>AT TORBI 709M</Name><Description>HIGH CYLINDER BITORIC - ZEISS Micro Incision Aspheric (aberration neutral) IOL: Foldable square edged, single piece IOL for capsular bag fixation</Description><Size>6mm optic, 11mm overall diameter.  Diopter range: Sph -10.0 to +32.0D, +7.0 to 12.0D (all 0.5D steps)</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109707</SubGroupID><Suffix>at, t2</Suffix><ARTGs><ARTG>151348</ARTG></ARTGs><MinimumBenefit>751</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LN003</BillingCode><Name>ALSAFIT</Name><Description>Single piece aspheric foldable intraocular lens for implantation into the capsular bag.</Description><Size>Diopter power range: 0.0 D to 32.00 D (0.50 D increments). Optic size: 6mm. Overall length: 11.0mm.</Size><SupplierCode>40187</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>268033</ARTG></ARTGs><MinimumBenefit>232</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL011</BillingCode><Name>Acrysof Model SA60AT</Name><Description>Foldable Acrylic Single-piece Lens, asymmetric optic/consistent edge</Description><Size>Range of Powers: +6 to +40 D</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>214</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG001</BillingCode><Name>Rayner C-Flex</Name><Description>Hydrophilic HEMA-MMA copolymer, foldable with injector</Description><Size>5.75mm dia optic, 12.00mm dia overall</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><ARTGs><ARTG>100926</ARTG></ARTGs><MinimumBenefit>214</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CZ041</BillingCode><Name>CT LUCIA 202</Name><Description>Foldable, 3-piece, monofocal, square-edged, hydrophobic acrylic intraocular lens.</Description><Size>Diopter size: 4.0 to 34.0 DS.  Optic size: 6mm.  Overall length: 13mm</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><ARTGs><ARTG>151348</ARTG></ARTGs><MinimumBenefit>214</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AO002</BillingCode><Name>SENSAR IOL with OptiEdge Design</Name><Description>3-Piece, soft hydrophobic acrylic, foldable, UV absorbing, posterior</Description><Size>-10.0 D to +30.0 D in 0.5 D increments</Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><ARTGs><ARTG>170331</ARTG></ARTGs><MinimumBenefit>214</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL004</BillingCode><Name> Acrysof Multipiece Models MA50BM, MA60AC, MA60MA</Name><Description>Foldable Acrylic Multi-piece Lens</Description><Size> -5 D to +30 D</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>214</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG002</BillingCode><Name>Superflex</Name><Description>Hydrophilic HEMA-MMA copolymer, foldable with injector</Description><Size>6.25mm dia optic, 12.5mm dia overall</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><ARTGs><ARTG>100926</ARTG></ARTGs><MinimumBenefit>214</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL043</BillingCode><Name>Enhanced enVista Toric with Bausch + Lomb SimplifEYE preloaded delivery system</Name><Description>The enVista Family of Intraocular Lenses (IOLs) are ultraviolet-absorbing, posterior chamber, hydrophobic acrylic IOLs. They have an aspheric lens optic, square posterior edge, and modified C haptics. The lenses can be folded for insertion into the eye. The MX60PTC combines the preloaded IOL with the enVista SimplifEYE Preloaded Injector System inserter and is sold in a common package. This alternate packaging configuration allows for a simpler loading of the injector.</Description><Size>Specification: Optic Body Diameter 6.0 ± 0.1 mm Overall Diameter 12.5 ± 0.2 mm  Haptic Thickness 0.35 ± 0.04 mm Haptic Angulations Planar Haptic Lens Power Range +0.0 to +30.0D (in 0.5D increments) +0.90D to +5.75D (in 0.75D increments from +1.25D).</Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, t1</Suffix><ARTGs><ARTG>98915</ARTG></ARTGs><MinimumBenefit>530</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WP008</BillingCode><Name>Primus-HD Toric Clear</Name><Description>Preloaded Injector system, Biconvex optical with toric and high order coefficient aspheric surface IOL, foldable, one piece, hydrophobic acrylic, UV filter, 360 square edge</Description><Size>IOL Cylinder powers are : +1.00D, +1.50D, +2.25D, +3.00D, +4.00D and +4.50D Cylinder powers at corneal plane are : +0.72D, +1.07D, +1.59D, +2.11D, +2.8D, and +3.15D</Size><SupplierCode>40395</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, t1</Suffix><ARTGs><ARTG>397250</ARTG></ARTGs><MinimumBenefit>530</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG016</BillingCode><Name>RayOne Toric (Model RAO610T)</Name><Description>Single piece preloaded aspheric toric acrylic IOL, UV absorbing, 360 square edge, anti-vaulting haptics</Description><Size>6mm optic, +8 ro +30 sphere, +1 to +6 cylinder in 0.5 steps</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, t1</Suffix><ARTGs><ARTG>220612</ARTG></ARTGs><MinimumBenefit>530</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU004</BillingCode><Name>Medicontur Bi-Flex POB-MA Toric 877PT</Name><Description>Single piece posterior chamber hydrophobic acrylic monofocal toric intraocular lens. Preloaded with biconvex aspheric optic.</Description><Size>Powers: +10.0 D to +30.0 D in 0.5 diopter increments  Cylinder powers: 1.00 D, 1.50 D, 2.25 D, 3.00 D, 3.75 D, 4.50 D, 5.25 D, 6.00 D</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, t1</Suffix><ARTGs><ARTG>221834</ARTG></ARTGs><MinimumBenefit>530</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AO050</BillingCode><Name>TECNIS Eyhance Toric II Simplicity</Name><Description>1-piece enhanced monofocal pre-loaded IOL</Description><Size>+05.0 D to +34.0 D in 0.5 D increments. overall diameter: 13mm, optic size 6mm. Cylinder power: 1.00 D, 1.50 D, 2.25 D, 3.00 D, 3.75 D, 4.5 D, 5.25 D, 6.00 D</Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, t1</Suffix><ARTGs><ARTG>412991</ARTG></ARTGs><MinimumBenefit>530</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AO042</BillingCode><Name>Tecnis Toric 1-Piece Pre-Loaded IOL</Name><Description>1-piece IOL Posterior chamber Intraocular lens , incorporates a proprietary wavefront designed toric aspheric optic with a squared posterior optic edge designed to provide 360 degree barrier. The edge of the optic has a frosted design to reduce potential edge glare effects.</Description><Size>+5.0 to +34.0 diopter powers in 0.5 diopter increments. Cylinder power: 1.00 diopter, 1.50 diopter, 2.25 diopter, 3.00 diopter, 3.75 diopter, 4.00 diopter, 4.50 diopter, 5.25 diopter and 6.00 diopter (as measured at the IOL plane). Overall diameter 13mm, Optic size 6mm.</Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, t1</Suffix><ARTGs><ARTG>181845</ARTG></ARTGs><MinimumBenefit>530</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL045</BillingCode><Name>LuxGood Toric Preloaded Crystal</Name><Description>The LuxGood Toric intraocular lens (IOL) is a single-piece ultraviolet (UV) absorbing, posterior chamber, hydrophobic acrylic IOL and has aspheric and toric optics. The lens is provided sterile and is designed to be folded prior to insertion into the eye. The preloaded intraocular LuxGood Toric lens is supplied with an Accuject Pro Delivery System to provide a touch-free method of delivery of the lens into the capsular bag.</Description><Size>Body Diameter: 6.0 mm; Overall Diameter: 11 mm Haptic Angle: 0°  Powers: +6.00 to +34.00 Diopters Cylindrical Powers: +0.75 to +6.00 Diopters  </Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, t1</Suffix><ARTGs><ARTG>342175</ARTG></ARTGs><MinimumBenefit>530</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AO024</BillingCode><Name>Tecnis® One Piece (ZCB00)</Name><Description>One piece intraocular lens with edge modification and 360 degree square edge</Description><Size>+5 to +34 diopter powers in 0.5d increments. Overall diameter 13mm, Optic size 6mm</Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>170331</ARTG></ARTGs><MinimumBenefit>232</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AO043</BillingCode><Name>TECNIS® Eyhance IOL</Name><Description>1-piece enhanced monofocal IOL</Description><Size>+5.0 to 34.0 diopter powers in 0.5 diopter increments. Overall diamter 13mm, optic size 6mm</Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>170331</ARTG></ARTGs><MinimumBenefit>232</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CZ030</BillingCode><Name>CT ASPHINA 404</Name><Description>Small incision, foldable, single piece, monofocal, aspheric (aberration neutral), square-edged, hydrophilic acrylic (with hydrophobic surface properties) intraocular lens for capsular bag fixation. (Monofocal lens for powers outside standard 409MP MICS range).</Description><Size>Diopter range: -10.0 to 42.0, Optic size: 6.0mm, Overall length: 11.0mm</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>151348</ARTG></ARTGs><MinimumBenefit>232</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AO014</BillingCode><Name>TECNIS® Intraocular Lens (ZA9003)</Name><Description>Foldable Intraocular Lenses - Ultraviolet light absorbing posterior chamber intraocular lenses, Silicone/Acrylic</Description><Size>+10.0  to +30.0 D in 0.5 D increments</Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>170331</ARTG></ARTGs><MinimumBenefit>232</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG012</BillingCode><Name>Rayner "C-Flex" and Superflex" Aspheric IOL</Name><Description>Aspheric Intra Ocular Lenses with Amon-Apple enhanced 360 Degree square edge, Anti-vaulting Haptics</Description><Size>C-Flex -970C + 22.5D to +34D Superflex-920H - 10D to +22D</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>100926</ARTG></ARTGs><MinimumBenefit>232</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IQ013</BillingCode><Name>PreciSAL 302AC</Name><Description>Acrylic, single piece, foldable intraocular lens with anterior and posterior optic-haptic square edge, 360 degree optic square edge design, precision power calculation, aberration technology and UV light filter.</Description><Size>Available in dioptric powers from 0.0 to +30.0. 1D steps: 0.0 to +10.0; 0.5D steps: +10.5 to + 17.5 and +28.5 to +30.0; 0.25D steps: +18.0 to +28.0</Size><SupplierCode>40011</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>183558</ARTG></ARTGs><MinimumBenefit>232</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL044</BillingCode><Name>LuxGood Toric Preloaded</Name><Description>The LuxGood Toric intraocular lens (IOL) is a single-piece ultraviolet (UV) absorbing, posterior chamber, hydrophobic acrylic IOL, with blue light filtering and has aspheric and toric optics. The lens is provided sterile and is designed to be folded prior to insertion into the eye. The preloaded intraocular LuxGood Toric lens is supplied with an Accuject Pro Delivery System to provide a touch-free method of delivery of the lens into the capsular bag.</Description><Size>Body Diameter: 6.0 mm; Overall Diameter: 11 mm Haptic Angle: 0°  Powers: +6.00 to +34.00 Diopters Cylindrical Powers: +0.75 to +6.00 Diopters  </Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, t1, vblf</Suffix><ARTGs><ARTG>342175</ARTG></ARTGs><MinimumBenefit>585</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG004</BillingCode><Name>Rayner Premium Toric C-Flex</Name><Description>HEMA-MMA copolymer, foldable with injector</Description><Size>5.75mm dia optic, 12.00mm dia overall, cyls 1.5D to 11.0D in 0.5D increments</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>t2</Suffix><ARTGs><ARTG>100926</ARTG></ARTGs><MinimumBenefit>666</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL023</BillingCode><Name>Akreos Advanced Optic</Name><Description>Posterior chamber, foldable acrylic IOL, with anterior optic-haptic square edge, posterior optic-haptic square edge, 360 degree optic square edge and aspheric optic for aberration control</Description><Size>0 D to 30.0 D</Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>98915</ARTG></ARTGs><MinimumBenefit>232</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG013</BillingCode><Name>Rayner Super Premium Toric I.O.L.</Name><Description>Acrylic foldable toric single piece I.O.L</Description><Size>-10.0D to 0.00D Sphere: 1D to 11.00D Cylinder in 0.25 steps                                                           +31.00D to +35.00 Spit: 1D to 11.00D Cylinder in 0.25steps</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>t2</Suffix><ARTGs><ARTG>100926</ARTG></ARTGs><MinimumBenefit>666</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU008</BillingCode><PriorBillingCodes><PriorBillingCode>IS022</PriorBillingCode></PriorBillingCodes><Name>Medicontur BiFlex 677TAY Hydrophilic Acrylic Foldable Toric Lens with Blue light Filter</Name><Description>Posterior chamber IOL, 360° Special Square Edge,  Aspheric – Coma optimized – Toric</Description><Size>Optic diameter: 6.0 mm ±0.05 mm, Overall diameter: 13.0 mm ±0.10 mm  Powers available:  -10.0  -  +30.0 D ±0.25 D increment:  0.5 D   +31.0  - +35.0 D ±0.5 D increment:  1.0 D  Cylinders available:    +1.5 D - +7.0 D increment:  0.75 D</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t1, vblf</Suffix><ARTGs><ARTG>221834</ARTG></ARTGs><MinimumBenefit>471</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL022</BillingCode><Name>SofPort Advanced Optic (AO)</Name><Description>Posterior chamber, foldable silicone IOL with anterior optic-haptic square edge, posterior optic-haptic square edge, 360-degree optic square edge and asperic optic for aberration control</Description><Size>0 D to 30.0 D</Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>98915</ARTG></ARTGs><MinimumBenefit>232</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL052</BillingCode><Name>Enhanced enVista IOL</Name><Description>The enhanced enVista (Model MX60E) is an ultraviolet-absorbing, posterior chamber, hydrophobic acrylic intraocular lens (IOL). They have an aspheric lens optic, square posterior edge, and modified C haptics. The lenses can be folded for insertion into the eye.</Description><Size>Specification:   Optic Body Diameter 6.0   Overall Diameter 12.5 Haptic Angulations Planar Haptic   Lens Power Range +0.0 to +34.0 Diopters (0.0 to +10.0 in 1.0 Diopter increments, +10.0 to +30.0 in 0.5 Diopter increments, and +30.0 to +34.0 in 1.0 Diopter increments)</Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>98915</ARTG></ARTGs><MinimumBenefit>232</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU010</BillingCode><PriorBillingCodes><PriorBillingCode>IS023</PriorBillingCode></PriorBillingCodes><Name>Medicontur BiFlex 677TAY Hydrophilic Acrylic Foldable Toric Lens with Blue light Filter</Name><Description>Posterior chamber IOL, 360° Special Square Edge,  Aspheric – Coma optimized – Toric</Description><Size>Optic diameter: 6.0 mm ±0.05 mm, Overall diameter: 13.0 mm ±0.10 mm  Powers available:  -10.0  -  +30.0 D ±0.25 D increment:  0.5 D  +31.0  - +35.0 D ±0.5 D increment:  1.0 D  Cylinders available:    +7.0 D - +9.0 D increment:  0.75 D  +9.0 D - +10.0 D increment:  1.0 D</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t2, vblf</Suffix><ARTGs><ARTG>221834</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL045</BillingCode><Name>AcrySof Aspheric UV Absorbing Toric Intraocular Lens</Name><Description>AcrySof UV Absorbing Toric is a biconvex, toric, aspheric, UV-absorbing, single-piece, foldable, hydrophobic monofocal intraocular lens</Description><Size>+6.0 to +34.0 diopter</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>514</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO060</BillingCode><Name>HumanOptics Torica</Name><Description>Toric posterior chamber IOL, foldable, UV absorber, Aspheric, aberration technology, 360° LEC barrier, HD optic</Description><Size>Sphere -20D to +59D, Cylinder 1D to 6D</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>227764</ARTG></ARTGs><MinimumBenefit>514</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU018</BillingCode><PriorBillingCodes><PriorBillingCode>IS048</PriorBillingCode></PriorBillingCodes><Name>Basis Z Hydrophilic Toric</Name><Description>Foldable hydrophilic toric intraocular lens</Description><Size>Available in spherical diopter powers from -10.0D to +35.0D in 0.5D steps from +10.0D to +30.0D and then 1.0D steps in the ranges of -10.0D to 9.0D and +31.0D to +35.0D. Cylinder Power range is 1.5-6.0D in 0.75D steps.</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t1, vblf</Suffix><ARTGs><ARTG>280510</ARTG></ARTGs><MinimumBenefit>471</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DV267</BillingCode><Name>Hoya Vivinex XY1AT Toric</Name><Description>Preloaded injector system, toric / corrects corneal astigmatism, micro-incision, aspheric, blue blocker, single piece hydrophobic</Description><Size>IOL Power: + 10.0 to 30.0 (0.5 steps), IOL Cylinder power: 1.0D (XY1AT2), 1.50D (XY1AT3), 2.25D (XY1AT4), 3.00D (XY1AT5), 3.75D (XY1AT6), 4.50D (XY1AT7), 5.25D (XY1AT8), 6.00D (XY1AT9)</Size><SupplierCode>39976</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, t1, vblf</Suffix><ARTGs><ARTG>287542</ARTG></ARTGs><MinimumBenefit>585</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL049</BillingCode><Name>Clareon AutonoMe Toric</Name><Description>Clareon AutonoMe Toric consists of a Clareon Toric Aspheric Hydrophobic Acrylic Intraocular Lens (Clareon Toric IOL) pre-loaded on the AutonoMe Automated Delivery System.</Description><Size>+6.0 to +30.0 diopters</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, t1, vblf</Suffix><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>585</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE674</BillingCode><Name>LENTIS Tplus LU-814T</Name><Description>Foldable one-piece acrylic posterior chamber aspheric toric IOL for capsular bag, sulcus and sulcus-sclera fixation.</Description><Size>Optic size: 6.2mm ,-10.0D to +23.0D (SEQ), 5.5mm +23.01D to +35.0D (SEQ) Overall length: 13.0mm, Available Dioptres: sph. -10.0D to +35.0D (0.01D increments), cyl. +0.25D to +12.0D (0.01D increments), axis. 1 degree increments.</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>328681</ARTG></ARTGs><MinimumBenefit>514</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE515</BillingCode><Name>LENTIS TplusX LU-313T</Name><Description>Foldable one-piece monofocal  toric IOL for capsular bag fixation</Description><Size>Optic Size 6.0mm, overall length 11.0mm. Sph -10.0D to +36.0D (in 0.01D increments) Cyl +0.50 to +10.0D cyl (in 0.01D increments), sph  + cyl &lt;40.0D,  axis 1 degree scaling</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>328681</ARTG></ARTGs><MinimumBenefit>514</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE517</BillingCode><Name>LENTIS LS-313T0-T6</Name><Description>Foldable one-piece monofocal toric acrylic IOL.</Description><Size>Optic Size 6.0mm, Overall Length 11.00mm. Available diopters: +10.0D to +30.0D (0.5D). Cyl: (T0 +0.75D) (T1 +1.5D) (T2 +2.25D) (T3 +3.0D) (T4 + 3.75D) (T5 + 4.5D) (T6 +5.25D)</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>328681</ARTG></ARTGs><MinimumBenefit>514</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LN010</BillingCode><Name>I-stream Toric Hydrophilic</Name><Description>One-piece posterior chamber lens with aspherical surface for capsular bag fixation.</Description><Size>Optic diameter: 6mm
Total diameter: 11mm
Diopter range: +15.0 to +25.0D (standard), 1.0 to 14.5D and 25.5 to 40.0D (made to order)
Cylinder range: 0.75 to 6.0D</Size><SupplierCode>40187</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>307407</ARTG></ARTGs><MinimumBenefit>514</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG018</BillingCode><Name>T-Flex Aspheric - Toric &lt;7 diopter</Name><Description>Acrylic foldable posterior chamber IOLs, aspheric, toric &lt;7 diopter</Description><Size>Standard -
Spheres: +6.0 to +30.0 D (spherical equivalent)
Cylinders: +1.0 to +6.0 D
Made to Order -
Spheres: -10.0 to +35.0 D (subject to spherical equivalent)
Cylinders: +1.0 to +6.0 D</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>100926</ARTG></ARTGs><MinimumBenefit>514</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AO046</BillingCode><Name>TECNIS® Eyhance Toric IOL</Name><Description>1-piece enhanced monofocal toric IOL</Description><Size>+5.0 to +34.0 diopter powers in 0.5 diopter increments.  Overall diameter 13mm, Optic size 6mm.  Cylinder power: 1.00, 1.50, 2.25, 3.00, 3.75, 4.00, 4.50, 5.25 and 6.00 diopter (as measured at the IOL plane). </Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>181845</ARTG></ARTGs><MinimumBenefit>514</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU003</BillingCode><Name>Medicontur Bi-Flex POB-MA Toric 877PTY</Name><Description>Single piece hydrophobic acrylic monofocal toric posterior chamber intraocular lens. Preloaded with blue light filter and with biconvex aspheric optic.</Description><Size>Powers: +10.0 D to +30.0 D in 0.5 diopter increments  Cylinder powers: 1.00 D, 1.50 D, 2.25 D, 3.00 D, 3.75 D, 4.50 D, 5.25 D, 6.00 D</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, t1, vblf</Suffix><ARTGs><ARTG>221834</ARTG></ARTGs><MinimumBenefit>585</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IQ020</BillingCode><Name>PreciSAL Toric PT302A</Name><Description>Pre-loaded acrylic single piece, foldable intraocular lens with anterior and posterior optic-haptic square edge, 360 degree optic square edge design, precision power calculation, aberration technology, toric correction on anterior surface with cylinder marks to indicate flat meridian plus the cylinder axis to allow alignment for astigmatic correction, and UV and blue light filters.</Description><Size>Available in spherical dioptric powers from 0.0 to +30.0. 1D steps: 0.0 to +10.0; 0.5D steps: +10.5 to +17.5 and +28.5 to +30.0; 0.25D steps: +18.0 to +28.0; Cylinder powers from 1.0D to 6.0D</Size><SupplierCode>40011</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, t1, vblf</Suffix><ARTGs><ARTG>183558</ARTG></ARTGs><MinimumBenefit>585</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU028</BillingCode><Name>Medicontur BiFlex 677CTAY Preloaded Hydrophilic Acrylic Foldable Toric Lens with Blue light Filter</Name><Description>Preloaded Posterior chamber IOL with blue light filter, 360° Special Square Edge,  Aspheric – Coma optimized – Toric</Description><Size>Optic diameter: 6.0 mm, Overall diameter: 13.0 mm. Sph eq powers available: +8.0 to +35.0, Cylinders 1.0 to 6.0D.</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, t1, vblf</Suffix><ARTGs><ARTG>221834</ARTG></ARTGs><MinimumBenefit>585</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG019</BillingCode><Name>T-Flex Aspheric - Toric ≥7 diopter</Name><Description>Acrylic foldable posterior chamber IOLs, aspheric, toric ≥7 diopter</Description><Size>Standard
Spheres: +6.0 to +30.0 D (spherical equivalent)
Cylinders: +1.0 to +6.0 D
Made to Order
Spheres: -10.0 to +35.0 D (subject to spherical equivalent)
Cylinders: +7.0 to +11.0 D</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t2</Suffix><ARTGs><ARTG>100926</ARTG></ARTGs><MinimumBenefit>753</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO058</BillingCode><Name>HumanOptics Torica Y</Name><Description>Toric posterior chamber IOL, foldable, UV absorber, Aspheric, aberration technology, 360° LEC barrier, HD optic, Blue light filter</Description><Size>Sphere -20D to +59D, Cylinder 7D to 30D</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t2, vblf</Suffix><ARTGs><ARTG>227764</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO059</BillingCode><Name>HumanOptics Torica</Name><Description>Toric posterior chamber IOL, foldable, UV absorber, Aspheric, aberration technology, 360° LEC barrier, HD optic</Description><Size>Sphere -20D to +59D, Cylinder 7D to 30D</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t2</Suffix><ARTGs><ARTG>227764</ARTG></ARTGs><MinimumBenefit>753</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AO047</BillingCode><Name>TECNIS® Eyhance Toric IOL</Name><Description>1-piece enhanced monofocal toric IOL</Description><Size>+5.0 to +34.0 diopter powers in 0.5 diopter increments. Overall diameter 13mm, Optic size 6mm. Cylinder power: 7.00 and 8.00 diopter (as measured at the IOL plane).</Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t2</Suffix><ARTGs><ARTG>181845</ARTG></ARTGs><MinimumBenefit>753</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AO040</BillingCode><Name>TECNIS® Toric 1-Piece IOL</Name><Description>1-piece IOL Posterior chamber Intraocular lens, incorporates a proprietary wavefront designed toric aspheric optic with a squared posterior optic edge designed to provide a 360 degree barrier. The edge of the optic has a frosted design to reduce potential edge glare effects.</Description><Size>+5.0 to +34.0 diopter powers in 0.5 diopter increments.  Cylinder power: 7.00 diopter, 8.00 diopter (as measured at the IOL plane). Overall diameter 13mm, Optic size 6mm.</Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t2</Suffix><ARTGs><ARTG>181845</ARTG></ARTGs><MinimumBenefit>753</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU009</BillingCode><PriorBillingCodes><PriorBillingCode>IS025</PriorBillingCode></PriorBillingCodes><Name>Medicontur BiFlex 677TA Hydrophilic Acrylic Foldable Toric Lens without Blue light Filter</Name><Description>Posterior chamber IOL, 360° Special Square Edge,  Aspheric – Coma optimized – Toric</Description><Size>Optic diameter: 6.0 mm ±0.05 mm, Overall diameter: 13.0 mm ±0.10 mm  Powers available:  -10.0  -  +30.0 D ±0.25 D increment:  0.5 D   +31.0  - +35.0 D ±0.5 D increment:  1.0 D  Cylinders available:    +7.0 D - +9.0 D increment:  0.75 D  +9.0 D - +10.0 D increment:  1.0 D</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t2</Suffix><ARTGs><ARTG>221834</ARTG></ARTGs><MinimumBenefit>753</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL016</BillingCode><Name>Alcon Acrysof Natural Model SN60AT</Name><Description>Foldable Acrylic Single-piece Lens, asymmetric optic/consistent edge, with blue light protection</Description><Size>+6 to +40D</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>vblf</Suffix><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>232</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL025</BillingCode><Name>AcrySof Multipiece Models MN60MA, MN60AC</Name><Description>Foldable Acrylic multi-piece Lens with Blue light Protection</Description><Size>- 5 D to + 30 D</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>vblf</Suffix><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>232</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU027</BillingCode><Name>Medicontur BiFlex 677CTA Preloaded Hydrophilic Acrylic Foldable Toric Lens without Blue light Filter</Name><Description>Preloaded Posterior chamber IOL, 360° Special Square Edge,  Aspheric – Coma optimized – Toric</Description><Size>Optic diameter: 6.0 mm, Overall diameter: 13.0 mm. Sph eq powers available: +8.0 to +35.0, Cylinders 1.0 to 6.0D.</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, t1</Suffix><ARTGs><ARTG>221834</ARTG></ARTGs><MinimumBenefit>530</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG017</BillingCode><Name>RayOne Ashperic preloaded</Name><Description>Preloaded aspheric intraocular lens, hydrophilic acrylic, UV absorbing, 360 square edge, anti-vaulting haptics</Description><Size>6mm optic, range sphere -10 to +34</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>220612</ARTG></ARTGs><MinimumBenefit>239</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG020</BillingCode><Name>RayOne Hydrophobic IOL</Name><Description>Hydrophobic acrylic IOL, preloaded injector system, micro incision, aspheric, UV filtering, single piece.</Description><Size>Power range: 
-10.0 D to +7.0 D (1.0 D increments, including plano)
+8.0 D to +30.0 D (0.5 D increments)
+31.0 D to +32.0 D (1.0 D increments) 
Shapes:
Biconvex (positive powers), Plano, Concave (negative powers)</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>100926</ARTG></ARTGs><MinimumBenefit>239</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU005</BillingCode><PriorBillingCodes><PriorBillingCode>IS036</PriorBillingCode></PriorBillingCodes><Name>BiFlex 877PA Preloaded Hydrophobic Acrylic Foldable Aspheric Monofocal Lens without Blue Light Filter</Name><Description>Posterior Chamber IOL, special 360° sharp edge, Aspheric Aberration Balanced</Description><Size>Optic diameter: 6.0 mm ±0.10 mm, Overall diameter: 13.0 mm ±0.20 mm  Powers available:   -0.0 - +9.0 D  ±0.25 D increment: 1.0 D  +10.0 - +25.0 D ±0.25 D increment: 0.5 D   +25.5 - +30.0 D ±0.5 D  increment: 0.5 D  +31.0 - +35.0 D ±0.5 D  increment: 1.0 D</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>221834</ARTG></ARTGs><MinimumBenefit>239</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU016</BillingCode><PriorBillingCodes><PriorBillingCode>IS043</PriorBillingCode></PriorBillingCodes><Name>Basis Z Preloaded Hydrophylic IOL</Name><Description>Hydrophylic preloaded IOL</Description><Size>6mm Optic Diameter and 13mm Length</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>280510</ARTG></ARTGs><MinimumBenefit>239</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AO034</BillingCode><Name>TECNIS® 1-Piece Pre-Loaded IOL</Name><Description>1-piece IOL Posterior Chamber Intraocular lens, incorporates a proprietary wavefront-designed aspheric optic with a squared posterior optic edge designed to provide a 360 degree barrier. The edge of the optic has a frosted design to reduce potential edge glare effects. Supplied pre-loaded in either a screw style disposable injector or in a pre-loaded cartridge.</Description><Size>+5.0 to +34.0 diopter powers in 0.5 diopter increments.  Overall diameter 13mm, Optic size 6mm</Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>377171</ARTG></ARTGs><MinimumBenefit>239</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IQ014</BillingCode><Name>PreciSAL P302AC  PreciSAL PS302AC</Name><Description>Preloaded Acrylic, single piece, foldable intraocular lens with anterior and posterior optic-haptic square edge, 360 degree optic square edge design, precision power calculation, aberration technology and UV light filter.</Description><Size>Available in dioptric powers from 0.0 to +30.0. 1D steps: 0.0 to +10.0; 0.5D steps: +10.5 to + 17.5 and +28.5 to +30.0; 0.25D steps: +18.0 to +28.0</Size><SupplierCode>40011</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>183558</ARTG></ARTGs><MinimumBenefit>239</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG036</BillingCode><Name>Simedice Intraocular Lens</Name><Description>Foldable Acrylic Single-piece Lens with Blue Light Protection and Aspheric Correction</Description><Size>Spherical power: +10.0 to +30.0 D, in 0.5 increments</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, vblf</Suffix><ARTGs><ARTG>385552</ARTG></ARTGs><MinimumBenefit>221</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IQ015</BillingCode><Name>PreciSAL 302A</Name><Description>Acrylic, single piece, foldable intraocular lens with anterior and posterior optic-haptic square edge, 360 degree optic square edge design, precision power calculation, aberration technology and blue light filter.</Description><Size>Available in dioptric powers from 0.0 to +30.0. 1D steps: 0.0 to +10.0; 0.5D steps: +10.5 to +17.5 and +28.5 to +30.0; 0.25D steps: +18.0 to +28.0</Size><SupplierCode>40011</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, vblf</Suffix><ARTGs><ARTG>183558</ARTG></ARTGs><MinimumBenefit>221</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL021</BillingCode><Name>Alcon AcrySof SN60WF</Name><Description>Foldable Acrylic Single-piece Lens with Blue Light Protection and Aspheric Correction</Description><Size>+ 6.0 D to +30.0 D</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, vblf</Suffix><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>221</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO055</BillingCode><Name>HumanOptics Aspira Y</Name><Description>Posterior chamber IOL, foldable, UV absorber, Aspheric, aberration technology, 360° LEC barrier, HD optic, Blue light filter</Description><Size>-20 to +60 D</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, vblf</Suffix><ARTGs><ARTG>227764</ARTG></ARTGs><MinimumBenefit>221</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL032</BillingCode><Name>enVista Toric</Name><Description>The enVista toric (Model MX60T) is a one-piece glistening-free hydrophobic foldable IOL. The enVista Toric, model MX60T IOL has a Toric aspheric lens optic, a square posterior edge and modified C haptics, an overall diameter of 12.5mm and an optic body of 6.0mm.  It is available in multiple spherical and cylindrical powers.</Description><Size>Overall diameter is 12.5mm for the entire lens power range, with spherical equivalent powers from +6.0 to +30.0 Diopters in 0.5 Diopter steps and cylinder powers from +1D to 6D  Diopters (at the IOL plane).</Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, t1</Suffix><ARTGs><ARTG>98915</ARTG></ARTGs><MinimumBenefit>530</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO057</BillingCode><Name>HumanOptics Torica Y</Name><Description>Toric posterior chamber IOL, foldable, UV absorber, Aspheric, aberration technology, 360° LEC barrier, HD optic, Blue light filter</Description><Size>Sphere -20D to +59D, Cylinder 1D to 6D</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t1, vblf</Suffix><ARTGs><ARTG>227764</ARTG></ARTGs><MinimumBenefit>471</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL056</BillingCode><Name>Clareon Toric Aspheric Hydrophobic Acrylic IOL </Name><Description>The Clareon Toric Aspheric Hydrophobic Acrylic IOL is a toric, UV-absorbing, blue light filtering, foldable, single-piece posterior chamber intraocular lens.</Description><Size>+6.0 to +30.0 diopters (in 0.5 diopter increments). Cylinder 1.00 – 6.00 diopters</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t1, vblf</Suffix><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>471</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL032</BillingCode><Name>AcrySof IQ Toric IOL</Name><Description>Posterior chamber, UV absorbing, foldable, acrylic, toric, single piece lens with blue light protection and aspheric correction</Description><Size>+6 to +30 D spherical, +31.0 to +34.0 (1.0 D increments); 1.00 to 	6.00 D cylinder.</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t1, vblf</Suffix><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>471</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WP002</BillingCode><Name>Primus-HD Toric Yellow</Name><Description>Preloaded Injector system, Biconvex optical with toric and high order coefficient aspheric surface IOL, foldable, one piece, hydrophobic acrylic, blue light filter, 360 square edge</Description><Size>IOL Cylinder powers are : +1.00D, +1.50D, +2.25D, +3.00D, +4.00D and +4.50D Cylinder powers at corneal plane are : +0.72D, +1.07D, +1.59D, +2.11D, +2.8D, and +3.15D</Size><SupplierCode>40395</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t1, vblf</Suffix><ARTGs><ARTG>397250</ARTG></ARTGs><MinimumBenefit>471</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LN005</BillingCode><Name>ALSAFIT TORIC VF</Name><Description>Single piece toric aspheric foldable intraocular lens for implantation into the capsular bag. Violet filter.</Description><Size>Diopter power range: Sphere: From 0.0 D to +32.00 D (0.50 D increments). Cylinder: From +0.50 D to +6.00 D (0.50 D increments).
Optic size: 6mm. Overall length: 11.0mm.</Size><SupplierCode>40187</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t1, vblf</Suffix><ARTGs><ARTG>268033</ARTG></ARTGs><MinimumBenefit>471</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IQ019</BillingCode><Name>PreciSAL Toric T302A</Name><Description>Acrylic single piece, foldable intraocular lens with anterior and posterior optic-haptic square edge, 360 degree optic square edge design, precision power calculation, aberration technology, toric correction on anterior surface with cylinder marks to indicate flat meridian plus the cylinder axis to allow alignment for astigmatic correction, and UV and blue light filters.</Description><Size>Available in spherical dioptric powers from 0.0 to +30.0. 1D steps: 0.0 to +10.0; 0.5D steps: +10.5 to +17.5 and +28.5 to +30.0; 0.25D steps: +18.0 to +28.0; Cylinder powers from 1.0D to 6.0D</Size><SupplierCode>40011</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t1, vblf</Suffix><ARTGs><ARTG>183558</ARTG></ARTGs><MinimumBenefit>471</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG039</BillingCode><Name>Simedice Toric IOL</Name><Description>Posterior chamber, UV absorbing, foldable, acrylic, toric, single piece lens with blue light protection and aspheric correction.</Description><Size>Sperical diopter: +10.0 to +30.0 D, in 0.5 increments Cylinder power: 0.75 to 5.75</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t1, vblf</Suffix><ARTGs><ARTG>385551</ARTG></ARTGs><MinimumBenefit>471</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG003</BillingCode><Name>Rayner Standard Toric C-Flex</Name><Description>Hydrophilic HEMA-MMA copolymer, foldable with injector</Description><Size>5.00mm dia optic, 12.00mm dia overall, cyls 2.0D to 6.0D in 2D increments</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>t1</Suffix><ARTGs><ARTG>100926</ARTG></ARTGs><MinimumBenefit>465</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL037</BillingCode><Name>MicroPure 123</Name><Description>Preloaded, posterior chamber, UV absorbing, foldable, aspheric, acrylic, single piece hydrophobic glistening-free Intra Ocular Lens.</Description><Size>Overall diameter of 10D to 24.5D: 11.00mm
25D to 30D: 10.75mm

Optic diameter of 10D to 24.5D: 6.00mm
25D to 30 D: 5.75mm

Power from 10D to 30D with 0.5 diopter increments.</Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, vblf</Suffix><ARTGs><ARTG>211587</ARTG></ARTGs><MinimumBenefit>291</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG037</BillingCode><Name>RayOne Hydrophobic Aspheric BLF IOL</Name><Description>Hydrophobic acrylic IOL, preloaded injector system, micro incision, aspheric, UV filtering, single piece, with blue light filtering.</Description><Size>Power range:   +0.0 D to +7.0 D (1.0 D increments)  +8.0 D to +30.0 D (0.5 D increments)  +31.0 D to +32.0 D (1.0 D increments)Shapes:  Biconvex (positive powers), Plano</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, vblf</Suffix><ARTGs><ARTG>100926</ARTG></ARTGs><MinimumBenefit>291</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CZ047</BillingCode><Name>CT LUCIA 621PY</Name><Description>One ZEISS UV light-absorbing Heparin Surface Hydrophobic Acrylic Posterior Chamber Intra-ocular Lens. This lens is intended to correct aphakia. It is made from an optically clear hydrophobic acrylic with yellow dye additive (Acrylmex Yellow) [Optically clear blue-light blocking]</Description><Size>Dioptre Range: 00.0 to +34.0 with increments of 0.5   Optic Size: 6.0mm   Overall Length: 13.0mm</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, vblf</Suffix><ARTGs><ARTG>389793</ARTG></ARTGs><MinimumBenefit>291</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU006</BillingCode><PriorBillingCodes><PriorBillingCode>IS034</PriorBillingCode></PriorBillingCodes><Name>BiFlex Preloaded 877PAY Hydrophobic Acrylic Foldable Aspheric Monofocal Lens with Blue light Filter</Name><Description>Posterior Chamber IOL, special 360° sharp edge, Aspheric - Aberration Balanced</Description><Size>Optic diameter: 6.0 mm ±0.10 mm, Overall diameter: 13.0 mm ±0.20 mm Powers available: -0.0 - +9.0 D ±0.25 D increment: 1.0 D  +10.0 -+25.0  D ±0.25 D increment: 0.5 D  +25.5- +30.0 D ±0.5 D increment: 0.5 D  +31.0 - +35.0 D ±0.5 D increment: 1</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, vblf</Suffix><ARTGs><ARTG>221834</ARTG></ARTGs><MinimumBenefit>291</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE648</BillingCode><Name>FEMTIS FB-313</Name><Description>Foldable one-piece monofocal acrylic plate haptic IOL for fixation in the capsulorhexis</Description><Size>Optic Size 5.7mm, Overall length 10.5mm. Available Diopters: +-15.0D to 30.0D (0.5D steps)</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>328681</ARTG></ARTGs><MinimumBenefit>232</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LN008</BillingCode><Name>ALSIOL</Name><Description>Single piece aspheric foldable intraocular lens for implantation into the capsular bag.</Description><Size>Diopter power range: 0.0 D to +32.00 D (0.50 D increments). Optic size: 6 mm. Overall length: 11.0 mm.</Size><SupplierCode>40187</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>277174</ARTG></ARTGs><MinimumBenefit>232</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE492</BillingCode><Name>LENTIS L-313</Name><Description>Foldable one-piece monofocal acrylic plate haptic IOL</Description><Size>Optic Size 6.0mm, Overall length 11.0mm. Available Diopters: +-10.0D to 36.0D (1.0D steps) +10.5D to 29.5D (0.5D steps)</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>328681</ARTG></ARTGs><MinimumBenefit>232</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-09-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LN013</BillingCode><Name>Vision Pro Hydrophobic Acrylic Aspheric Intraocular Lens (RS60A)</Name><Description>Hydrophobic Acrylic Aspheric Posterior Chamber Foldable IOL</Description><Size>Aspheric IOL: +0 to +34 D in 0.5 D increments; Overall diameter 13mm, Optic size 6mm.</Size><SupplierCode>40187</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>344091</ARTG></ARTGs><MinimumBenefit>232</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE673</BillingCode><Name>LENTIS LU-814VR</Name><Description>Foldable one-piece acrylic posterior chamber aspheric IOL for capsular bag, sulcus and sulcus-sclera fixation.</Description><Size>Optic size: 6.2mm 0.0D to +23.0D, 5.5mm +23.01D to +35.0D , Overall length: 13.0mm, Available Dioptres: 0.0D to +35.0D (1.0D steps), +15.5D to +26.5D (0.5D steps).</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>328681</ARTG></ARTGs><MinimumBenefit>232</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO074</BillingCode><Name>HumanOptics Aspira</Name><Description>Posterior chamber IOL, foldable, UV absorber, Aspheric, aberration technology, 360° LEC barrier, HD optic</Description><Size>-20.0 to +60.0 D</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>227764</ARTG></ARTGs><MinimumBenefit>232</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO084</BillingCode><Name>Aspira-aXA</Name><Description>Posterior chamber IOL, foldable, UV absorber, Aspheric, aberration technology, 360° LEC barrier, HD optic.</Description><Size>-20D to +40 D.</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>227764</ARTG></ARTGs><MinimumBenefit>232</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AO048</BillingCode><Name>TECNIS® Eyhance Pre-Loaded IOL</Name><Description>1-piece enhanced monofocal pre-loaded IOL</Description><Size>+5.0 to 34.0 diopter powers in 0.5 diopter increments. Overall diameter 13mm, optic size 6mm</Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>377170</ARTG></ARTGs><MinimumBenefit>239</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CZ048</BillingCode><Name>CT LUCIA 621P</Name><Description>One ZEISS UV light-absorbing Heparin Surface Hydrophobic Acrylic Posterior Chamber Intra-ocular Lens. This lens is intended to correct aphakia. It is made from an optically clear hydrophobic acrylic material which incorporates an UV-absorbing component and has a Heparin coating.</Description><Size>Dioptre Range: 00.0 to +34.0 with increments of 0.5  Optic Size: 6.0mm  Overall Length: 13.0mm</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>389794</ARTG></ARTGs><MinimumBenefit>239</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO075</BillingCode><Name>HumanOptics Aspira Preloaded</Name><Description>Preloaded posterior chamber IOL, foldable, UV absorber, Aspheric, aberration technology, 360° LEC barrier, HD optic</Description><Size>+10.0 to +40.0 D</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>227764</ARTG></ARTGs><MinimumBenefit>239</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL041</BillingCode><Name>LuxGood Preloaded Crystal</Name><Description>The LuxGood intraocular lens (IOL) is a single-piece ultraviolet (UV) absorbing, posterior chamber, hydrophobic acrylic IOL and has aspheric optics. The lens is provided sterile and is designed to be folded prior to insertion into the eye. The preloaded intraocular LuxGood lens is supplied with an Accuject Pro Delivery System to provide a touch-free method of delivery of the lens into the capsular bag.</Description><Size>Body Diameter: +00.00 D to +34.00 D: 6.0 mm +/- 0.1 mm  Overall Diameter: +00.00 D to +34.00 D: 11.00 mm +/- 0.2 mm  Power Range: +0.00 D to +34.00 D Label Increments: 0.1 D</Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>342175</ARTG></ARTGs><MinimumBenefit>239</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL040</BillingCode><Name>Enhanced enVista IOL with Bausch + Lomb SimplifEYE Preloaded Delivery System</Name><Description>The enVista Family of Intraocular Lenses (IOLs) are ultraviolet-absorbing, posterior chamber, hydrophobic acrylic IOLs. They have an aspheric lens optic, square posterior edge, and modified C haptics. The lenses can be folded for insertion into the eye.  The MXPLC combines the preloaded IOL with an inserter and is sold in a common package. This alternate packaging configuration allows for a simpler loading of the injector.  </Description><Size>Specification  Optic Body Diameter                 6.0 ± 0.1 mm     Overall Diameter                        12.5 ± 0.2 mm        Haptic Thickness                       0.35 ± 0.04 mm     Haptic Angulations                         Planar Haptic  Lens       Power Range                    +0.0 to +34.0D                                                     (+0.0 to +9.0D in 1D increments)                                                         (+10.0 to +30.0D in 0.5D increments)    (+31.0 to +34.0D in 1D increments)  </Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>98915</ARTG></ARTGs><MinimumBenefit>239</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO083</BillingCode><Name>Aspira-aXA Preloaded</Name><Description>Preloaded posterior chamber IOL, foldable, UV absorber, Aspheric, aberration technology, 360  LEC barrier, HD optic</Description><Size>0 to +30.0 D</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>227764</ARTG></ARTGs><MinimumBenefit>239</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WP001</BillingCode><Name>ZOE</Name><Description>Preloaded Injector system, Posterior convex IOL, aspherical optic to correct far and intermediate vision, foldable, one piece, High purity hydrophobic acrylic, UV filter, 360 square edge</Description><Size>+5D to +36D in 0.5D increments</Size><SupplierCode>40395</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>397250</ARTG></ARTGs><MinimumBenefit>239</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DV268</BillingCode><Name>Hoya Vivinex iSert preloaded IOL (Model XC1)</Name><Description>Preloaded injector system, micro incision, aspheric, UV filtering, single piece, hydrophobic acrylic</Description><Size>+6.0 to 30.0 D (in 0.5D steps)</Size><SupplierCode>39976</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>287542</ARTG></ARTGs><MinimumBenefit>239</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL057</BillingCode><Name>Clareon Aspheric Hydrophobic Acrylic Intraocular Lens (Model SY60WF) </Name><Description>Clareon™ Aspheric Hydrophobic Acrylic IOL Model SY60WF is an ultraviolet and blue light filtering, foldable, single-piece, monofocal intraocular lens. </Description><Size>+6.0 to +30.0 diopters</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, vblf</Suffix><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>221</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL039</BillingCode><Name>AcrySof IQ Aspheric IOL with UltraSert pre-loaded delivery system</Name><Description>Pre-loaded foladable Acrylic Single-piece Lens with Blue light protection and Aspheric correction (SN60WF)</Description><Size>+6.0D to +30.0D</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, vblf</Suffix><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>291</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DV250</BillingCode><Name>Hoya-PS AF-1 (UY) PY-60AD</Name><Description>Preloaded in cartridge, Aspheric, Blue blocker, Foldable, Single-Piece, Hydrophobic Acrylic</Description><Size>+6.0D to +30.0D (0.5D steps)</Size><SupplierCode>39976</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, vblf</Suffix><ARTGs><ARTG>287542</ARTG></ARTGs><MinimumBenefit>291</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DV264</BillingCode><Name>Hoya Vivinex iSert  Preloaded IOL (Model XY1)</Name><Description>Intra Ocular Lens</Description><Size>Power +6 dioptres  - +30 dioptres</Size><SupplierCode>39976</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, vblf</Suffix><ARTGs><ARTG>287542</ARTG></ARTGs><MinimumBenefit>291</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DV252</BillingCode><Name>HOYA iSert® 251</Name><Description>Preloaded injector system, Micro-incision, Aspheric, Blue-Blocker, Single Piece, Hydrophobic</Description><Size>+6.0D to 30.0D (5 steps)</Size><SupplierCode>39976</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, vblf</Suffix><ARTGs><ARTG>287542</ARTG></ARTGs><MinimumBenefit>291</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WP007</BillingCode><Name>Primus-HD Yellow</Name><Description>Preloaded Injector system, Posterior convex IOL, aspheric, foldable, one piece, High purity hydrophobic acrylic, blue light filter, 360 square edge</Description><Size>Powers from -10.0D to +36.0D in 0.5D increments</Size><SupplierCode>40395</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, vblf</Suffix><ARTGs><ARTG>397250</ARTG></ARTGs><MinimumBenefit>291</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL044</BillingCode><Name>Clareon AutonoMe</Name><Description>The Clareon Aspheric Hydrophobic Acrylic Lens is an ultraviolet and blue light filtering foldable single-piece posterior chamber intraocular lens, provided in the AutonoMe Pre-loaded Delivery System.</Description><Size>+6.0 to +30.0D</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, vblf</Suffix><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>291</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO067</BillingCode><Name>HumanOptics Aspira Y Preloaded</Name><Description>Preloaded posterior chamber IOL, foldable, UV absorber, Aspheric, aberration technology, 360° LEC barrier, HD optic, Blue light filter</Description><Size>+10.0 to +30.0 D</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, vblf</Suffix><ARTGs><ARTG>227764</ARTG></ARTGs><MinimumBenefit>291</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL031</BillingCode><Name>AcrySert C Model SN6CWS</Name><Description>Posterior chamber, UV absorbing, foldable, acrylic, single piece lens with blue light protection and aspheric correction, in cartridge</Description><Size>+6.0 to +30.0 D</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, vblf</Suffix><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>291</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IW001</BillingCode><PriorBillingCodes><PriorBillingCode>BL037</PriorBillingCode></PriorBillingCodes><Name>MicroPure 123</Name><Description>Preloaded, posterior chamber, UV absorbing, foldable, aspheric, acrylic, single piece hydrophobic glistening-free Intra Ocular Lens.</Description><Size>Overall diameter of 10D to 24.5D: 11.00mm  25D to 30D: 10.75mm    Optic diameter of 10D to 24.5D: 6.00mm  25D to 30 D: 5.75mm    Power from 10D to 30D with 0.5 diopter increments.</Size><SupplierCode>40471</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, vblf</Suffix><ARTGs><ARTG>363012</ARTG></ARTGs><MinimumBenefit>291</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL042</BillingCode><Name>LuxGood Preloaded</Name><Description>The LuxGood intraocular lens (IOL) is a single-piece ultraviolet (UV) absorbing, posterior chamber, hydrophobic acrylic IOL, blue light filtering and has aspheric optics. The lens is provided sterile and is designed to be folded prior to insertion into the eye. The preloaded intraocular LuxGood lens is supplied with an Accuject Pro Delivery System to provide a touch-free method of delivery of the lens into the capsular bag.</Description><Size>Body Diameter: +00.00 D to +34.00 D: 6.0 mm +/- 0.1 mm   Overall Diameter: +00.00 D to +34.00 D: 11.00 mm +/- 0.2 mm   Power Range: +0.00 D to +34.00 D Label Increments: 0.1D</Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, vblf</Suffix><ARTGs><ARTG>342175</ARTG></ARTGs><MinimumBenefit>291</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IQ016</BillingCode><Name>PreciSAL P302A  PreciSAL PS302A</Name><Description>Preloaded Acrylic, single piece, foldable intraocular lens with anterior and posterior optic-haptic square edge, 360 degree optic square edge design, precision power calculation, aberration technology and blue light filter.</Description><Size>Available in dioptric powers from 0.0 to +30.0. 1D steps: 0.0 to +10.0; 0.5D steps: +10.5 to +17.5 and +28.5 to +30.0; 0.25D steps: +18.0 to +28.0</Size><SupplierCode>40011</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, vblf</Suffix><ARTGs><ARTG>183558</ARTG></ARTGs><MinimumBenefit>291</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU017</BillingCode><PriorBillingCodes><PriorBillingCode>IS044</PriorBillingCode></PriorBillingCodes><Name>Basis Z Preloaded Hydrophobic IOL</Name><Description>Hydrophobic preloaded IOLs</Description><Size>6mm Optic Diameter and 13mm Length</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl, vblf</Suffix><ARTGs><ARTG>280510</ARTG></ARTGs><MinimumBenefit>291</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WP003</BillingCode><Name>Primus-HD Clear</Name><Description>Preloaded Injector system, Posterior convex IOL, aspheric, foldable, one piece, High purity hydrophobic acrylic, UV filter, 360 square edge</Description><Size>-10.0D to +36D in 0.5D increments</Size><SupplierCode>40395</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>397250</ARTG></ARTGs><MinimumBenefit>239</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LN014</BillingCode><Name>Vision Pro Preloaded Hydrophobic Acrylic Aspheric Intraocular Lens (PRS60A)</Name><Description>Preloaded, Hydrophobic Acrylic Aspheric Posterior Chamber Foldable IOL</Description><Size>Aspheric IOL: +0 to +34 D in 0.5 D increments; Overall diameter 13mm, Optic size 6mm</Size><SupplierCode>40187</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>357110</ARTG></ARTGs><MinimumBenefit>239</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LN011</BillingCode><Name>I-Stream Pre-Loaded Aspheric Hydrophobic</Name><Description>Single piece, pre-loaded aspheric  hydrophobic acrylic IOL</Description><Size>Optic diameter: 6mm
Total diameter: 13mm
Power range: +9.0 to +32.0D</Size><SupplierCode>40187</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>307407</ARTG></ARTGs><MinimumBenefit>239</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG027</BillingCode><Name>RayOne Toric Aspheric preloaded - Premium/Made to Order</Name><Description>Single piece preloaded aspheric toric acrylic IOL, UV absorbing, 360 square edge, anti-vaulting haptics</Description><Size>-9.5 to +34.5 D SE (subject to sphere power)  +7 to +11 cylinder  Further pre-selected SE/cylinder combinations are available above and below the stated SE range.</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t2, pl</Suffix><ARTGs><ARTG>220612</ARTG></ARTGs><MinimumBenefit>793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AO051</BillingCode><Name>TECNIS Eyhance Toric II Simplicity</Name><Description>1-piece enhanced monofocal pre-loaded IOL</Description><Size>+05.0 D to +34.0 D in 0.5 D increments. overall diameter: 13mm, optic size 6mm. Cylinder power: 7.00 D, 8.00 D</Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t2, pl</Suffix><ARTGs><ARTG>412991</ARTG></ARTGs><MinimumBenefit>793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL051</BillingCode><Name>Enhanced enVista Toric IOL</Name><Description>The enhanced enVista Toric (Model MX60ET) is an ultraviolet-absorbing, posterior chamber, hydrophobic acrylic toric intraocular lens (IOL). They have an aspheric lens optic, square posterior edge, and modified C haptics. The lenses can be folded for insertion into the eye.</Description><Size>Specification:   Optic Body Diameter 6.0   Overall Diameter 12.5  Haptic Angulations Planar Haptic   Lens Power Range +6.0 Diopters to +30.0 Diopters in 0.5 Diopter increments </Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>98915</ARTG></ARTGs><MinimumBenefit>514</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AO041</BillingCode><Name>Tecnis Toric 1-Piece IOL</Name><Description>1-piece IOL Posterior chamber Intraocular lens , incorporates a proprietary wavefront designed toric aspheric optic with a squared posterior optic edge designed to provide 360 degree barrier. The edge of the optic has a frosted design to reduce potential edge glare effects.</Description><Size>+5.0 to +34.0 diopter powers in 0.5 diopter increments. Cylinder power: 1.00 diopter, 1.50 diopter, 2.25 diopter, 3.00 diopter, 3.75 diopter, 4.00 diopter, 4.50 diopter, 5.25 diopter and 6.00 diopter (as measured at the IOL plane). Overall diameter 13mm, Optic size 6mm.</Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>181845</ARTG></ARTGs><MinimumBenefit>514</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU007</BillingCode><PriorBillingCodes><PriorBillingCode>IS024</PriorBillingCode></PriorBillingCodes><Name>Medicontur BiFlex 677TA Hydrophilic Acrylic Foldable Toric Lens without Blue light Filter</Name><Description>Posterior chamber IOL, 360° Special Square Edge,  Aspheric – Coma optimized – Toric</Description><Size>Optic diameter: 6.0 mm ±0.05 mm, Overall diameter: 13.0 mm ±0.10 mm  Powers available:  -10.0  -  +30.0 D ±0.25 D increment:  0.5 D  +31.0  - +35.0 D ±0.5 D increment:  1.0 D  Cylinders available:    +1.5 D - +7.0 D increment:  0.75 D</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>221834</ARTG></ARTGs><MinimumBenefit>514</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL030</BillingCode><Name>enVista</Name><Description>The enVista, Model MX60, is an ultra-violet-absorbing, posterior chamber, hydrophobic acrylic one-piece foldable intraocular lens (IOL)  Has an aspheric lens optic, square posterior edge, modified C haptics and available in dioptric powers ranging from +0.0 to +34.0D.</Description><Size>Overall diameter 12.5mm, optic body diameter 6.0mm in dioptric powers ranging from +0.0 to +34D
0.0D to 10.0D in 1 Diopter increments
11.0D to 30.0D in 0.5 Diopter increments
31.0D to 34.0D in 1 Diopter increments</Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>98915</ARTG></ARTGs><MinimumBenefit>232</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL038</BillingCode><Name>Acrysof Aspheric UV-absorbing IOL</Name><Description>Foldable Acrylic Single-piece Lens with UV Absorbing and Aspheric Correction</Description><Size>+ 6.0 D to +30.0 D</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109709</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>232</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO065</BillingCode><Name>HumanOptics Diffractiva Preloaded</Name><Description>Preloaded Multifocal posterior chamber IOL, foldable, UV absorber, Aspheric, aberration technology, 360° LEC barrier, HD optic</Description><Size>Sphere: +10D to +30D, Near addition +3.5D</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>227764</ARTG></ARTGs><MinimumBenefit>635</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL053</BillingCode><Name>Clareon PanOptix Trifocal UV Absorbing IOL with the AutonoMe Automated Pre-loaded Delivery System</Name><Description>The Clareon PanOptix Trifocal UV Absorbing IOL with the AutonoMe Automated Pre-loaded Delivery System is a presbyopia correcting, UV-absorbing, foldable, single-piece posterior chamber, multifocal IOL, pre-loaded on the AutonoMe Automated Delivery System </Description><Size>+6.0 to +30.0 diopters </Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>635</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ272</BillingCode><Name>AT LISA TRI TORIC 949M - High Cyl</Name><Description>Trifocal (aspheric), bitoric, micro incision, single-piece IOL for capsular bag fixation. The trifocal (anterior) optic provides two diffractive focal points (+3.33D near focus and +1.66D intermediate focus) with asymmetric light distribution 50% distance / 20% intermediate / 30% near vision.</Description><Size>Spherical Equivalent (SE): -5.0 to +35.0 D, 0.5 D increments, High Cylinder +7.0 to 12.0 D, 0.5D increments. Optic size: 6.0 mm Overall length: 11.mm</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t2</Suffix><ARTGs><ARTG>151348</ARTG></ARTGs><MinimumBenefit>1130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ273</BillingCode><Name>AT LISA TRI TORIC 949M - Low Cyl</Name><Description>Trifocal (aspheric), bitoric, micro incision, single-piece IOL for capsular bag fixation. The trifocal (anterior) optic provides two diffractive focal points (+3.33D near focus and +1.66D intermediate focus) with asymmetric light distribution 50% distance / 20% intermediate /30% near vision.</Description><Size>Spherical Equivalent (SE): -5.0 to +35.0 D, 0.5 D increments Low Cylinder +4.5 to +6.5 D, 0.5 D increments. Optic size: 6.0 mm Overall length: 11.mm</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>151348</ARTG></ARTGs><MinimumBenefit>902</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG038</BillingCode><Name>RayOne EMV Toric</Name><Description>Single piece preloaded monofocal toric aspheric acrylic IOL, enhanced monovision (EMV) UV absorbing, 360 degree square edge, anti vaulting haptics</Description><Size>6mm optic,   Power Range: SE: +10.0 D to +25.0 D (0.5 D increments), Cylinder: +0.75 D, +1.5 D, +2.25 D, +3.0 D, +3.75 D, +4.5 D</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl, t1</Suffix><ARTGs><ARTG>220612</ARTG></ARTGs><MinimumBenefit>918</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CZ046</BillingCode><Name>AT LARA toric 929MP</Name><Description>Bitoric Extended depth of focus (EDoF), micro incision, single-piece IOL for capsular bag fixation implantable with preloaded injector system, aberration neutral aspheric optical design</Description><Size>Diopter range SE: - 8.0 D to + 32.0 D in 0.5 increments
Cylinder: + 1.0 D to + 4.0 D in 0.5 increments
Further preselected SE/cylinder combinations are available above and below the stated SE range.
Optic size: 6mm, total diameter: 11mm</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl, t1</Suffix><ARTGs><ARTG>151348</ARTG></ARTGs><MinimumBenefit>918</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG023</BillingCode><Name>RayOne Trifocal Toric</Name><Description>Trifocal posterior chamber, toric, aberration-neutral technology, pre-loaded single piece acrylic IOL.</Description><Size>Spherical Equivalent: +6.0 D to +30.0 D (0.5 D increments), Cylinders: +0.75 D, +1.5 D, +2.25 D, +3.0 D, +3.75 D, +4.5 D, Trifocal, diffractive, +3.5 D near add and +1.75 D intermediate add at the IOL plane</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl, t1</Suffix><ARTGs><ARTG>220612</ARTG></ARTGs><MinimumBenefit>918</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CZ036</BillingCode><Name>AT LISA tri Toric 939MP</Name><Description>Trifocal (aspheric), bitoric, micro incision, single-piece IOL for capsular bag fixation, implantable with preloaded injector system. The trifocal (anterior) optic provides two diffractive focal points (+3.33D near focus and + 1.66D intermediate focus) with asymmetric light distribution 50% distance / 20% intermediate / 30% near vision,</Description><Size>Diopter range -10.00 to +28.0 and +1 to +4.0 DC Optic size: 6..00mml; Overall length: 11.mm</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl, t1</Suffix><ARTGs><ARTG>151348</ARTG></ARTGs><MinimumBenefit>918</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL050</BillingCode><Name>LuxSmart Toric Preloaded Crystal</Name><Description>The LuxSmart Toric intraocular lens (IOL) is a single-piece ultraviolet (UV) absorbing, posterior chamber, hydrophobic acrylic IOL, and has aspheric and toric optics. The lens is provided sterile and is designed to be folded prior to insertion into the eye. The preloaded intraocular LuxSmart lens is supplied with an Accuject Pro Delivery System to provide a touch-free method of delivery of the lens into the capsular bag.</Description><Size>Body Diameter: 6.0 mm; Overall Diameter: 11 mm; Haptic Angle: 0° ; Powers: +6.00 to +34.00 Diopters; Cylindrical Powers: +0.75 to +6.00 Diopters </Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl, t1</Suffix><ARTGs><ARTG>342175</ARTG></ARTGs><MinimumBenefit>918</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CZ042</BillingCode><Name>AT LARA 829MP</Name><Description>Extended depth of focus (EDoF), micro incision, single-piece IOL for capsular bag fixation, implantable with preloaded injector system, aberration neutral aspheric optical design</Description><Size>Diopter range: -10.0 D to +32.0 D, 0.5 increments
Optic size: 6mm
Overall length: 11mm</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>151348</ARTG></ARTGs><MinimumBenefit>635</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ282</BillingCode><Name>AT LISA TRI TORIC 949MP</Name><Description>Trifocal (aspheric), bitoric, micro incision, single-piece IOL for capsular bag fixation, implantable with preloaded injector system. The trifocal (anterior) optic provides two diffractive focal points (+3.33D near focus and + 1.66D intermediate focus) with asymmetric light distribution 50% distance / 20% intermediate / 30% near vision.</Description><Size>Spherical Equivalent (SE): -5.0 to +32.0 D, 0.5 D increments Cylinder +1.0 to +4.0 D, 0.5 D increments, Optic size: 6.0 mm Overall length: 11.mm</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl, t1</Suffix><ARTGs><ARTG>151348</ARTG></ARTGs><MinimumBenefit>918</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ201</BillingCode><Name>Medicontur Bi-Flex Elon 877PEY EDOF IOL</Name><Description>Single piece, sterile, foldable aspheric hydrophobic acrylic intraocular lens (IOL) with UV blocker and blue light filter. The optic is EDOF. The IOL is available as part of a preloaded injector system.</Description><Size>Optic Diameter: 6mm, Overall Dameter: 13mm, Standard Powers +8.0 D to + 30 D in 0.5 D steps, Extreme Powers +31.0 D to 35.0 D in 1.0 D steps</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl, vblf</Suffix><ARTGs><ARTG>221834</ARTG></ARTGs><MinimumBenefit>666</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ165</BillingCode><Name>Bi-Flex Elon 877PETY EDOF Toric IOL</Name><Description>Single piece, sterile, foldable aspheric hydrophobic acrylic intraocular lens (IOL) with UV blocker and blue light filter. The optic is EDOF toric.
The IOL is available as part of a preloaded injector system.</Description><Size>Standard Powers, +10.0D to 30.0 D (0.5D steps); Cylinders, T2 1.0D, T3 1.5D, T4 2.25D, T5 3.0D, T6 3.75D, T7 4.5D, T8 5.25D, T9 6.0D</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl, t1, vlbf</Suffix><ARTGs><ARTG>221834</ARTG></ARTGs><MinimumBenefit>950</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ152</BillingCode><Name>TECNIS PureSee IOL with Simplicity Delivery System</Name><Description>Pre-loaded, 1-piece posterior chamber, presbyopia correcting, UV absorbing hydrophobic acrylic with violet-light filter, Non Toric IOL offering extended vision</Description><Size>Diopter range +5.0 D to +34.0 D. in 0.5 diopter increments</Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl, vblf</Suffix><ARTGs><ARTG>426290</ARTG></ARTGs><MinimumBenefit>666</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU019</BillingCode><PriorBillingCodes><PriorBillingCode>IS045</PriorBillingCode></PriorBillingCodes><Name>Basis Z Progressive IOL</Name><Description>Progressive Hydrophilic IOL</Description><Size>Optic Diameter: 6mm  Length: 13mm</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>280510</ARTG></ARTGs><MinimumBenefit>619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL053</BillingCode><PriorBillingCodes><PriorBillingCode>ER281</PriorBillingCode></PriorBillingCodes><Name>IC-8, Hydrophobic Small Aperture Intraocular Lens</Name><Description>A hydrophobic posterior chamber intraocular lens (IOL), embedded with a central circular mask, which operates under the principle of small aperture optics to reduce near vision blur and provide seamless extended range vision from distance to near.</Description><Size>The overall diameter is 12.5 millimetres with a 6 millimetre diameter aspheric optic.</Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>236210</ARTG></ARTGs><MinimumBenefit>619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL052</BillingCode><Name>Clareon PanOptix Trifocal UV Absorbing Intraocular Lens (Model CCWTT0) </Name><Description>The Clareon PanOptix Trifocal UV Absorbing Intraocular Lens (Model CCWTT0) is a presbyopia correcting, UV-absorbing, foldable, single-piece posterior chamber, multifocal IOL </Description><Size>+6.0 to +30.0 diopters</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO063</BillingCode><Name>HumanOptics Diffractiva</Name><Description>Multifocal posterior chamber IOL, foldable, UV absorber, Aspheric, aberration technology, 360° LEC barrier, HD optic</Description><Size>Sphere: +10D to +30D, Near addition +3.5D</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>227764</ARTG></ARTGs><MinimumBenefit>619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE496</BillingCode><Name>LENTIS Mplus   LENTIS Comfort</Name><Description>Foldable one-piece multifocal plate haptic acrylic IOL</Description><Size>Overall Length 11.0mm and Optic Size 6.0mm.  Available diopters -10.0D to -1.0D (1.0D), 0.0D to +36.0D (0.5D)</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>328681</ARTG></ARTGs><MinimumBenefit>619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-09-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE650</BillingCode><Name>FEMTIS Comfort FB-313MF15</Name><Description>Foldable one-piece multifocal acrylic plate haptic IOL for fixation in the capsulorhexis</Description><Size>Optic Size 5.7mm, Overall length 10.5mm. Available Dioptres: +15.0D to 30.0D (0.5D steps)</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>328681</ARTG></ARTGs><MinimumBenefit>619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE785</BillingCode><Name>FEMTIS Mplus FB-313MF30</Name><Description>Foldable one-piece multifocal acrylic plate haptic IOL for fixation in the capsulorhexis</Description><Size>Optic Size 5.7mm, Overall length 10.5mm. Available Dioptres: +15.0D to 30.0D (0.5Dsteps)</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>328681</ARTG></ARTGs><MinimumBenefit>619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE675</BillingCode><Name>LENTIS Mplus LU-814MF30</Name><Description>Foldable one-piece acrylic posterior chamber aspheric multifocal IOL for capsular bag, sulcus and sulcus-sclera fixation.</Description><Size>Optic size: 6.2mm , 0.0D to +23.0D,  5.5mm +23.01D to +36.0D Overall length: 13.0mm, Available Dioptres: 0.0D to +36.0D (0.5D increments).</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>328681</ARTG></ARTGs><MinimumBenefit>619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE764</BillingCode><Name>LENTIS Comfort LU-814MF15</Name><Description>Foldable one-piece acrylic posterior chamber aspheric multifocal IOL for capsular bag, sulcus and sulcus-sclera fixation.</Description><Size>Optic size: 6.2mm, Overall length: 13.0mm, Available Dioptres: 0.0D to +36.0D (0.5D increments).</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>328681</ARTG></ARTGs><MinimumBenefit>619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL040</BillingCode><Name>AcrySof IQ PanOptix Trifocal IOL</Name><Description>Trifocal posterior chamber, UV absorbing, foldable, acrylic, aspheric, single piece lens with apodised diffractive trifocal optic and blue light protection.  The apodised diffractive trifocal optic (anterior) provides two diffractive focal points (+3.25D near focus and 2.17D intermediate focus).</Description><Size>+6.0 to +30.0D in 0.5 Diopter increments and +31.0 to +34.0D in 1.0 Diopter increments</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, vblf</Suffix><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>651</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL050</BillingCode><Name>AcrySof IQ Vivity Extended Vision Intraocular Lens</Name><Description>Vivity Model DFT015 is an extended vision, non-diffractive, UV-absorbing and blue light filtering, single-piece, foldable, hydrophobic, posterior chamber intraocular lens</Description><Size>+10.0 to +30.0 diopters</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, vblf</Suffix><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>651</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LN004</BillingCode><Name>ALSAFIT TRIFOCAL VF</Name><Description>Single piece trifocal aspheric foldable intraocular lens for implantation into the capsular bag. Violet filter.</Description><Size>Diopter power range: 0.0 D to +32.00 D (0.50 D increments).
Optic size: 6mm. Overall length: 11.0mm.</Size><SupplierCode>40187</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, vblf</Suffix><ARTGs><ARTG>268033</ARTG></ARTGs><MinimumBenefit>651</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE774</BillingCode><Name>Acunex Vario AN6V</Name><Description>Foldable one-piece acrylic EDOF C loop IOL with aspheric surface and violet blue light filter.</Description><Size>Overall Length 12.5mm and Optic Size 6.0mm, SE +10.0D to +30.0D (0.5D steps), ADD +1.5D.</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, vblf</Suffix><ARTGs><ARTG>328681</ARTG></ARTGs><MinimumBenefit>651</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE789</BillingCode><Name>Acunex Variomax Toric AN6VMT</Name><Description>Foldable one-piece acrylic Multifocal C loop IOL with aspheric surface and violet blue light filter.</Description><Size>Overall Length 12.5mm and Optic Size 6.0mm, SE: +10.0D to +30.0D (0.5D steps), cyl: T0 +0.75D T1 +1.5D T2 +2.25D T3 +3.0D, ADD +3.0D.</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1, vblf</Suffix><ARTGs><ARTG>328681</ARTG></ARTGs><MinimumBenefit>934</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IW002</BillingCode><PriorBillingCodes><PriorBillingCode>BL036</PriorBillingCode></PriorBillingCodes><Name>FineVision Toric POD FT</Name><Description>Posterior chamber, toric, trifocal diffractive (aspheric), UV and blue light blocker, single piece acrylic IOL.</Description><Size>An overall diameter of 11.40mm and optic diameter of 6.00mm. From 0 to +35 Diopters with 0.5 diopter increments.</Size><SupplierCode>40471</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1, vblf</Suffix><ARTGs><ARTG>363012</ARTG></ARTGs><MinimumBenefit>934</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL046</BillingCode><Name>FINEVISION HP TORIC (POD FT 49P)</Name><Description>The POD FT 49P (FINEVISION HP TORIC) posterior chamber intraocular lens is indicated for the replacement of the human lens to achieve the visual correction of aphakia and pre-existing corneal astigmatism in astigmatic adult patients in whom a cataractous lens has been removed by phacoemulsification who desire improved uncorrected vision, reduction of residual refractive cylinder, useful near and intermediate visual functions, and reduced spectacle dependence. The intraocular lens is intended to maintain rotational stability after placement in the capsular bag and is intended to be placed in the capsular bag. The GF-Glistening Free, material is an acrylic copolymer of medical quality which includes a UV absorbing filter. For the yellow intraocular lenses, a blue light-filtering chromophore is covalently bounded to the UV-absorbing material and the spectral transmittance through a central diopter IOL. They have biconvex optics with an aspheric anterior diffractive trifocal structure that partitions the light to give pseudo-accommodative vision and a posterior toric optic which compensates for corneal astigmatism. The add-power for near vision is + 3.5 diopters and for the intermediate vision + 1.75 diopters at IOL plane allowing the patient to benefit from near vision without a reading aid, and from increased spectacle independence for near and intermediate visions.</Description><Size>Optic diameter: 6.00mm; Total diameter: 11.40mm; From 6 to +35 Diopters, with 0.5 Diopter increments; Cylinders (IOL Plane) 1.00D, 1.50D, 2.25D, 3.00D, 3.75D, 4.50D, 5.25D, 6.00D.</Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1, vblf</Suffix><ARTGs><ARTG>211587</ARTG></ARTGs><MinimumBenefit>934</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL036</BillingCode><Name>FineVision Toric POD FT</Name><Description>Posterior chamber, toric, trifocal diffractive (aspheric), UV and blue light blocker, single piece acrylic IOL.</Description><Size>An overall diameter of 11.40mm and optic diameter of 6.00mm. From 0 to +35 Diopters with 0.5 diopter increments.</Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1, vblf</Suffix><ARTGs><ARTG>211587</ARTG></ARTGs><MinimumBenefit>934</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CZ039</BillingCode><Name>AT LISA tri toric 939M high powered cylinder</Name><Description>Trifocal (aspheric), bitoric, micro incision, single-piece IOL for capsular bag fixation. The trifocal (anterior) optic provides two diffractive focal points (+3.33D near focus and +1.66D intermediate focus) with asymmetric light distribution 50% distance / 20% intermediate / 30% near vision.</Description><Size>Diopter range: -10.00 to + 32.0 DS and +7 to +12 DC
Optic Size: 6.0mm. Overall Length: 11.0mm</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t2</Suffix><ARTGs><ARTG>151348</ARTG></ARTGs><MinimumBenefit>1130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CZ044</BillingCode><Name>AT LARA toric 929M high cylinder</Name><Description>Bitoric Extended depth of focus (EDoF), micro incision, single-piece IOL for capsular bag fixation implantable with injector system, aberration neutral aspheric optical design</Description><Size>Diopter range SE: - 4.0 D to + 32.0 D in 0.5 increments
Cylinder: + 7.0 D to + 12.0 D increments
Further preselected SE/cylinder combinations are available above and below the stated SE range.
Optic size: 6mm, total diameter: 11mm</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t2</Suffix><ARTGs><ARTG>151348</ARTG></ARTGs><MinimumBenefit>1130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL051</BillingCode><Name>Clareon PanOptix Trifocal Hydrophobic Intraocular Lens (Model CNWTT0) </Name><Description>The Clareon PanOptix Trifocal Hydrophobic Intraocular Lens (Model CNWTT0) is a presbyopia correcting, ultraviolet and blue light filtering, foldable, single-piece posterior chamber, multifocal IOL </Description><Size> +6.0 to +30.0 diopters</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, vblf</Suffix><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>651</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU014</BillingCode><PriorBillingCodes><PriorBillingCode>IS019</PriorBillingCode></PriorBillingCodes><Name>Medicontur BiFlex 677MY Hydrophilic Acrylic Foldable Multifocal Lens with Blue light Filter</Name><Description>Posterior chamber IOL, 360° Special Square Edge, Aspheric – Coma optimized</Description><Size>Optic diameter: 6.0 mm ±0.10 mm, Overall diameter: 13.0 mm ±0.20 mm  Powers available:   -10.0 - +9.0 D ±0.25 D increment:  1.0 D  +10.0 - +25.0 D ±0.25 D increment:  0.5 D   +25.5 - +30.0 D ±0.5 D increment:  0.5 D   +31.0- +45.0 D ±0. D increment:  1.0 D</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, vblf</Suffix><ARTGs><ARTG>221834</ARTG></ARTGs><MinimumBenefit>651</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AO044</BillingCode><Name>TECNIS Synergy IOL</Name><Description>1-piece continuous multifocal IOL</Description><Size>+5.0 to 34.0 diopter powers in 0.5 diopter increments. Overall diameter 13mm, optic size 6mm</Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, vblf</Suffix><ARTGs><ARTG>170331</ARTG></ARTGs><MinimumBenefit>651</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO064</BillingCode><Name>HumanOptics Diffractiva Y</Name><Description>Multifocal posterior chamber IOL, foldable, UV absorber, Aspheric, aberration technology, 360° LEC barrier, HD optic, Blue light filter</Description><Size>Sphere: +10D to +30D, Near addition +3.5D</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, vblf</Suffix><ARTGs><ARTG>227764</ARTG></ARTGs><MinimumBenefit>651</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL060</BillingCode><Name>Clareon Vivity Extended Vision Hydrophobic IOL (Model CNWET0) </Name><Description>Presbyopia correcting, ultraviolet and blue light filtering, foldable, single-piece posterior chamber IOL which provides an extended range of vision from distance to near while maintaining a low incidence of visual disturbances </Description><Size>+10.0 to +30.0 diopters</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, vblf</Suffix><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>651</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO081</BillingCode><Name>HumanOptics ToricaDiff Preloaded</Name><Description>Preloaded Toric Multifocal posterior chamber IOL, foldable, UV absorber, Aspheric, aberration technology, 360° LEC barrier, HD optic</Description><Size>Sphere +10D to +30D, Cylinder 1D to 6D, Near addition +3.5D</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl, t1</Suffix><ARTGs><ARTG>227764</ARTG></ARTGs><MinimumBenefit>918</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AO049</BillingCode><Name>TECNIS Synergy Toric II Simplicity</Name><Description>Preloaded 1-piece continuous multifocal toric IOL</Description><Size>+5.0 Diopters to +34.0 Diopters in 0.5 Diopter increments. Overall diameter 13mm, optic size 6mm  Cylinder powers 1.00 D, 1.50 D, 2.25 D, 3.00 D, 3.75 D.</Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl, t1, vlbf</Suffix><ARTGs><ARTG>411930</ARTG></ARTGs><MinimumBenefit>950</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU013</BillingCode><PriorBillingCodes><PriorBillingCode>IS037</PriorBillingCode></PriorBillingCodes><Name>677MTY</Name><Description>BiFlex Single-Piece Aspheric Hydrophilic Progressive Diffractive Toric IOL with Blue filter and 360' Special Square Edge for implantation into capsular bag</Description><Size>Optic diameter: 6.0 mm ±0.05 mm, Overall diameter: 13.0 mm ±0.10 mm  Powers available:   -10.0  -  +30.0 D ±0.25 D increment:  0.5 D    Cylinders available:              +1.0 D - +4.5 D increment:  0.5 D     +5.25D - +6.0 D increment:  0.75 D</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1, vblf</Suffix><ARTGs><ARTG>221834</ARTG></ARTGs><MinimumBenefit>934</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL033</BillingCode><Name>AcrySof IQ ReSTOR multifocal toric IOL (SND1T2-T6; SV25T2-T6)</Name><Description>Posterior chamber UV absorbing foldable, acrylic, aspheric, toric single piece lens with apodised diffractive optic and blue light protection.</Description><Size>+6  to +34 D spherical; 1.00 to 3.75 D cylinder</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1, vblf</Suffix><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>934</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL043</BillingCode><Name>AcrySof IQ PanOptix Toric Trifocal IOL</Name><Description>Trifocal posterior chamber, toric, UV absorbing, foldable, acrylic, aspheric, single piece lens with apodised diffractive trifocal optic and blue light protection.  The apodised diffractive trifocal optic (anterior) provides two diffractive focal points (+3.25D near focus and 2.17D intermediate focus).</Description><Size>+6.0 to +30.0D in 0.5 Diopter increments and +31.0 to +34.0D in 1.0 Diopter increments. Cylinder: +1.0; +1.50; +2.25; +3.00 and +3.75 D</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1, vblf</Suffix><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>934</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL058</BillingCode><Name>Clareon PanOptix Toric Trifocal Hydrophobic Intraocular Lens (Models CNWTT2 – CNWTT6) </Name><Description>Clareon PanOptix Toric Trifocal Hydrophobic IOL is a toric, presbyopia correcting, hydrophobic, UV-absorbing, blue light filtering, foldable, single-piece, posterior chamber, multifocal IOL</Description><Size>+6.0 to +30.0 diopters (in 0.5 diopter increments); +31.0 to +34.0 diopter in 1.0 diopter increments with a +2.17 diopter intermediate and a +3.25 diopter near add power; Cylinder 1.00 to 3.75 diopters.</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1, vblf</Suffix><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>934</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL059</BillingCode><Name>Clareon Vivity Toric Extended Vision Hydrophobic IOL (Models CNWET2 - CNWET6)</Name><Description>Presbyopia correcting, ultraviolet and blue light filtering, foldable, single-piece posterior chamber IOL which provides an extended range of vision from distance to near while maintaining a low incidence of visual disturbances, and also compensates for corneal astigmatism
</Description><Size>+10.0 to +30.0 diopters; Cylinder:1.00 to 3.75 diopters</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1, vblf</Suffix><ARTGs><ARTG>92318</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Description, Size</ChangeExplanation><MinimumBenefit>934</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL046</BillingCode><Name>AcrySof IQ Vivity Toric Extended Vision Intraocular Lens</Name><Description>Vivity Toric Models DFT215, DFT315, DFT415, DFT515 and DFT615 are a toric, extended vision, non-diffractive, UV-absorbing and blue light filtering, single-piece, foldable, hydrophobic, posterior chamber intraocular lens.</Description><Size>+10.0 to +30.0 diopters;   Cylinder: 1.0 to 3.75 diopters</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1, vblf</Suffix><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>934</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE778</BillingCode><Name>Acunex Vario Toric AN6VT</Name><Description>Foldable one-piece acrylic EDOF C loop IOL with aspheric surface and violet blue light filter.</Description><Size>Overall Length 12.5mm and Optic Size 6.0mm, SE: +10.0D to +30.0D (0.5D steps), cyl: T0 +0.75D  T1 +1.5D  T2 +2.25D  T3 +3.0D, ADD +1.5D.</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1, vblf</Suffix><ARTGs><ARTG>328681</ARTG></ARTGs><MinimumBenefit>934</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU026</BillingCode><Name>Medicontur BiFlex Preloaded 677CMTY</Name><Description>BiFlex Single-Piece Preloaded Aspheric Hydrophilic Progressive Diffractive Toric IOL with Blue light filter and 360' Special Square Edge for implantation into capsular bag</Description><Size>Optic diameter: 6.0 mm ±0.10 mm, Overall diameter: 13.0 mm ±0.20 mm  Powers available:  Sph eq: +8.0 to +35.0D in 0.5D increments., Cylinder: 1.0 to 6.0D.</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl, t1, vlbf</Suffix><ARTGs><ARTG>221834</ARTG></ARTGs><MinimumBenefit>950</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO080</BillingCode><Name>HumanOptics ToricaDiff Y Preloaded</Name><Description>Preloaded Toric Multifocal posterior chamber IOL, foldable, UV absorber, Aspheric, aberration technology, 360° LEC barrier, HD optic, Blue light filter</Description><Size>Sphere +10D to +30D, Cylinder 1D to 6D, Near addition +3.5D</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl, t1, vlbf</Suffix><ARTGs><ARTG>227764</ARTG></ARTGs><MinimumBenefit>950</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE523</BillingCode><Name>LENTIS Mplus LU-313MFTY</Name><Description>Patient specific one-piece multifocal toric plate haptic acrylic IOL. Violet light filter.</Description><Size>Overall Length 11.0mm and Optic Size 6.0mm, +-0.0D to +36.0D inclusive in 0.01D increments. Cyl +0.50D to +12.0D inclusive in 0.01D increments, axis 1 degree increments</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1, vblf</Suffix><ARTGs><ARTG>328681</ARTG></ARTGs><MinimumBenefit>934</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO066</BillingCode><Name>HumanOptics Diffractiva Y Preloaded</Name><Description>Preloaded Multifocal posterior chamber IOL, foldable, UV absorber, Aspheric, aberration technology, 360° LEC barrier, HD optic, Blue light filter</Description><Size>Sphere: +10D to +30D, Near addition +3.5D</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl, vblf</Suffix><ARTGs><ARTG>227764</ARTG></ARTGs><MinimumBenefit>666</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IQ025</BillingCode><Name>PreciSAL Multifocal PM302A</Name><Description>Pre-loaded acrylic single piece, foldable intraocular lens with anterior and posterior optichaptic square edge, 360 degree optic square edge design, precision power calculation, aberration technology, pupil independent diffractive anterior surface with a near sight correction addition of up to +3.5D, and UV and blue filter powers.</Description><Size>Available in spherical dioptric powers from 0.0 to +30.0. 1D steps: 0.0 to +10.0; 0.5D steps: +10.5 to +17.5 and +28.5 to +30.0; 0.25D steps: +18.0 to +28.0; near sight correction addition up to +3.5D on all spherical dioptric powers.</Size><SupplierCode>40011</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl, vblf</Suffix><ARTGs><ARTG>183558</ARTG></ARTGs><MinimumBenefit>666</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AO052</BillingCode><Name>TECNIS Synergy Simplicity</Name><Description>Preloaded 1-piece continuous multifocal IOL</Description><Size>5.0 Diopters to +34.0 Diopters in 0.5 Diopter increments. Overall diameter 13mm, optic size 6mm</Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl, vblf</Suffix><ARTGs><ARTG>411514</ARTG></ARTGs><MinimumBenefit>666</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU012</BillingCode><Name>Medicontur Trifocal Bi-Flex Liberty preloaded Hydrophilic Acrylic Multifocal with Blue Light Filter</Name><Description>Posterior chamber IOL, 360° Special Square Edge, Aspheric – Coma optimized</Description><Size>Optic diameter: 6.0 mm ±0.10 mm, Overall diameter: 13.0 mm ±0.20 mm  Powers available:   -10.0 - +9.0 D ±0.25 D increment:  1.0 D  +10.0 - +25.0 D ±0.25 D increment:  0.5 D   +25.5 - +30.0 D ±0.5 D increment:  0.5 D   +31.0- +45.0 D ±0. D increment:  1.0 D</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl, vblf</Suffix><ARTGs><ARTG>221834</ARTG></ARTGs><MinimumBenefit>666</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL048</BillingCode><Name>LuxSmart Preloaded</Name><Description>The LuxSmart intraocular lens (IOL) is a single-piece ultraviolet (UV) absorbing, posterior  chamber, hydrophobic acrylic IOL, blue light filtering and has aspheric optics. The lens is  provided sterile and is designed to be folded prior to insertion into the eye. The preloaded  intraocular LuxSmart lens is supplied with an Accuject Pro Delivery System to provide a  touch-free method of delivery of the lens into the capsular bag.</Description><Size>Body Diameter: +00.00 D to +34.00 D: 6.0 mm +/- 0.1 mm Overall Diameter: +00.00 D to  +34.00 D: 11.00 mm +/- 0.2 mm Power Range: +0.00 D to +34.00 D Label Increments:  0.1D</Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl, vblf</Suffix><ARTGs><ARTG>342175</ARTG></ARTGs><MinimumBenefit>666</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AO037</BillingCode><Name>TECNIS® Symfony Extended Range of Vision (ZXR00)</Name><Description>Extended Range of Vision Posterior Chamber IOL</Description><Size>+5.0 to 34.0 diopter powers in 0.5 diopter increments Overall diamter 13mm, Optic size 6mm</Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>170331</ARTG></ARTGs><MinimumBenefit>619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG009</BillingCode><Name>Rayner "M-Flex" Mulitfocal Foldable IOL</Name><Description>Acrylic, Foldable, Single piece multi-zoned refractive aspheric multifocal with Amon-Apple 360 Degree Square edge, Anti Vaulting Haptics</Description><Size>6.5mm Optic-Overall diameter 12.5mm: +3D or + 4D Addition: +14D to +25D in 1.0D increments: +8.5D to +23.5D in 0.5D increments</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>100926</ARTG></ARTGs><MinimumBenefit>619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IQ023</BillingCode><Name>PreciSAL Multifocal M302AC</Name><Description>Acrylic single piece, foldable intraocular lens with anterior and posterior optic-haptic edge, 360 degree optic square edge design, precision power calculation, abreration technology, pupil independent diffractive anterior surface with a near sigh correction addition of up to +3.5D, and UV Filter.</Description><Size>Available in spherical dioptric powers from 0.0D to +30.0D. 1D steps: 0.0D to+10.0D; 0.5D steps: +10.5 to +17.5 and +28.5 to +30.0; 0.25D steps: +18.0 to +28.0; near sight correction addition up to +3.5D on all spherical dioptric powers.</Size><SupplierCode>40011</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>183558</ARTG></ARTGs><MinimumBenefit>619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CZ034</BillingCode><Name>AT LISA tri 839MP</Name><Description>Trifocal (aspheric) micro incision, single-piece IOL for capsular bag fixation, implantable with preloaded injector system.  The trifocal (anterior) optic provides two diffractive focal points (+3.33D near focus and +1.66D intermediate focus) with asymmetric light distribution 50% distance / 20% intermediate / 30% near vision.</Description><Size>Diopter range: 0.0 to +32.0D (0.5D increments). Optic size: 6.0mm. Overall Length: 11.0mm</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>134490</ARTG></ARTGs><MinimumBenefit>635</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG021</BillingCode><PriorBillingCodes><PriorBillingCode>DV271</PriorBillingCode></PriorBillingCodes><Name>RayOne Trifocal</Name><Description>Diffractive step trifocal with smooth transition and reduced light loss</Description><Size>0.0 D to +30.0D (increments 0.5D)</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>220612</ARTG></ARTGs><MinimumBenefit>635</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG034</BillingCode><Name>RayOne EMV RAO200E Intraocular lens</Name><Description>RayOne EMV Model 200E is an extended vision, non-diffractive, UV-Absorbing, single-piece, foldable, hydrophilic, posterior chamber intraocular lens.  Provided preloaded in two-step injector.</Description><Size>6mm optic, Power range +10.0 to +30.0D (0.5D increments)</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>220612</ARTG></ARTGs><MinimumBenefit>635</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IQ024</BillingCode><Name>PreciSAL Mulitfocal PM302AC</Name><Description>Pre-loaded acrylic single piece, foldable intraocular lens with anterior and posterior optichaptic square edge, 360 degree optic square edge design, precision power calculation, aberration technology, pupil independent diffractive anterior surface with a near sight correction addition of up to +3.5D, and UV filter.</Description><Size>Available in spherical dioptric powers from 0.0 to +30.0.  1D steps: 0.0 to +10.0; 0.5D steps: +10.5 to +17.5 and +28.5 to +30.0; 0.25D steps: +18.0 to +28.0; near sight correction addition up to +3.5D on all spherical dioptric powers.</Size><SupplierCode>40011</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>183558</ARTG></ARTGs><MinimumBenefit>635</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL047</BillingCode><Name>LuxSmart Preloaded Crystal</Name><Description>The LuxSmart intraocular lens (IOL) is a single-piece ultraviolet (UV) absorbing, posterior chamber, hydrophobic acrylic IOL and has aspheric optics. The lens is provided sterile and is designed to be folded prior to insertion into the eye. The preloaded intraocular LuxSmart lens is supplied with an Accuject Pro Delivery System to provide a touch-free method of delivery of the lens into the capsular bag.</Description><Size>Body Diameter: +00.00 D to +34.00 D: 6.0 mm +/- 0.1 mm Overall Diameter: +00.00 D to +34.00 D: 11.00 mm +/- 0.2 mm Power Range: +0.00 D to +34.00 D Label Increments: 0.1D</Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl</Suffix><ARTGs><ARTG>342175</ARTG></ARTGs><MinimumBenefit>635</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU020</BillingCode><PriorBillingCodes><PriorBillingCode>IS047</PriorBillingCode></PriorBillingCodes><Name>Basis Z Hydrophilic Toric Progressive IOL</Name><Description>One piece foldable hydrophilic progressive toric intraoccular lens</Description><Size>Available in spherical diopter powers from +10D to 35D in 0.5 steps  Cylindrical powers range from 1.0-6.0D</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1, vblf</Suffix><ARTGs><ARTG>280510</ARTG></ARTGs><MinimumBenefit>934</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AO045</BillingCode><Name>TECNIS® Synergy Toric IOL</Name><Description>1-piece continuous multifocal toric IOL</Description><Size>+5.0 Diopters to +34.0 Diopters in 0.5 Diopter increments.  Overall diameter 13mm, optic size 6mm  Cylinder powers 1.00 D, 1.50 D, 2.25 D, 3.00 D, 3.75 D, 4.50 D, 5.25 D, and 6.00 D (as measured on the IOL plane).</Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1, vblf</Suffix><ARTGs><ARTG>181845</ARTG></ARTGs><MinimumBenefit>934</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG011</BillingCode><Name>Rayner "M-Flex" Toric (Non Standard)</Name><Description>Acrylic, Foldable, Single Piece, Muli-Zoned Refractive, Toric Multifocal with Amon-Apple enhanced 360 Degree square edge, Anti-vaulting Haptics, Patient Specific.</Description><Size>5.75/12.0mm: 6.25/12.5mm +3.00D to +4.00D Addition FAR: +14.0D to +32.0D in 0.5D Increments: NEAR: +14.0D to +27.0D in 0.50D Increments Cylinder: 1.0D to 1.5D and 2.5D to 6.00D in 0.5 increments</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>100926</ARTG></ARTGs><MinimumBenefit>902</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AO038</BillingCode><Name>TECNIS Symfony Toric Extended Range of Vision (ZXT00)</Name><Description>Extended Range of Vision Toric Multifocal Posterior Chamber IOL</Description><Size>+6 to +30 in 0.5d steps Available Cyl powers +1.0d, 1.5d, 2.25d, 3.00d, 3.75d, 4.5d, 5.25d, 6.00d</Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>181845</ARTG></ARTGs><MinimumBenefit>902</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CZ045</BillingCode><Name>AT LARA toric 929M low cylinder</Name><Description>Bitoric Extended depth of focus (EDoF), micro incision, single-piece IOL for capsular bag fixation implantable with injector system, aberration neutral aspheric optical design</Description><Size>Diopter range SE: - 4.0 D to + 32.0 D in 0.5 increments
Cylinder: + 4.5 D to + 6.5 D increments
Further preselected SE/cylinder combinations are available above and below the stated SE range.
Optic size: 6mm, total diameter: 11mm</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>151348</ARTG></ARTGs><MinimumBenefit>902</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CZ038</BillingCode><Name>AT LISA tri toric 939M low cylinder</Name><Description>Trifocal (aspheric), bitoric, micro incision, single-piece IOL for capsular bag fixation.  The trifocal (anterior) optic provides two diffractive focal points (+3.33D near focus and +1.66D intermediate focus) with asymmetric light distribution 50% distance / 20% intermediate / 30% near vision.</Description><Size>Diopter range: -10.00 to + 32.0 DS and +1 to +6.5DC
Optic Size: 6.0mm. Overall Length: 11.0mm</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>151348</ARTG></ARTGs><MinimumBenefit>902</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG010</BillingCode><Name>Rayner M-Flex Toric (Standard)</Name><Description>Acrylic, Foldable, Single Piece, Multi-zoned Refractive Aspheric Toric Mulitfocal with Amon-Apple enhanced 360 degree Square edge, Anti Vaulting Haptics</Description><Size>5.75mm / 12.0mm: 6.25mm / 12.5mm +3.00D or +4.00D Addition FAR: +14.0D to +32.00D in 0.5 STEPS: +2.00D +3.00D  +4.00D Cylinder. NEAR: +14.0D to 27.0D in 0.5 STEPS: +2.00D +3.00D  +4.00D Cylinder</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>100926</ARTG></ARTGs><MinimumBenefit>902</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE676</BillingCode><Name>LENTIS Mplus toric LU-814MF30T</Name><Description>Foldable one-piece acrylic posterior chamber aspheric multifocal toric IOL for capsular bag, sulcus and sulcus-sclera fixation.</Description><Size>Optic size: 6.2mm, Overall length: 13.0mm, Available Dioptres: sph. 0.0D to +36.0D (0.01D increments), cyl. +0.50D to +12.0D (0.01D increments), axis 1 deg. increments.</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>328681</ARTG></ARTGs><MinimumBenefit>902</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ318</BillingCode><Name>TECNIS PureSee IOL Toric II with TECNIS Simplicity Delivery System (DET)</Name><Description>Pre-loaded, 1-piece posterior chamber, presbyopia correcting, UV absorbing hydrophobic acrylic with violet-light filter, Toric IOL</Description><Size>+5.0 D to +34.0 D in 0.5 D increments, Cyl: 1.00D to 6.00D (as measured in the IOL plane) Overall diameter 13.0mm, optic size of of 6.0 mm</Size><SupplierCode>40059</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl, t1, vlbf</Suffix><ARTGs><ARTG>440190</ARTG></ARTGs><ChangeExplanation>New listing</ChangeExplanation><MinimumBenefit>950</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Insert</ActionFlag><CycleStartDate>2024-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE494</BillingCode><Name>LENTIS Mplus Toric LU-313MFT</Name><Description>Patient specific one-piece multifocal-toric plate haptic acrylic IOL</Description><Size>Overall Length 11.0mm and Optic Size 6.0 + 0.0D to +36.0D inclusive in 0.01D increments. Cyl +0.50 to +12.00D inclusive in 0.01D increments  sph + cyl &lt;40.0D  axis 1 degree scaling</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>328681</ARTG></ARTGs><MinimumBenefit>902</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-09-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE786</BillingCode><Name>FEMTIS Mplus Toric FB313MF30T0-T3</Name><Description>Foldable one-piece toric multifocal acrylic plate haptic IOL for fixation in the capsulorhexis</Description><Size>Optic Size 5.7mm, Overall length 10.5mm. Available Dioptres: SE +15.0D to +30.0D (0.5Dsteps), cyl T0 +0.75D | T1 +1.5D | T2 +2.25D | T3 +3.0D</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>328681</ARTG></ARTGs><MinimumBenefit>902</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE765</BillingCode><Name>LENTIS Mplus Toric LU-814MF15T</Name><Description>Foldable one-piece acrylic posterior chamber aspheric multifocal toric IOL for capsular bag,sulcus and sulcus-sclera fixation</Description><Size>Optic size: 6.2mm,Overall length:13.0mm, Available Dioptres: sph. 0.0D to +36.0D (0.01D increments), cyl. +0.25D to +12.0D (0.01D increments), axis 1 deg. increments</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>328681</ARTG></ARTGs><MinimumBenefit>902</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE718</BillingCode><Name>FEMTIS Comfort Toric FB-313MF15T0-T3</Name><Description>Foldable one-piece toric multifocal acrylic plate haptic IOL for fixation in the capsulorhexis</Description><Size>Optic Size 5.7mm, Overall length 10.5mm. Available Dioptres: SE +15.0D to 30.0D (0.5Dsteps), cyl  T0 +0.75D | T1 +1.5D | T2 +2.25D | T3 +3.0D</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>328681</ARTG></ARTGs><MinimumBenefit>902</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE526</BillingCode><Name>LENTIS Comfort Toric LS-313MF15T0-T6</Name><Description>Foldable one piece multifocal toric plate haptic acrylic IOL</Description><Size>Overall Length 11.0mm and Optic Size 6.0mm, SE: +10.0D to +30.0D (0.5D steps), Cyl: +0.75D to +5.25D (0.75D steps).</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>328681</ARTG></ARTGs><MinimumBenefit>902</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL034</BillingCode><Name>FineVision Micro F</Name><Description>Posterior chamber, UV absorbing, foldable, aspheric, acrylic, single piece lens with apodised diffractive , trifocal optic and blue light protection</Description><Size>An overall diameter of 10.75mm and optic diameter of 6.15mm. From 0 to +35 dopters with 0.5 diopter increments.</Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, vblf</Suffix><ARTGs><ARTG>211587</ARTG></ARTGs><MinimumBenefit>651</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IW004</BillingCode><PriorBillingCodes><PriorBillingCode>BL038</PriorBillingCode></PriorBillingCodes><Name>B+L FINEVISION HP (POD F GF)</Name><Description>POD F GF test intraocular lens (IOL) is a foldable IOL with a quadripode “POD” open-loop design intended for capsular bag implantation. The IOL is made of the proprietary hydrophobic glistening-free(GFree®) material containing a UV-blocker and additional blue blocker. The material is a hydrophobic acrylic copolymer of medical quality which includes a UV(wavelength less than 400 nm) absorbing filter and a blue light-filtering chromophore which is covalently bounded to the hydrophobic material.  The optical part of the test POD F GF lens is biconvex and aspherical partially compensating the positive spherical aberration of the cornea. The optic bears a diffractive TRIFOCAL element on its anterior side (toward patient pupil), allowing for presbyopia correction and spectacle independence for near and intermediate visions. The add-power at the IOL plane for the near vision is + 3.5 diopters and for the intermediate vision + 1.75 diopters. POD F GF is intended for implantation in the capsular bag after human lens extraction after cataract. The IOL material is capable of being folded prior to insertion, allowing placement through an incision (2.0-2.2 mm) smaller than the optic diameter of the lens. After surgical insertion into the eye, the lens unfolds to ReSTOR the optical performance. The supporting haptics provide for proper positioning and fixation of the IOL optic within the eye</Description><Size>Optic diameter: 6.00mm  Total diameter: 11.40mm  From Ø to +35 Diopters, with 0.5 Diopter increments</Size><SupplierCode>40471</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, vblf</Suffix><ARTGs><ARTG>363012</ARTG></ARTGs><MinimumBenefit>651</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL038</BillingCode><Name>B+L FINEVISION HP (POD F GF)</Name><Description>POD F GF test intraocular lens (IOL) is a foldable IOL with a quadripode “POD” open-loop design intended for capsular bag implantation. The IOL is made of the proprietary hydrophobic glistening-free (GFree®) material containing a UV-blocker and additional blue blocker. The material is a hydrophobic acrylic copolymer of medical quality which includes a UV (wavelength &lt; 400 nm) absorbing filter and a blue light-filtering chromophore which is covalently bounded to the hydrophobic material.
The optical part of the test POD F GF lens is biconvex and aspherical partially compensating the positive spherical aberration of the cornea. The optic bears a diffractive TRIFOCAL element on its anterior side (toward patient pupil), allowing for presbyopia correction and spectacle independence for near and intermediate visions. The add-power at the IOL plane for the near vision is + 3.5 diopters and for the intermediate vision + 1.75 diopters.
POD F GF is intended for implantation in the capsular bag after  human lens extraction after cataract. The IOL material is capable of being folded prior to insertion, allowing placement through an incision (2.0-2.2 mm) smaller than the optic diameter of the lens. After surgical insertion into the eye, the lens unfolds to ReSTOR the optical performance. The supporting haptics provide for proper positioning and fixation of the IOL optic within the eye.</Description><Size>Optic diameter: 6.00mm
Total diameter: 11.40mm
From Ø to +35 Diopters, with 0.5 Diopter increments</Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, vblf</Suffix><ARTGs><ARTG>211587</ARTG></ARTGs><MinimumBenefit>651</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IQ022</BillingCode><Name>PresiSAL Multifocal M302A</Name><Description>Acrylic single piece, foldable intraocular lens with anterior and posterior optic-haptic square edge, 360 degree optic square edge design, precision power calculation. Aberration technology, pupil independent diffractive anterior surface with a near sight correction addition of up to +3.5D, and UV and blue light fliters.</Description><Size>Available in sperical dioptric powers from 0.0D to +30.0D. 1D steps: 0.0D to +10.0D; 0.5D steps: +10.5 to +17.5 and +28.5 to +30.0; 0.25D steps: +18.0.0 to +28.0; near sight correction addition up to +3.5D on all spherical dioptric powers.</Size><SupplierCode>40011</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, vblf</Suffix><ARTGs><ARTG>183558</ARTG></ARTGs><MinimumBenefit>651</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IW003</BillingCode><PriorBillingCodes><PriorBillingCode>BL034</PriorBillingCode></PriorBillingCodes><Name>FineVision Micro F</Name><Description>Posterior chamber, UV absorbing, foldable, aspheric, acrylic, single piece lens with apodised diffractive , trifocal optic and blue light protection</Description><Size>An overall diameter of 10.75mm and optic diameter of 6.15mm. From 0 to +35 dopters with 0.5 diopter increments.</Size><SupplierCode>40471</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, vblf</Suffix><ARTGs><ARTG>363012</ARTG></ARTGs><MinimumBenefit>651</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL030</BillingCode><Name>AcrySof IQ ReSTOR SN6AD1, SV25T0 and MN6AD1</Name><Description>Posterior Chamber, UV absorbing, foldable, acrylic, single piece lens with apodised diffractive optic and blue light protection</Description><Size>+6 D to + 34 D</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, vblf</Suffix><ARTGs><ARTG>92318</ARTG></ARTGs><MinimumBenefit>651</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE766</BillingCode><Name>Acunex Variomax AN6VM</Name><Description>Foldable one-piece acrylic multifocal C loop IOL with aspheric surface and violet blue light filter.</Description><Size>Overall Length 12.5mm and Optic Size 6.0mm, SE +10.0D to +30.0D (0.5D steps), ADD +3.0D.</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, vblf</Suffix><ARTGs><ARTG>328681</ARTG></ARTGs><MinimumBenefit>651</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BL049</BillingCode><Name>LuxSmart Toric Preloaded</Name><Description>The LuxSmart Toric intraocular lens (IOL) is a single-piece ultraviolet (UV) absorbing, posterior chamber, hydrophobic acrylic IOL, with blue light filtering and has aspheric and toric optics. The lens is provided sterile and is designed to be folded prior to insertion into the eye. The preloaded intraocular LuxSmart lens is supplied with an Accuject Pro Delivery System to provide a touch-free method of delivery of the lens into the capsular bag.</Description><Size>Body Diameter: 6.0 mm; Overall Diameter: 11 mm; Haptic Angle: 0° ; Powers: +6.00 to +34.00 Diopters; Cylindrical Powers: +0.75 to +6.00 Diopters </Size><SupplierCode>39948</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108464</GroupID><SubGroupID>109710</SubGroupID><Suffix>at, pl, t1, vlbf</Suffix><ARTGs><ARTG>342175</ARTG></ARTGs><MinimumBenefit>950</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG008</BillingCode><Name>Rayner "Sulcoflex" Pseudophakic I.O.L.</Name><Description>Sulcoflex Aspheric Pseudophakic I.O.L</Description><Size>-5D to +5D</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108465</GroupID><SubGroupID>109712</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>100926</ARTG></ARTGs><MinimumBenefit>296</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG024</BillingCode><Name>Rayner Sulcoflex Ashperic (Premium) I.O.L.</Name><Description>Pseudophakic Supplementary I.O.L.O.L.</Description><Size>-10.0D to -5.50D in 0.5D increments.                +5.50D to 10.00D in 0.5D increments</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108465</GroupID><SubGroupID>109712</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>100926</ARTG></ARTGs><MinimumBenefit>296</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG005</BillingCode><Name>Rayner Sulcoflex Aspheric Toric Pseudophakic Secondary I.O.L - Standard</Name><Description>Acrylic, Aspheric, Toric Pseudophakic Secondary IOL :  Sulcus fixated with undulating Haptics and Posterior Haptic Angulation (Standard)</Description><Size>SE -3 to +3 in 0.5 D steps
Cyl +1 to +3 in 1D steps</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108465</GroupID><SubGroupID>109712</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>100926</ARTG></ARTGs><MinimumBenefit>567</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG007</BillingCode><Name>Rayner Sulcoflex Aspheric Toric Pseudophakic Secondary IOL (Premium)</Name><Description>Acrylic, Aspheric, Toric Pseudophakic Secondary IOL: Sulcus fixated with undulating Haptics and Posterior Haptic Angulation (Premium)</Description><Size>SE -7.00 to +7.00 in 0.5 D steps; Cyl +1.00 to +6.00 in 0.5D steps</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108465</GroupID><SubGroupID>109712</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>100926</ARTG></ARTGs><MinimumBenefit>567</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU023</BillingCode><PriorBillingCodes><PriorBillingCode>IS039</PriorBillingCode></PriorBillingCodes><Name>AddOn Spherical</Name><Description>Add on hydrophilic spherical intraocular lens</Description><Size>Optic Diameter: 6mm  Length: 13mm</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108465</GroupID><SubGroupID>109712</SubGroupID><ARTGs><ARTG>280510</ARTG></ARTGs><MinimumBenefit>262</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU021</BillingCode><PriorBillingCodes><PriorBillingCode>IS046</PriorBillingCode></PriorBillingCodes><Name>AddOn SML</Name><Description>Add-on hydrophilic lens for macular degeneration</Description><Size>Central Optic Diameter - 1.5mm  Optic Diameter - 6mm  Length - 13mm</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108465</GroupID><SubGroupID>109712</SubGroupID><Suffix>hm</Suffix><ARTGs><ARTG>280510</ARTG></ARTGs><MinimumBenefit>634</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU022</BillingCode><PriorBillingCodes><PriorBillingCode>IS041</PriorBillingCode></PriorBillingCodes><Name>AddOn Toric</Name><Description>Add on hydrophilic toric lens</Description><Size>Optic Diameter: 6mm  Length:13mm</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108465</GroupID><SubGroupID>109712</SubGroupID><Suffix>t1</Suffix><ARTGs><ARTG>280510</ARTG></ARTGs><MinimumBenefit>551</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU015</BillingCode><PriorBillingCodes><PriorBillingCode>IS038</PriorBillingCode></PriorBillingCodes><Name>Scharioth Macula Lens</Name><Description>Add-on hydrophilic lens for maculopathies such as macula degeneration</Description><Size>Central Optic Diameter - 1.5mm    Optic Diameter - 6mm    Length - 13mm</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108465</GroupID><SubGroupID>109713</SubGroupID><ARTGs><ARTG>221834</ARTG></ARTGs><MinimumBenefit>634</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU025</BillingCode><PriorBillingCodes><PriorBillingCode>IS040</PriorBillingCode></PriorBillingCodes><Name>AddOn Progressive</Name><Description>Add on hydrophillic progressive lens</Description><Size>Optic Diameter: 6mm  Length 13mm</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108465</GroupID><SubGroupID>109713</SubGroupID><ARTGs><ARTG>280510</ARTG></ARTGs><MinimumBenefit>634</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG022</BillingCode><Name>Sulcoflex Trifocal</Name><Description>Acrylic, aberration-neutral, trifocal pseudophakic secondary IOL; sulcus-fixated with undulating and rounded C-loop haptics.</Description><Size>Power range: -3.0 D to +3.0 D (increments 0.5 D). -1.0 D to +1.0 D (increments 0.25 D)
Trifocal, diffractive,
+3.5 D near add and +1.75 D intermediate add at the IOL plane</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108465</GroupID><SubGroupID>109713</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>100926</ARTG></ARTGs><MinimumBenefit>668</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG026</BillingCode><PriorBillingCodes><PriorBillingCode>DV255</PriorBillingCode></PriorBillingCodes><Name>Rayner Standard Sulcoflex Multifocal Toric Supplementary IOL</Name><Description>653Z-Standard Multifocal Toric Supplementary IOL</Description><Size>-3D to +3D (Spherical Equivalent) Cylinders 2D and 3D Addition 3.5D</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108465</GroupID><SubGroupID>109713</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>100926</ARTG></ARTGs><MinimumBenefit>973</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VU024</BillingCode><PriorBillingCodes><PriorBillingCode>IS049</PriorBillingCode></PriorBillingCodes><Name>1stQ addon progressive toric lens</Name><Description>One piece, foldable intraocular lens (IOL), biocompatible hydrophilic acrylic (25% water content), as additional IOL in combination with a Basis IOL.  Fixation is in the sulcus.</Description><Size>-3.0D to +3.0D spherical equivalent in 0.5D steps and +1.0D to +4.5D cylindrical in 0.5D steps and +3.0D add</Size><SupplierCode>40233</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108465</GroupID><SubGroupID>109713</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>280510</ARTG></ARTGs><MinimumBenefit>973</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG025</BillingCode><PriorBillingCodes><PriorBillingCode>DV254</PriorBillingCode></PriorBillingCodes><Name>Rayner Premium Sulcoflex Multifocal Toric Supplementary IOL</Name><Description>653Z-Premium Multifocal Toric Supplementary IOL</Description><Size>-7D to +7D (Spherical Equivalent) Cylinder 1D, 4D, 5D, 6D Addition 3.5D</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108465</GroupID><SubGroupID>109713</SubGroupID><Suffix>at, t1</Suffix><ARTGs><ARTG>100926</ARTG></ARTGs><MinimumBenefit>973</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG006</BillingCode><Name>Rayner "Sulcoflex" Aspheric Multi-focal Pseudophakic Secondary IOL</Name><Description>Acrylic, Aspheric Multi-focal Pseudophakic Secondary IOL: Sulcus-Fixated with Undulating Haptics and Posterior Haptic Angulation</Description><Size>6.5mm / 13.5mm - 5.00D+5.00D sphere with  + 3.00 Addition</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107639</SubCategoryID><GroupID>108465</GroupID><SubGroupID>109713</SubGroupID><Suffix>at</Suffix><ARTGs><ARTG>100926</ARTG></ARTGs><MinimumBenefit>668</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL005</BillingCode><Name>DUOVISC VISCOELASTIC SYSTEM</Name><Description>ProVisc contains sodium hyaluronate, Viscoat contains chondroitin sulfate and sodium hyaluronate</Description><Size>1 unit 0.50ml Viscoat and 1 unit 0.55ml ProVisc</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><SubGroupID>109714</SubGroupID><ARTGs><ARTG>141482</ARTG></ARTGs><MinimumBenefit>66</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CZ019</BillingCode><Name>TWINVISC Viscoelastic</Name><Description>TWINVISC includes a cohesive and a dispersive viscoelastic in one syringe, separated by a valve.  Dispersive: sodium hyaluronate (2.2%).  Cohesive: sodium hyaluronate (1%)</Description><Size>Total volume 1.4 ml</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><SubGroupID>109714</SubGroupID><ARTGs><ARTG>160685</ARTG></ARTGs><MinimumBenefit>66</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CZ043</BillingCode><Name>COMBIVISC</Name><Description>COMBIVISC consists of two ophthalmic viscoelastic devices. One prefilled syringe of dispersive viscoelastic 3% (0.85ml) and one prefilled syringe of cohesive viscoleastic 1.5% (1.0ml),  along with one 25 gauge Viscoflow cannula and one 27 gauge Viscoflow cannula, that can be used jointly or independently in surgical interventions to remove cataracts and implant a prosthetic lens.</Description><Size>COMBIVISC dispersive 3% 0.85ml 25G cannula
COMBIVISC cohesive 1.5% 1ml 27G cannula
Supplied as a single unit pack, comprising a single syringe of the COMBIVISC Dispersive and a single syringe of the COMBIVISC Cohesive 
Also supplied as a multipack containing five sealed pouched units</Size><SupplierCode>39956</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107640</SubCategoryID><GroupID>108466</GroupID><SubGroupID>109714</SubGroupID><ARTGs><ARTG>293592</ARTG></ARTGs><MinimumBenefit>66</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AL037</BillingCode><Name>Ex-Press Glaucoma Filtration Device</Name><Description>Miniature glaucoma shunt</Description><Size>50 microns; 200 microns</Size><SupplierCode>40047</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107642</SubCategoryID><GroupID>108471</GroupID><SubGroupID>109715</SubGroupID><ARTGs><ARTG>319620</ARTG></ARTGs><MinimumBenefit>645</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE641</BillingCode><Name>ESNOPER Glaucoma Implant</Name><Description>Glaucoma Drainage Implant</Description><Size>3.00mm x 1.40mm x 2.85mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107642</SubCategoryID><GroupID>108471</GroupID><SubGroupID>109716</SubGroupID><ARTGs><ARTG>290207</ARTG></ARTGs><MinimumBenefit>384</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RQ084</BillingCode><Name>Glaukos iStent inject W System </Name><Description>An improved product to PLAC billing code RQ075 (product name iStent Inject) with a wider flange for better surgeon visualisation and stent confirmation. The improvement includes a delivery injection unit with 2 stents. Intended purpose per TGA submission is for implantation with or without cataract surgery and to reduce intraocular pressure in adult patients diagnosed with mild to moderate primary open-angle glaucoma (POAG) currently treated with ocular hypotensive medication. </Description><Size>One Size</Size><SupplierCode>40089</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107642</SubCategoryID><GroupID>108472</GroupID><SubGroupID>109717</SubGroupID><Suffix>tda</Suffix><ARTGs><ARTG>321526</ARTG></ARTGs><MinimumBenefit>1444</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RQ075</BillingCode><Name>iStent Inject System</Name><Description>The iStent Inject is a pre-loaded injection system which delivers two stents across the trabecular meshwork to provide a pathway for aqueous humor to flow from the anterior chamber. It is indicated for use in conjunction with cataract surgery for the reduction of IOP in subjects with mild to moderate open angle glaucoma currently treated with ocular hypotensive medication.</Description><Size>One size</Size><SupplierCode>40089</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107642</SubCategoryID><GroupID>108472</GroupID><SubGroupID>109717</SubGroupID><Suffix>tda</Suffix><ARTGs><ARTG>250914</ARTG></ARTGs><MinimumBenefit>1444</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ325</BillingCode><Name>Glaukos iStent Infinite System</Name><Description>The iStent infinite System consists of a single-use pre-loaded injector designed to deliver, with an unlimited insertion mechanism, three intraocular stents (Model G2-W) through a single incision into Schlemm’s canal, creating a bypass through the trabecular meshwork to increase physiological aqueous outflow and reduce IOP. The stents used in the iStent infinite System are identical to those in iStent inject W (Billing code RQ084), which is designed to deliver two stents. 

As per the TGA submission and associated Instructions for Use, the iStent infinite is intended to reduce IOP in adult patients with primary open-angle glaucoma, pseudo-exfoliative glaucoma or pigmentary glaucoma, and can be performed with or without cataract surgery. It may also be implanted in patients who continue to have elevated IOP despite prior treatment with glaucoma medications and/or conventional glaucoma surgery. </Description><Size>One Size</Size><SupplierCode>40089</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107642</SubCategoryID><GroupID>108472</GroupID><SubGroupID>109717</SubGroupID><Suffix>tda</Suffix><ARTGs><ARTG>444851</ARTG></ARTGs><ChangeExplanation>New listing</ChangeExplanation><MinimumBenefit>1444</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Insert</ActionFlag><CycleStartDate>2024-08-08</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER501</BillingCode><PriorBillingCodes><PriorBillingCode>OQ002</PriorBillingCode></PriorBillingCodes><Name>Hydrus Microstent</Name><Description>Intracanalicular scaffold, made from a biocompatible alloy, for the treatment of primary open angle glaucoma</Description><Size>8 mm in length</Size><SupplierCode>40067</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107642</SubCategoryID><GroupID>108472</GroupID><SubGroupID>109717</SubGroupID><Suffix>smp</Suffix><ARTGs><ARTG>301403</ARTG></ARTGs><MinimumBenefit>1264</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RQ085</BillingCode><Name>PRESERFLO™ MicroShunt &amp; 3mm Scleral Marker</Name><Description>The MicroShunt is made of a flexible SIBS [poly (Styrene-block-IsoButylene-block-Styrene)] polymer with triangular fins that prevent migration of the tube into the AC. It is designed to be implanted under the subconjunctival/Tenon space and intended for reduction of intraocular pressure in eyes of patients with primary open angle glaucoma where IOP remains uncontrollable while on maximum tolerated medical therapy and/or where glaucoma progression warrants surgery</Description><Size>1 size ( 8.5 mm length; 70 µm internal lumen; 350 μm outer diameter; 1.1 mm wingspan)</Size><SupplierCode>40089</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107642</SubCategoryID><GroupID>108472</GroupID><SubGroupID>109718</SubGroupID><ARTGs><ARTG>367151</ARTG></ARTGs><MinimumBenefit>1264</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ051</BillingCode><PriorBillingCodes><PriorBillingCode>AW027</PriorBillingCode><PriorBillingCode>AW027</PriorBillingCode></PriorBillingCodes><Name>XEN Glaucoma Treatment System</Name><Description>The XEN Glaucoma Treatment System consists of an injector device that is preloaded with a XEN Gel Implant. The XEN Gel Implant creates a new subconjunctival outflow pathway to reduce intraocular pressure in patients with mild to advanced primary open-angle glaucoma where previous treatments have failed.</Description><Size>XEN Gel Implant is 6mm long, 150µm outside diameter and 45µm inside diameter.</Size><SupplierCode>40388</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107642</SubCategoryID><GroupID>108472</GroupID><SubGroupID>109718</SubGroupID><ARTGs><ARTG>297899</ARTG></ARTGs><MinimumBenefit>1264</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UK033</BillingCode><Name>MINIject</Name><Description>The MINIject implant is a network of hollow spheres made of silicone which enhances suprachoroidal outflow of aqueous humor to reduce intraocular pressure in glaucoma patients. The MINIject delivery device has a polyimide sheath. </Description><Size>5mm long</Size><SupplierCode>40267</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107642</SubCategoryID><GroupID>108472</GroupID><SubGroupID>109718</SubGroupID><ARTGs><ARTG>400268</ARTG></ARTGs><MinimumBenefit>1264</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UK034</BillingCode><Name>MINIject S</Name><Description>The MINIject implant is a network of hollow spheres made of silicone which enhances suprachoroidal outflow of aqueous humor to reduce intraocular pressure in glaucoma patients. The MINIject S delivery device has a nitinol sheath.</Description><Size>5mm long</Size><SupplierCode>40267</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107642</SubCategoryID><GroupID>108472</GroupID><SubGroupID>109718</SubGroupID><ARTGs><ARTG>400268</ARTG></ARTGs><MinimumBenefit>1264</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO047</BillingCode><Name>Meddev Eyelid Weight, Implantable</Name><Description>Thin Profile eyelid implants for patients with facial palsy</Description><Size>Gold Thin 0.6, 0.8, 1.0, 1.2, 1.4, 1.6g</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107643</SubCategoryID><GroupID>108475</GroupID><SubGroupID>109720</SubGroupID><ARTGs><ARTG>212173</ARTG></ARTGs><MinimumBenefit>384</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG032</BillingCode><PriorBillingCodes><PriorBillingCode>DE183</PriorBillingCode></PriorBillingCodes><Name>Lid Load Gold Eyelid Weights;</Name><Description>Gold</Description><Size>0.6, 0.8, 1.0, 1.2, 1.4, 1.6 grams</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107643</SubCategoryID><GroupID>108475</GroupID><SubGroupID>109720</SubGroupID><ARTGs><ARTG>337652</ARTG></ARTGs><MinimumBenefit>384</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG033</BillingCode><PriorBillingCodes><PriorBillingCode>DE182</PriorBillingCode></PriorBillingCodes><Name>Lid Load Gold Eyelid Weights;</Name><Description>Gold</Description><Size>1.8, 2.0, 2.2, 2.4, 2.6, 2.8 grams</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107643</SubCategoryID><GroupID>108475</GroupID><SubGroupID>109721</SubGroupID><ARTGs><ARTG>337652</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO046</BillingCode><Name>Meddev Eyelid Weight, Implantable</Name><Description>Contour eyelid implants for patients with facial palsy.</Description><Size>Contour Gold 1.8, 2.0, 2.2, 2.4, 2.6, 2.8g</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107643</SubCategoryID><GroupID>108475</GroupID><SubGroupID>109721</SubGroupID><ARTGs><ARTG>212173</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO048</BillingCode><Name>Meddev Eyelid Weight, Implantable Platinum</Name><Description>Platinum Contour and Thin Profile eyelid implants for patients with facial palsy</Description><Size>Platinum Thin 0.6, 0.8, 1.0, 1.2, 1.4, 1.6, 1.8g  Contour Platinum 1.8, 2.0, 2.2, 2.4, 2.6, 2.8g</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107643</SubCategoryID><GroupID>108475</GroupID><SubGroupID>109722</SubGroupID><ARTGs><ARTG>212173</ARTG></ARTGs><MinimumBenefit>1173</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE584</BillingCode><Name>ALOS Eyelid Implants - Platinum</Name><Description>Platinum Eyelid Implants</Description><Size>0.6, 0.8, 1.0, 1.2, 1.4, 1.6, 1.8 grams</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107643</SubCategoryID><GroupID>108475</GroupID><SubGroupID>109722</SubGroupID><ARTGs><ARTG>290117</ARTG></ARTGs><MinimumBenefit>1173</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RC001</BillingCode><Name>LIDCHAIN Platinum Eyelid Implant</Name><Description>Platinum</Description><Size>Weights - 0.8, 1.0, 1.2, 1.4, 1.6, 1.8 grams</Size><SupplierCode>39997</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107643</SubCategoryID><GroupID>108475</GroupID><SubGroupID>109722</SubGroupID><ARTGs><ARTG>182945</ARTG></ARTGs><MinimumBenefit>1173</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK521</BillingCode><Name>Sphere</Name><Description>Orbital Sphere Models 6316, 6326, 6327, 6317 and 6322 8702-8704. COI implant, models 7222, 7223 &amp; 80026. MCOI implant, models 7207 - 7209 Quad Motility Implants 9866 - 9868 &amp; 80022</Description><Size>Orbital Sphere Models 6316: 14mm, 6326: 16mm, 6327: 18mm, 6317: 20mm, 6322: 22mm, 8702: 19mm, 8703: 21mm, 8704: 23mm, COI Implants 7222: Approx 4ml, 7223: Approx 5ml, 80026: Approx 6ml, MCOI 7207: Approx 3ml, 7208: Approx 4.2ml,  7209: Approx 5.6ml, QUAD Motility Small 16ml, Medium: 18ml, Large: 20ml, Extra Large: 22ml.</Size><SupplierCode>40329</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107645</SubCategoryID><GroupID>108480</GroupID><SubGroupID>109723</SubGroupID><ARTGs><ARTG>189075</ARTG><ARTG>257435</ARTG><ARTG>189074</ARTG></ARTGs><MinimumBenefit>709</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO085</BillingCode><Name>Ezypor</Name><Description>High density porous polyethylene orbital implant</Description><Size>12mm to 22mm</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107645</SubCategoryID><GroupID>108480</GroupID><SubGroupID>109723</SubGroupID><Suffix>vp</Suffix><ARTGs><ARTG>143210</ARTG></ARTGs><MinimumBenefit>1741</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO007</BillingCode><Name>FCI Orbital Implants</Name><Description>Mesh wrapped orbital implant: mesh wrapped bioceramic (aluminium oxide), mesh wrapped hydroxyapatite (synthetic), mesh wrap (polyglycolic acid)</Description><Size>Bioceramic diameter: 16, 18, 20, 22mm; Synthetic Hydroxyapatite diameter: 16, 18, 20, 22mm</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107645</SubCategoryID><GroupID>108480</GroupID><SubGroupID>109723</SubGroupID><Suffix>vp</Suffix><ARTGs><ARTG>143210</ARTG></ARTGs><MinimumBenefit>1741</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO006</BillingCode><Name>FCI Orbital Implants</Name><Description>Orbital Implant, Bioceramic (Aluminium Oxide)/Hydroxyapatite (Synthetic)</Description><Size>Bioceramic diameter, 12, 14, 16, 18, 20, 21, 22mm; Synthetic Diameter, 10, 12, 14, 16, 18, 20, 22mm</Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107645</SubCategoryID><GroupID>108480</GroupID><SubGroupID>109723</SubGroupID><Suffix>vp</Suffix><ARTGs><ARTG>143210</ARTG></ARTGs><MinimumBenefit>1741</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ315</BillingCode><PriorBillingCodes><PriorBillingCode>RJ007</PriorBillingCode><PriorBillingCode>VL002</PriorBillingCode></PriorBillingCodes><Name>Su-Por Sphere</Name><Description>An implantable device made of high-density polyethylene material with an interconnecting pore structure that supports tissue ingrowth. The device is available in sizes to meet the patient's specific needs.  Used for orbital reconstruction following enucleation and evisceration procedure.</Description><Size>14mm, 16mm, 18mm, 20mm, 22mm, 24mm (diameter)</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107645</SubCategoryID><GroupID>108480</GroupID><SubGroupID>109723</SubGroupID><Suffix>vp</Suffix><ARTGs><ARTG>335454</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Organisation
Billing code transferred from VL002
Sponsor transferred from SU-POR AUSTRALIA PTY LTD</ChangeExplanation><MinimumBenefit>1741</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Insert</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE585</BillingCode><Name>OCULFIT Orbital Implant</Name><Description>Porous polyethylene spherical orbital implant</Description><Size>14, 16, 18, 19, 20, 21, 22, 23 mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107645</SubCategoryID><GroupID>108480</GroupID><SubGroupID>109723</SubGroupID><Suffix>vp</Suffix><ARTGs><ARTG>290198</ARTG></ARTGs><MinimumBenefit>1741</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AP002</BillingCode><Name>Mira: Scleral Implants</Name><Description>Silicone Sponge- Retinal Implant Used in Scleral Buckling (Silicone Elastomer Sponge)</Description><Size>Sponge- Mira 502 Cylinder 2mm, Mira 5025 Cylinder 2.5mm, Mira 503 Cylinder 3mm, Mira 504 Cylinder 4mm, Mira 505 Cylinder 5mm, Mira 505G Grooved cylinder 5mm, Mira 505T Packer tunnel cylinder 5mm, Mira 510 Half cylinder 5mm, Mira 515 Brucker two-thirds cylinder 5mm, Mira 501 Masciulli oval 2.5mm by 4mm, Mira 506 Vaiser oval 3mm by 5mm, Mira 506G Vaiser grooved oval 3mm by 5mm, Mira 507 oval 5.5mm by 7.5mm, Mira 507G Grooved oval 5.5mm by 7.5mm, Mira 507T Packer tunnel oval 5.5mm by 7.5mm, Mira 511 Half oval 7.5mm, Mira 517 Brucker two-thirds oval 7.5mm, Mira 509 Fuller flat oval 3.5mm by 7.5mm, Mira 509G Fuller grooved flat oval 3.5mm by 7.5mm, Mira 518 Frederick grooved flat oval 2.5mm by 12mm, Mira 508 Frederick flat oval 4mm by 12mm, Mira 508G Frederick grooved flat oval 4mm by 12mm, Mira 513 Snyder 3+ meridional 7mm by 4mm, Mira 514 Snyder 4+ meridional 8mm by 5mm, Mira 516G Tapered groove 6.4mm, Mira 519G Tapered groove 7.5mm by 3.2mm.</Size><SupplierCode>40030</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108482</GroupID><SubGroupID>109725</SubGroupID><ARTGs><ARTG>143682</ARTG></ARTGs><MinimumBenefit>82</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG031</BillingCode><Name>Labtician Retinal Implants - Sponges</Name><Description>Silicone Sponge- Retinal Implant Used in Scleral Buckling (Silicone Elastomer Sponge)</Description><Size>S 1981-4 Oval Sponge,  S 1981-5 Oval Sponge,  S 1981-7 Oval Sponge,  S 1981-7.5 Oval Sponge,  S 1982-1.5 Round Sponge 1.5mm,  S 1982-2 Round Sponge 2mm,  S 1982-2.5 Round Sponge 2.5mm,  S 1982-3 Round Sponge 3mm,  S 1982-4 Round Sponge 4mm,  S 1982-5 Round Sponge 5mm,  S 1982-5T Round Tunnel Sponge 5mm,  S 1982-7 Round Sponge 7mm,  S 1982-7.5 Round Sponge 7.5mm x 50mm,  S 1983-2.3 Grooved Sponge,  S 1983-2.5 Grooved Part Thickness Sponge,  S 1983-2.8 Grooved Part Thickness Sponge,  S 1983-3 Grooved Sponge,  S 1983-3.2 Grooved Sponge,  S 1983-3.5 Grooved Sponge,  S 1983-4 Grooved Sponge,  S 1983-5 Grooved Sponge,  S 1983-7.5 Grooved Sponge,  S 1984-2.5 Part Thickness Sponge,  S 1984-3 Partial Thickness Sponge,  S 1984-3.3 Partial Thickness Sponge,  S 1984-5 Partial Thickness Sponge,  S 1984-7.5 Partial Thickness Sponge,  S 1986-3.5 Oblong Sponge,  S 1986-4 Oblong Sponge,  S 1987-7 Accessory Sponge,  S 1987-8 Accessory Sponge</Size><SupplierCode>40199</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108482</GroupID><SubGroupID>109725</SubGroupID><ARTGs><ARTG>337137</ARTG></ARTGs><MinimumBenefit>82</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SO012</BillingCode><Name>FCI Scleral Buckling Devices</Name><Description>Sponge/Cord: Silicone</Description><Size>Cord: 1.0 to 5.0mm O.D. x 150mm length; Half Cord: 3.0mm to width x1.5mm to 2.5mm height x150mm; Circular Sponge: 3 to 5mm; Oval Sponge: 2 to 5.5mm x 4 to 12mm; Half Sponge: 2 to 3.1mm x 4 to 7.5mm; Grooved Sponge: 3 to 5mm x 5 to  12mm; Gain Sponge: 6 x </Size><SupplierCode>40335</SupplierCode><CategoryID>107559</CategoryID><SubCategoryID>107646</SubCategoryID><GroupID>108482</GroupID><SubGroupID>109725</SubGroupID><ARTGs><ARTG>143211</ARTG></ARTGs><MinimumBenefit>82</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI926</BillingCode><Name>Sternalock 360</Name><Description>Sternal Closure System</Description><Size>Box Plate (4 Holes, 1 Integrated Cable)</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111931</SubGroupID><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>982</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI927</BillingCode><Name>Sternalock 360</Name><Description>Sternal Closure System</Description><Size>X-Plate 8 Holes, 1 Integrated Cable</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111932</SubGroupID><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>1048</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK027</BillingCode><Name>eight-Plate Plus</Name><Description>The guided growth plate system plus consists of different sizes of eight-Plate plus. The device is designed for the gradual correction of paediatric congenital as well as acquired deformities in both upper and lower extremities.</Description><Size>12mm  16mm  20mm</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><ARTGs><ARTG>289399</ARTG></ARTGs><MinimumBenefit>354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN058</BillingCode><Name>Plating system Com, LK</Name><Description>Plating system Com, LK</Description><Size>≤ 6 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG></ARTGs><MinimumBenefit>325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN071</BillingCode><Name>TC 100</Name><Description>4.5mm Straight Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ001</BillingCode><Name>Flexit System, Flexit HTO Opening Wedge Tibial Plate</Name><Description>Anatomic Locking Tibial Plates</Description><Size>51mm,63mm,2.8mm thick 4-6 holes</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>206422</ARTG></ARTGs><MinimumBenefit>325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN942</BillingCode><Name>Peri-Loc</Name><Description>4.5 Straight Non Locking Plates</Description><Size>≤6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM066</BillingCode><Name>TriMed Olecranon Sled</Name><Description>Washer</Description><Size>one size</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST039</BillingCode><Name>Stryker Plating System</Name><Description>L-Plates</Description><Size>4-6hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><ARTGs><ARTG>25735</ARTG><ARTG>119848</ARTG></ARTGs><MinimumBenefit>354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ074</BillingCode><Name>PediPlates Plating System</Name><Description>O-Plate, Delta Plate, Center Hole</Description><Size>12-24mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><ARTGs><ARTG>191530</ARTG></ARTGs><MinimumBenefit>354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN076</BillingCode><Name>Newclip pelvis plates</Name><Description>Pariarticular anatomic pelvis plates</Description><Size>≤ 6 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG></ARTGs><MinimumBenefit>325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ150</BillingCode><Name>PediLoc Plating System</Name><Description>PediFrag Clavicle Plates</Description><Size>2.7-3.5mm
7-8 Holes
Left, Right</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>191530</ARTG></ARTGs><MinimumBenefit>325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ149</BillingCode><Name>PediLoc Plating System</Name><Description>PediFrag Clavicle Plates</Description><Size>2.7-3.5mm
6 Holes
Left, Right</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>191530</ARTG></ARTGs><MinimumBenefit>325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT014</BillingCode><Name>Superior Fusion Plate System - Plate</Name><Description>Anatomically contoured 6 hole plate and screw set with locking screw hole option, for
anterior fixation of ankle joint. Used for Primary, Revision and Pantalar fusions.</Description><Size>The fixation plate is 77mm in length, 22mm in width and 23mm in depth. 6 hole plate</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>177278</ARTG></ARTGs><MinimumBenefit>1178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU105</BillingCode><PriorBillingCodes><PriorBillingCode>DE651</PriorBillingCode></PriorBillingCodes><Name>Mesh Plate</Name><Description>Plate for Fracture fixation and Arthrodesis</Description><Size>Short  Long</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ111</BillingCode><Name>Iso-Elastic SuperCable Trochanteric Grips and Cable-Plates System</Name><Description>Cable Plates Titanium</Description><Size>6 Hole 185mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>260681</ARTG></ARTGs><MinimumBenefit>1178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU104</BillingCode><Name>Ankle Fusion Plate</Name><Description>Plate for Arthrodesis</Description><Size>One Universal Size</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ077</BillingCode><Name>PediLoc Plating System</Name><Description>4.5mm Locking Plate</Description><Size>2-6 Holes</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>191530</ARTG></ARTGs><MinimumBenefit>1178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU113</BillingCode><PriorBillingCodes><PriorBillingCode>DE348</PriorBillingCode></PriorBillingCodes><Name>Calcaneal Step Plate</Name><Description>Calcaneal Step Plate</Description><Size>5mm, 7.5mm, 10mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>351000</ARTG><ARTG>350871</ARTG></ARTGs><MinimumBenefit>1178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW716</BillingCode><PriorBillingCodes><PriorBillingCode>WR067</PriorBillingCode></PriorBillingCodes><Name>Displacement Plate - DPS</Name><Description>Unique steep plate design allows for controlled fixation of displacement calcaneal osteotomies. 3 step variations allows for accurate corrections. 3.5mm Titanium locking plate</Description><Size>6, 8 &amp; 10mm step, 4 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>1178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM367</BillingCode><Name>Calcaneal Osteotomy Device</Name><Description>Calcaneal Osteotomy Device</Description><Size>All sizes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>306780</ARTG></ARTGs><MinimumBenefit>1178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL202</BillingCode><PriorBillingCodes><PriorBillingCode>IG091</PriorBillingCode></PriorBillingCodes><Name>Newdeal HTO Plates</Name><Description>Stainless steel anatomically shaped plates for high tibial osteotomy;4 or 5 holes </Description><Size>Opening wedge HTO plates, left and right. Closing wedge HTO plates, left and right. Reinforced closing wedge HTO plates, left and right</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>173932</ARTG></ARTGs><MinimumBenefit>1178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER670</BillingCode><Name>Paragon 28 Gorilla Plating System-Plate, tibial (≤ 6 holes),  anterior, TT  </Name><Description>Silverback anterior mini-open plate, TT, contoured or flat, left or right, Ti, complex, variable angle locking</Description><Size>65-109 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>Com,VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>1473</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL243</BillingCode><Name>Smith &amp; Nephew Plate and Screw System- EVOS</Name><Description>Large Fragment Plate –  Non Locking </Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><ARTGs><ARTG>108428</ARTG><ARTG>368492</ARTG></ARTGs><MinimumBenefit>354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU200</BillingCode><PriorBillingCodes><PriorBillingCode>DE217</PriorBillingCode></PriorBillingCodes><Name>Titanium Femoral Osteotomy Plate </Name><Description>Titanium Femoral Osteotomy Plate with 7 Variable Angle Locking Holes </Description><Size>5mm - 17.5mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>Com,VAL</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1473</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU199</BillingCode><Name>Titanium Anterior Posterior Sloped Tibial Osteotomy Plate</Name><Description>Titanium Anterior Posterior Sloped Tibial Osteotomy Plate with 4 variable angle locking holes and 6 variable angle locking holes </Description><Size>0-17.5mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>Com,VAL</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1473</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER610</BillingCode><Name>Paragon 28 Gorilla Plating System-Plate, tibial (≤ 6 holes), Periarticular, Posterior, TT</Name><Description>Paragon 28 Gorilla Silverback tibiotalar (TTC) posterior ankle fusion plate, left or  right, variable ankle locking, complex shape, left or right</Description><Size>≤ 6 holes</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>826</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM541</BillingCode><Name>Omni Stable AF Plating System</Name><Description>Fibula Plates</Description><Size>5 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>306780</ARTG></ARTGs><MinimumBenefit>826</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN008</BillingCode><Name>Newclip Activmotion HTO Plate</Name><Description>Fixation plates for high tibial osteotomy (HTO)</Description><Size>≤ 6 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260229</ARTG></ARTGs><MinimumBenefit>826</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL200</BillingCode><PriorBillingCodes><PriorBillingCode>IG088</PriorBillingCode></PriorBillingCodes><Name>Newdeal Distal Femoral Varus Osteotomy Plate</Name><Description>Stainless steel periarticular anatomically shaped plate fixed with 3 locking screws into femoral condyle </Description><Size>1 Size </Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>173932</ARTG></ARTGs><MinimumBenefit>487</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY622</BillingCode><Name>AO/ASIF Plates</Name><Description>Non Locking Specialty Plates</Description><Size>≤ 6 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>487</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI752</BillingCode><Name>ZPS-Zimmer Plate &amp; Screw System</Name><Description>3.5mm and 4.5mm pelvic plates</Description><Size>6 holes or less</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>487</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK075</BillingCode><Name>Stryker Plating System Basic Fragment Set</Name><Description>4.5mm Reconstruction Plate</Description><Size>3-9 Holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>139635</ARTG></ARTGs><MinimumBenefit>487</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT001</BillingCode><Name>Hawk Anterior Ankle Fusion Set</Name><Description>Anatomically contoured 6 hole plate and screw set for anterior fixation of the ankle joint.</Description><Size>77mm in length
22mm in width
23mm depth</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>177278</ARTG></ARTGs><MinimumBenefit>487</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU198</BillingCode><PriorBillingCodes><PriorBillingCode>DE094</PriorBillingCode></PriorBillingCodes><Name> Anterior Posterior Sloped Stainless Steel Tibial Osteotomy Plate</Name><Description>Anterior Posterior Sloped Stainless Steel Tibial Osteotomy Plate with 4 non locking holes</Description><Size>5 - 15mm length</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>487</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ075</BillingCode><Name>PediPlates Plating System</Name><Description>I-Plate
Center Hole</Description><Size>16-32mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>191530</ARTG></ARTGs><MinimumBenefit>487</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN143</BillingCode><Name>TC 100 </Name><Description>4.5mm Reconstruction Plate         </Description><Size>&lt; 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>487</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL201</BillingCode><PriorBillingCodes><PriorBillingCode>IG089</PriorBillingCode></PriorBillingCodes><Name>Newdeal Femoral Varus and De-rotation Osteotomy Plates</Name><Description>Stainless steel periarticular anatomic plate fixed with locking screws into proximal femur </Description><Size>Newdeal Femoral Varus and De-rotation Osteotomy Plates - 3 holes, Newdeal Femoral Varus and De-rotation Osteotomy Plates - 4 holes, Newdeal Reinforced Femoral Newdeal and De-rotation Osteotomy Plates - left and right</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>173932</ARTG></ARTGs><MinimumBenefit>487</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX014</BillingCode><Name>ARMAR 4.5mm Meril Locking Plate System ≤ 6 holes</Name><Description>TiCP locking plates</Description><Size>2-6 Holes
44-120mm Length</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK535</BillingCode><Name>Stryker Plating System</Name><Description>Locking Reconstruction Plates</Description><Size>5.0mm, 4-6 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>139635</ARTG></ARTGs><MinimumBenefit>325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL199</BillingCode><PriorBillingCodes><PriorBillingCode>IG084</PriorBillingCode></PriorBillingCodes><Name>Newdeal Bendable Osteosynthesis Plates</Name><Description>Composition - 316L Stainless Steel.  To be used only with Newdeal screws/lock screws.</Description><Size>3-6 holes </Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>173932</ARTG></ARTGs><MinimumBenefit>325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK532</BillingCode><Name>Stryker Plating System</Name><Description>Locking Compression Anatomical Shape</Description><Size>2-6 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>139635</ARTG><ARTG>295226</ARTG><ARTG>269713</ARTG><ARTG>119848</ARTG></ARTGs><MinimumBenefit>325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL198</BillingCode><PriorBillingCodes><PriorBillingCode>IG083</PriorBillingCode></PriorBillingCodes><Name>Newdeal Reinforced Bendable Osteosynthesis Plates</Name><Description>Stainless Steel 2 - 4 Holes </Description><Size>2 holes, 4 holes/77mm, 4 holes/112mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>173932</ARTG></ARTGs><MinimumBenefit>325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU196</BillingCode><Name>Stainless Steel Square Wedge Tibial Osteotomy Plate</Name><Description>Steel Square Wedge Tibial Osteotomy Plate with 4 non locking holes </Description><Size>3mm - 17.5mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>351000</ARTG><ARTG>350871</ARTG></ARTGs><MinimumBenefit>487</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL176</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Large Fragment Plate – Locking</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>368492</ARTG><ARTG>108428</ARTG></ARTGs><MinimumBenefit>325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY116</BillingCode><Name>AO/ASIF Plates</Name><Description>LCP Large Fragement Plates</Description><Size>≤ 6 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111933</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU303</BillingCode><Name>Posterior Pilon Fusion Plate</Name><Description>Plate for Arthrodesis</Description><Size>13-15 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>508</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL177</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Large Fragment Plate – Locking </Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>368492</ARTG><ARTG>108428</ARTG></ARTGs><MinimumBenefit>508</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ078</BillingCode><Name>PediLoc System ≥7 to ≤15 holes, screw size ≥4.5mm</Name><Description>4.5mm Bowed locking compression femur 10, 12, 14 hole plates
4.5mm contour locking compression femur 8, 10, 12, 14 hole plates left and right</Description><Size>4.5mm bowed 10, 12, 14 hole
4.5mm contour 8,10,12,14 hole right
4.5mm contour 8, 10, 12, 14 hole left</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>191586</ARTG></ARTGs><MinimumBenefit>707</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY814</BillingCode><Name>AO/ASIF Plates</Name><Description>Non Locking Fragment Plate</Description><Size>7 - 15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>707</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER671</BillingCode><Name>Paragon Silverback Straddle Plate-anterior TT</Name><Description>Silverback Anterior Straddle Plate, TT, Contoured or flat, standard or long, left or right        </Description><Size>various sizes</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>1244</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK544</BillingCode><Name>Stryker Plating System Basic Fragment Set</Name><Description>4.5mm Reconstruction Plate</Description><Size>7-15 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><ARTGs><ARTG>139635</ARTG><ARTG>119848</ARTG></ARTGs><MinimumBenefit>645</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN943</BillingCode><Name>Peri-Loc</Name><Description>4.5 Straight Non Locking Plates</Description><Size>≥7 to ≤15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>645</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL244</BillingCode><Name>Smith &amp; Nephew Plate and Screw System- EVOS</Name><Description>Large Fragment Plate –  Non Locking </Description><Size>7-15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><ARTGs><ARTG>108428</ARTG><ARTG>368492</ARTG></ARTGs><MinimumBenefit>645</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN133</BillingCode><Name>TC-100</Name><Description>4.5mm Straight Plates</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>645</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN043</BillingCode><Name>Newclip Plating System</Name><Description>VAL Locking plates</Description><Size>Standard ≥ 7 to ≤ 15 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260229</ARTG></ARTGs><MinimumBenefit>1244</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER609</BillingCode><Name>Paragon 28 Gorilla Plating System-Plate, tibial ( ≥ 7 to ≤ 15 holes), Periarticular, Posterior, TT</Name><Description>Paragon 28 Gorilla Silverback tibiotalar (TT) posterior ankle fusion plate, left or right</Description><Size>( ≥ 7 to ≤ 15 holes); 65-109 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>290443</ARTG></ARTGs><MinimumBenefit>1244</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER676</BillingCode><Name>Gorilla Silverback Spanning Plates-Anterior/Lateral</Name><Description>Silverback Spanning Plates-Anterior/Lateral, flat, standard or long, left or right</Description><Size>69-109 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>1244</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM542</BillingCode><Name>Omni Stable AF Plating System</Name><Description>Fibula Plates</Description><Size>9 - 15 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>306780</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>1244</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM524</BillingCode><Name>Ankle Fusion Plate</Name><Description>Ankle Fusion Plate</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>306780</ARTG></ARTGs><MinimumBenefit>1244</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER611</BillingCode><Name>Paragon 28 Gorilla Plating System-Plate, tibial ( ≥ 7 to ≤ 15 holes), Periarticular, Posterior, TTC</Name><Description>Paragon 28 Gorilla Silverback tibiotalarcalcaneal (TTC) posterior ankle fusion plate, left or right, variable ankle locking, complex shape, flat or contoured, left or right</Description><Size>( ≥ 7 to ≤ 15 holes); 65-109 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>290443</ARTG></ARTGs><MinimumBenefit>1244</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER674</BillingCode><Name>Paragon Silverback Straddle Plate-posterior TTC</Name><Description>Silverback Straddle Plate-posterior TTC, flat or contoured, left or right, Ti</Description><Size>Various lengths</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>1244</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER677</BillingCode><Name>Gorilla Silverback Spanning Plates-Posterior</Name><Description>Silverback Spanning Plates-posterior, flat, standard or long, left or right</Description><Size>various lengths</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>1244</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN098</BillingCode><Name>TC-100</Name><Description>4.5mm Reconstruction Plate</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>645</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU176</BillingCode><Name>Arthrex Clavicle Plating System</Name><Description>Locking clavicle plate and screw system for fixation of clavicle fractures.</Description><Size>7-10 holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>645</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU114</BillingCode><PriorBillingCodes><PriorBillingCode>DE342</PriorBillingCode></PriorBillingCodes><Name>PEEKPower HTO Plate</Name><Description>Medial High Tibial Osteotomy Implant Device System</Description><Size>One Universal Size</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><ARTGs><ARTG>350871</ARTG></ARTGs><MinimumBenefit>645</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK533</BillingCode><Name>Stryker Plating System</Name><Description>Locking Compression Anatomical Shape</Description><Size>7-15 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>139635</ARTG><ARTG>269713</ARTG><ARTG>295226</ARTG><ARTG>119848</ARTG></ARTGs><MinimumBenefit>508</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH065</BillingCode><Name>Sternalock</Name><Description>Straight plate, locking, </Description><Size>8 hole</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>508</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK536</BillingCode><Name>Stryker Plating System</Name><Description>Locking Reconstruction Plates</Description><Size>5.0mm, 8-14 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>139635</ARTG></ARTGs><MinimumBenefit>508</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY636</BillingCode><Name>AO/ASIF Plates</Name><Description>LC-LCP Fragment Plates</Description><Size>7-15 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>508</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU305</BillingCode><Name>Anterolateral Pilon Fusion Plate</Name><Description>Plate for Arthrodesis</Description><Size>7-15 Holes  </Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1295</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ112</BillingCode><Name>Iso-Elastic SuperCable Trochanteric Grips and Cable-Plates System</Name><Description>Cable Plates Titanium</Description><Size>8 Hole 240mm  10 Hole 290mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>260681</ARTG></ARTGs><MinimumBenefit>1295</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU148</BillingCode><Name>Ankle Fusion Plating System</Name><Description>Fusion Plate</Description><Size>Anterior Plate </Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1295</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX015</BillingCode><Name>ARMAR 4.5mm Meril Locking Plate System ≥ 7 to ≤ 15 holes</Name><Description>TiCP humeral locking plates</Description><Size>7-15 Holes
118-283mm Length</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>508</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI948</BillingCode><Name>Ankle Fix - Plate ≥ 7 to ≤ 15 holes</Name><Description>Ankle Fusion plate</Description><Size>Standard and Large</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>140687</ARTG></ARTGs><MinimumBenefit>1295</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW956</BillingCode><PriorBillingCodes><PriorBillingCode>WR446</PriorBillingCode></PriorBillingCodes><Name>ORTHOLOC Universal Ankle Fusion Plating System</Name><Description>The ORTHOLOC Universal Ankle Fusion Plating System is intended to facilitate arthrodesis of the ankle including tibiotalocalcaneal and tibiotalar joints and tibiocalcaneal arthrodeses, in conjunction with osteotomies and fractures of the distal tibia, talus, and calcaneus.</Description><Size>82mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>Com,VAL</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>1244</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK633</BillingCode><Name>VariAx Wrist plates</Name><Description>Wrist plates</Description><Size>7-15 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>Com,VAL</Suffix><ARTGs><ARTG>269713</ARTG></ARTGs><MinimumBenefit>1244</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER541</BillingCode><Name>Paragon 28 Gorilla Plating System-Plate, tibial ( ≥ 7 to ≤ 15 holes), Tibiotalarcalcaneal (TTC)</Name><Description>Paragon 28 Gorilla Silverback tibiotalarcalcaneal (TTC) anterior ankle fusion plate, left or right, variable ankle locking, complex shape, flat or contoured, left or right</Description><Size>( ≥ 7 to ≤ 15 holes); 65-109 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>Com,VAL</Suffix><ARTGs><ARTG>290443</ARTG></ARTGs><MinimumBenefit>1244</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN360</BillingCode><Name>VA-LCP Periprosthetic Proximal Femur Plating System</Name><Description>VAL compression plate, proximal femur hook plates, stainless steel</Description><Size>≥7 to ≤15 holes, left &amp; right profile</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>Com,VAL</Suffix><ARTGs><ARTG>157069</ARTG><ARTG>286609</ARTG></ARTGs><MinimumBenefit>1244</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU203</BillingCode><Name>Ankle Fusion Plating System</Name><Description>Fusion Plate for Ankle Joint Arthritis</Description><Size>Anterior, Posterior, Lateral</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>508</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN077</BillingCode><Name>Newclip pelvis plates</Name><Description>Pariarticular anatomic pelvis plates</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG></ARTGs><MinimumBenefit>508</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI168</BillingCode><Name>Zimmer Internal Fixation Systems: Cable System</Name><Description>Cable-Ready 8 Hole Plate - Stainless Steel</Description><Size>246mm long</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><ARTGs><ARTG>108377</ARTG></ARTGs><MinimumBenefit>645</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN060</BillingCode><Name>Plating System Com, LK</Name><Description>Plating System Com, LK</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG></ARTGs><MinimumBenefit>508</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ002</BillingCode><Name>FlexiSystem, Flexit HTO Opening wedge Tibial Plate</Name><Description>Anatomic Locking Tibial Plates</Description><Size>80mm, 7-15 holes</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>206422</ARTG></ARTGs><MinimumBenefit>508</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN038</BillingCode><Name>Newclip Activmotion HTO Plate</Name><Description>Fixation plates for high tibial osteotomy (HTO)</Description><Size>7 to 15 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111934</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG></ARTGs><MinimumBenefit>508</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN078</BillingCode><Name>TC-100</Name><Description>4.5mm Straight Plates</Description><Size>≥ 16 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111935</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>322</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN034</BillingCode><Name>Newclip Femoral Plate</Name><Description>Variable angle plates for femur</Description><Size>Standard ≥ 16 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111935</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260229</ARTG></ARTGs><MinimumBenefit>1207</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER673</BillingCode><Name>Paragon Silverback Straddle Plate-lateral TTC</Name><Description>Paragon Silverback Straddle Plate-lateral TTC, long, left or right.</Description><Size>one size</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111935</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>1207</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER672</BillingCode><Name>Paragon Silverback Straddle Plate-lateral TC</Name><Description>Silverback Straddle Plate-lateral TC, long, left or right        </Description><Size>one size</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111935</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>1207</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU106</BillingCode><PriorBillingCodes><PriorBillingCode>DE572</PriorBillingCode></PriorBillingCodes><Name>Plantar Lapidus Plates</Name><Description>Arthrodesis Plate</Description><Size>Short and Standard  Left &amp; Right side specific</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111935</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1378</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU306</BillingCode><Name>Anterolateral Pilon Fusion Plate</Name><Description>Plate for Arthrodesis</Description><Size>&gt;16 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111935</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1378</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN359</BillingCode><Name>VA-LCP Periprosthetic Proximal Femur Plating System</Name><Description>VAL compression plate, proximal femur hook plates, stainless steel</Description><Size>≥16 holes, left &amp; right profile</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111935</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>286609</ARTG><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1378</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN356</BillingCode><Name>VA-LCP Periprosthetic Proximal Femur Plating System</Name><Description>VAL compression plate, proximal femur plates, stainless steel</Description><Size>≥16 holes, left &amp; right profile</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111935</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>286609</ARTG><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1378</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI943</BillingCode><Name>Ankle Fix -Plate ≥ 16 holes</Name><Description>Ankle fusion plate</Description><Size>One size only</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111935</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>140687</ARTG></ARTGs><MinimumBenefit>1378</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU304</BillingCode><Name>Posterior Pilon Fusion Plate</Name><Description>Plate for Arthrodesis</Description><Size>≥ 16 Holes  </Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111935</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG><ARTG>350871</ARTG></ARTGs><MinimumBenefit>762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK537</BillingCode><Name>Stryker Plating System</Name><Description>Locking Reconstruction Plates</Description><Size>5.0mm, 16-22 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111935</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>139635</ARTG></ARTGs><MinimumBenefit>762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK534</BillingCode><Name>Stryker Plating System</Name><Description>Locking Compression Anatomical Shape</Description><Size>16-22 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111935</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>119848</ARTG><ARTG>139635</ARTG><ARTG>237797</ARTG><ARTG>295226</ARTG></ARTGs><MinimumBenefit>762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX016</BillingCode><Name>ARMAR 4.5mm Meril Locking Plate System ≥ 16 holes</Name><Description>TiCP locking plates</Description><Size>16-26 Holes
262-481mm Length</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111935</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN078</BillingCode><Name>Newclip pelvis plates</Name><Description>Pariarticular anatomic pelvis plates</Description><Size>≥ 16 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111935</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>260232</ARTG><ARTG>260229</ARTG></ARTGs><MinimumBenefit>762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN784</BillingCode><Name>Peri-Loc</Name><Description>Plates, Stainless Steel, Non-Locking, Broad, Left &amp; Rights</Description><Size>≥ 16 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111935</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>322</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK545</BillingCode><Name>Stryker Plating System Basic Fragment Set</Name><Description>4.5mm Reconstruction Plate</Description><Size>16-22 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111935</SubGroupID><ARTGs><ARTG>139635</ARTG><ARTG>119848</ARTG></ARTGs><MinimumBenefit>322</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL178</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Large Fragment Plate – Locking </Description><Size>≥ 16 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111935</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>368492</ARTG><ARTG>108428</ARTG></ARTGs><MinimumBenefit>762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY637</BillingCode><Name>AO/ASIF Plates</Name><Description>LC-LCP Plates</Description><Size>≥ 16 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111935</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ079</BillingCode><Name>PediLoc - Periarticular Locking Plating System Femur- &gt; 16 holes, screw size ≥4.5mm</Name><Description>4.5mm Bowed locking compression femur 16 hole plate
4.5mm Bowed locking compression femur 18 hole plate
4.5mm contour locking compression femur 16 hole plate right
4.5mm contour locking compression femur 18 hole plate right
4.5mm contour locking compression femur 20 hole plate right
4.5mm contour locking compression femur 16 hole plate left
4.5mm contour locking compression femur 18 hole plate left
4.5mm contour locking compression femur 20 hole plate left</Description><Size>4.5mm Bowed, 16 hole
4.5mm Bowed, 18 hole
4.5mm contour,16 hole, right
4.5mm contour,18 hole, right
4.5mm contour,20 hole, right
4.5mm contour,16 hole, left
4.5mm contour,18 hole, left
4.5mm contour,20 hole, left</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111935</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>191586</ARTG></ARTGs><MinimumBenefit>1041</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL096</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Small Fragment Plate</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ103</BillingCode><PriorBillingCodes><PriorBillingCode>EF001</PriorBillingCode></PriorBillingCodes><Name>Merete TTF Anterior Ankle Plate</Name><Description>Anterior Ankle Plates</Description><Size>≤ 6 holes Left and right</Size><SupplierCode>40063</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>203737</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN979</BillingCode><Name>Peri-Loc</Name><Description>Fibula Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU285</BillingCode><Name>Dynanite Compression Plates</Name><Description>Plate for Arthrodesis</Description><Size>2-4 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>355042</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ178</BillingCode><Name>PediFoot Deformity Correction System</Name><Description>3.5mm Plates, Compression/Neutral, Recon, Angle Iron, Wedge, Clover    </Description><Size>7-70mm length, 4-6mm wedge length, 2-6 holes</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>191530</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU302</BillingCode><Name>Lateral Hook Plate</Name><Description>Plate for fracture fixation</Description><Size>7-15 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST730</BillingCode><Name>Leibinger Titanium Implant System</Name><Description>Hand system, fixation plate, L-shape, right/left</Description><Size>1.7mm, 6 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><ARTGs><ARTG>200615</ARTG><ARTG>295882</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN109</BillingCode><Name>TC100</Name><Description>3.5mm Reconstruction Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JD022</BillingCode><Name>MTP Plate</Name><Description>Fusion Plates</Description><Size>Left and Right</Size><SupplierCode>40214</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>222648</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JD021</BillingCode><Name>1/3 Tubular Plate</Name><Description>1/3 Tubular Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40214</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>222648</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY702</BillingCode><Name>AO/ASIF Plates</Name><Description>DCS DHS Plate, Angled blade, Osteotomy</Description><Size>≤6 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN044</BillingCode><Name>TC-100 &amp; Peri-Loc</Name><Description> 3.5mm Straight Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU174</BillingCode><PriorBillingCodes><PriorBillingCode>DE565</PriorBillingCode></PriorBillingCodes><Name>Lisfranc Plates</Name><Description>Arthrodesis Plate</Description><Size>Small, Medium, Large  Plates come in Left &amp; Right</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU194</BillingCode><PriorBillingCodes><PriorBillingCode>DE417</PriorBillingCode></PriorBillingCodes><Name>Locking Medial Hook Plate</Name><Description>Locking Medial Hook Plate for Fixation of medial malleolus fractures</Description><Size>3-5 holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW596</BillingCode><Name>Stryker Locked Plating System</Name><Description>Periarticular variable angle locking plate - clavicle</Description><Size>7-15 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>237797</ARTG></ARTGs><MinimumBenefit>1159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM518</BillingCode><Name>OMNI Plating System</Name><Description>X and Dog Bone Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>306780</ARTG></ARTGs><MinimumBenefit>1159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW713</BillingCode><PriorBillingCodes><PriorBillingCode>WR064</PriorBillingCode></PriorBillingCodes><Name>MPJ Fusion Plate</Name><Description>Titanium locking plate with built-in 1- degree valgus angle for anatomic fixation of 1st MTP joint</Description><Size>Small, Medium &amp; Revision, Left &amp; Right, 0, 5 &amp; 10 degree</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>1159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH242</BillingCode><Name>ALPS Foot System</Name><Description>Complex periarticular foot plates</Description><Size>small to large</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>153056</ARTG></ARTGs><MinimumBenefit>1159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER480</BillingCode><Name>Paragon 28 Gorilla Plating System-Plate, small (≤ 6 holes);variable angle locking, complex</Name><Description>Paragon28 Gorilla, small titanium compression plates; universal; variable angle locking; compression; various complex shapes</Description><Size>thickness 1.3 - 2.0 mm; multi screw diameter purchase</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>1159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM304</BillingCode><Name>OsteoMed FPS</Name><Description>Titanium locking footplates</Description><Size>3.5mm and 4mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>202319</ARTG></ARTGs><MinimumBenefit>1159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN357</BillingCode><Name>VA-LCP Periprosthetic Proximal Femur Plating System </Name><Description>VAL compression plate, locking attachment plate, stainless steel</Description><Size>≤6 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>157069</ARTG><ARTG>286609</ARTG></ARTGs><MinimumBenefit>1159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL223</BillingCode><PriorBillingCodes><PriorBillingCode>IG132</PriorBillingCode></PriorBillingCodes><Name>TIBIAXYS Distal Tibia System - Ankle Arthrodesis - Medial anterior plate</Name><Description>Titanium medial anterior plate with 6 holes; left or right</Description><Size>3mm thick, 77mm long</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>173932</ARTG></ARTGs><MinimumBenefit>1159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU171</BillingCode><Name>MTP Plate, Straight</Name><Description>Metatarso-Phalangeal Fusion plate for 1st MTP</Description><Size>Small and Standard, ≤ 6 holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU242</BillingCode><PriorBillingCodes><PriorBillingCode>DE763</PriorBillingCode></PriorBillingCodes><Name>MaxForce MTP</Name><Description>Plate for Arthrodesis</Description><Size>6 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM121</BillingCode><Name>'TriMed Wire Plates</Name><Description>Wire Fixation plate</Description><Size>3 &amp; 5 hole</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK016</BillingCode><Name>Orthofix eight-Plate</Name><Description>Guided growth plate for correction of angular deformities over an open growth plate. Titanium, two screw holes, wire guided.</Description><Size>12mm, 16mm</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><ARTGs><ARTG>118320</ARTG><ARTG>189806</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK028</BillingCode><Name>Quad Plate Plus</Name><Description>The Guided Growth Plate System Plus consists of different sizes of quad- Plate plus, different cannulated and solid screw options. The device is designed for the gradual correction of paediatric congenital as well as acquired deformities in both the upper and lower extremities, provided that the physics are not fused. The plates feature a contoured waist and low profile for paediatric usage. There is a centre hole in the plates for a temporary guide pin to be implanted to aid application and removal of the plate. The plates are attached to the external surface of the bone over the growth plate by screws. These screws are not locked to the plate, but rather are allowed to swivel and diverge in their position as bone growth occurs. The implant acts like a flexible hinge, permitting growth at the growth plate to gradually straighten the limb.</Description><Size>16mm plate  22mm plate</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><ARTGs><ARTG>289399</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST037</BillingCode><Name>Stryker Plating System Small Fragment Set </Name><Description>One Third Tubular Plate with Collar</Description><Size>2-6 Holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><ARTGs><ARTG>295226</ARTG><ARTG>269713</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY726</BillingCode><Name>AO/ASIF Plates</Name><Description>Non-Locking Fragment Plates</Description><Size>≤6 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><ARTGs><ARTG>157069</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN012</BillingCode><Name>TC-100 &amp; Peri-Loc</Name><Description>1/3 Tubular Plates</Description><Size>≤ 6 holes.</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU175</BillingCode><PriorBillingCodes><PriorBillingCode>DE555</PriorBillingCode></PriorBillingCodes><Name>Locking POW Plate</Name><Description>Wedged Fusion Plate</Description><Size>0-7mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU107</BillingCode><PriorBillingCodes><PriorBillingCode>DE644</PriorBillingCode></PriorBillingCodes><Name>Proximal 1st Metatarsal Osteotomy Plate</Name><Description>1st Metatarsal Osteotomy Plate</Description><Size>Petite - Left and Right Side Specific  Standard - Left and Right Side Specific</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN028</BillingCode><Name>Newclip Plating System</Name><Description>Complex Locking Bone Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF126</BillingCode><Name>Islay Recon Plate</Name><Description>Islay Recon Plate</Description><Size>Recon Plate, 6 Hole (RRP)
Recon Plate, 8 Hole (RRP)
Recon Plate, 14 Hole (RRP)</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>208160</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY703</BillingCode><Name>AO/ASIF Plates</Name><Description>Specialty Locking Plate</Description><Size>≤ 6 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF119</BillingCode><Name>Islay Arthrodesis Wedge Plate</Name><Description>Islay Arthrodesis Wedge Plate</Description><Size>Arthrodesis Wedge Plate 0mm-8mm(AWP), - 30mm (3.5mm universal locking plate 12mm - 30mm (3.5ULP))</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>208160</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL217</BillingCode><PriorBillingCodes><PriorBillingCode>IG117</PriorBillingCode></PriorBillingCodes><Name>UNI-CP Compression plating system</Name><Description>2 or 4 hole stainless steel compression plate, with 3 plate configurations (2 or 4 hole 'straight' design, 4 hole T-design)</Description><Size>2 or 4 hole, 4 interaxis sizes: 17, 20, 25 and 30mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>173932</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL130</BillingCode><Name>Smith &amp; Nephew Plate and Screw System- EVOS</Name><Description>Small Fragment Plate</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF083</BillingCode><Name>Islay Universial Locking Plate</Name><Description>Titanium Plate with or without wedge with 4 and non locking holes. Left and right side specific.</Description><Size>Various length plates from 18-24mm with and without wedges (2-7mm), plates with valugus angle built in range.</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>208160</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL227</BillingCode><PriorBillingCodes><PriorBillingCode>IG136</PriorBillingCode></PriorBillingCodes><Name>Uni-CP Compression plating system</Name><Description>4 hole U design</Description><Size>4 hole, 3 interaxis sizes: 17,19,21mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>173932</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN796</BillingCode><Name>Peri-Loc</Name><Description>Locking 1/3 Tubular &amp; 3.5mm Straight Plates </Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU150</BillingCode><Name>Dual Syndesmosis Tightrope Plate</Name><Description>Buttress plate for syndesmosis repair</Description><Size>1 size (2 Hole Plate)</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO446</BillingCode><Name>Acumed Small Fragment Plates</Name><Description>One Third Tubular Plates</Description><Size>3 to 6 Holes</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN914</BillingCode><Name>Peri-Loc</Name><Description>Clavicle plates</Description><Size>≤6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL086</BillingCode><Name>PERI-LOC</Name><Description>Clavicle plates</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY723</BillingCode><Name>AO/ASIF Plates</Name><Description>LCP Plates</Description><Size>≤6 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ198</BillingCode><Name>ARIX Wrist System - Carpal Fusion Plate</Name><Description>Carpal Fusion Plate</Description><Size>6 holes </Size><SupplierCode>40063</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>409165</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ216</BillingCode><Name>Ankle Fusion Locking Plate</Name><Description>Mini and ANTT Ankle Fusion Locking Plates, Left/ Right, or Universal with different angles. </Description><Size>6 Holes or less</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>261562</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK548</BillingCode><Name>Stryker Plating System Small Fragment Set</Name><Description>3.5mm Reconstruction Plate</Description><Size>4-6 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><ARTGs><ARTG>295226</ARTG><ARTG>119848</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI789</BillingCode><Name>ZPS-Zimmer Plate and Screw System</Name><Description>3.5mm Straight Reconstruction Plates</Description><Size>3-6 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BU023</BillingCode><Name>Airlock Plating System</Name><Description>Airlock Plating System</Description><Size>None Plates 2 - 6 Holes</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>235766</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN026</BillingCode><Name>Newclip Plating System</Name><Description>Locking Bone Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>260232</ARTG><ARTG>260229</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW047</BillingCode><Name>WEGO Trauma Systems</Name><Description>Locking Plate Systems</Description><Size>≤ 6 holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ035</BillingCode><Name>Valens Shoulder and Elbow - Plates</Name><Description>LCP, Right/Oblique Angled, T-Plate</Description><Size>1-6 Holes</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ031</BillingCode><Name>Valetis Ankle - Plates</Name><Description>1/3 Tubular Plate</Description><Size>4 to 6 hole</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>284755</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW034</BillingCode><Name>WEGO Trauma Systems</Name><Description>Small Fragment Plating System</Description><Size>≤ 6 Holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU320</BillingCode><Name>Wedged Profile Plate</Name><Description>Wedged Profile Plate</Description><Size>2 holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><ARTGs><ARTG>350871</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW715</BillingCode><PriorBillingCodes><PriorBillingCode>WR066</PriorBillingCode></PriorBillingCodes><Name>Arthrodesis Flat Plate - AFP</Name><Description>Flat plate intended for use in isolated tarsal fusions, titanium locking plate, 2mm thickness</Description><Size>12, 14 &amp; 16mm length - 4 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI930</BillingCode><Name>Sternalock</Name><Description>≤ 6 holes, various shapes</Description><Size>≤ 6 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM291</BillingCode><Name>Forearm Locking Plate</Name><Description>Forearm plates</Description><Size>≤ 6 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW936</BillingCode><PriorBillingCodes><PriorBillingCode>WR423</PriorBillingCode></PriorBillingCodes><Name>MaxLock Extreme System – Edgelock II STP Plate</Name><Description>Calcaneal displacement osteotomies locking plate, Titanium.</Description><Size>≤ 6 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>214671</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW978</BillingCode><PriorBillingCodes><PriorBillingCode>WR069</PriorBillingCode></PriorBillingCodes><Name>TOM Plate</Name><Description>Designed for base osteotomies and fusions of MT1 with correction achieved through one cut. It is a titanium locking plate, anatomically designed with a smaller radius to fit the contour of the first metatarsal and 5 step variation in 1mm increments for ac</Description><Size>- L &amp; R: neutral, 1-5mm step, 4 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW902</BillingCode><PriorBillingCodes><PriorBillingCode>WR378</PriorBillingCode></PriorBillingCodes><Name>MaxLock Extreme System - Small Plates ≤ 6 holes</Name><Description>Small variable angle locking plates, titanium, ≤ 6 holes</Description><Size>≤ 6 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>214671</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW711</BillingCode><PriorBillingCodes><PriorBillingCode>WR057</PriorBillingCode></PriorBillingCodes><Name>Lapidus Plate</Name><Description>Titanium locking plate with unique stepped displacement in 1mm increments permits accurate plantarisation and lateralisation in midfoot fusions.</Description><Size> 3.5mm: neutral, 1-6mm step</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI543</BillingCode><Name>Zimmer Universal Locking System</Name><Description>3.5mm Locking T plate</Description><Size>3 hole head 5 hole shaft 73mm length; 4 hole head 6 hole shaft 85mm length; 3 hole head 3 hole shaft left 51mm length; 3 hole head 4 hole shaft left 63mm length; 3 hole head 3 hole shaft right 51mm length; 3 hole head 4 hole shaft right 63mm length.</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW707</BillingCode><PriorBillingCodes><PriorBillingCode>WR049</PriorBillingCode></PriorBillingCodes><Name>Charlotte MTP Fusion System</Name><Description>MTP plate, stainless steel</Description><Size>Left &amp; Right small &amp; standard, 6 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM125</BillingCode><Name>TriMed Sidewinder</Name><Description>Ankle Fixation Plate</Description><Size>≤ 6 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU186</BillingCode><Name>Titanium Plate with Wedge</Name><Description>Titanium Plate with Wedge. Left and right side specific.</Description><Size>6-10mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>351000</ARTG><ARTG>350871</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU192</BillingCode><Name>Locking Lateral Hook Plate</Name><Description>Locking Lateral Hook Plate for Fracture Fixation of the Lateral Malleolus</Description><Size>3-5 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ154</BillingCode><Name>PediLoc Plating System</Name><Description>Locking Cannulated Blade Plate</Description><Size>Infant, Child, Adolescent, 90-130 degrees, 0-14 mm offset, 25-80 mm blade, 2-4 holes</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>191530</ARTG></ARTGs><MinimumBenefit>572</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU201</BillingCode><PriorBillingCodes><PriorBillingCode>DE285</PriorBillingCode></PriorBillingCodes><Name> Titanium Lapidus Arthrodesis Plate </Name><Description>Titanium Lapidus Arthrodesis Plate with locking holes and compresion slot</Description><Size>Small, Large</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU110</BillingCode><PriorBillingCodes><PriorBillingCode>DE568</PriorBillingCode></PriorBillingCodes><Name>Posterolateral Distal Fibula Plate</Name><Description>Plate for fracture fixation</Description><Size>8 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU165</BillingCode><Name>Locking Reconstruction Plate</Name><Description>Reconstruction Plate for communited Fibula Shaft Fractures</Description><Size>4-6 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG><ARTG>350871</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU109</BillingCode><PriorBillingCodes><PriorBillingCode>DE533</PriorBillingCode></PriorBillingCodes><Name>Posterolateral Distal Fibula Plate</Name><Description>Plate for fracture fixation</Description><Size>4-6 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU317</BillingCode><Name>H-Plates</Name><Description>Plate for Arthrodesis</Description><Size>Small, Medium, Large</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU167</BillingCode><PriorBillingCodes><PriorBillingCode>DE453</PriorBillingCode></PriorBillingCodes><Name>X Plate</Name><Description>Plate for fusion</Description><Size>Medium, Large</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU168</BillingCode><PriorBillingCodes><PriorBillingCode>DE457</PriorBillingCode></PriorBillingCodes><Name>Low Profile Straight Plate</Name><Description>Plate for fusion</Description><Size>2-5 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG><ARTG>350871</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ138</BillingCode><Name>PediLoc Plating System</Name><Description>3.5mm Locking Plate,
PediLoc, PediFrag, PLEO</Description><Size>2-6 Hole</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>191530</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW068</BillingCode><Name>Equinox Trauma Systems</Name><Description>Clavicle Midshaft Locking Compression Plate </Description><Size>6 holes left, 6 holes right</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU108</BillingCode><PriorBillingCodes><PriorBillingCode>DE455</PriorBillingCode></PriorBillingCodes><Name>Low Profile T-Plate</Name><Description>Plate for fusion</Description><Size>2-4 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU169</BillingCode><PriorBillingCodes><PriorBillingCode>DE504</PriorBillingCode></PriorBillingCodes><Name>Double Compression Plate System</Name><Description>Fixation plates for surgical compression across fusion sites.</Description><Size>Double Compression Plate, 2 Hole, 20 mm   Double Compression Plate, 2 Hole, 25 mm   Double Compression Plate, 2 Hole, 30 mm   Double Compression Plate, 3 Hole, 20 mm   Double Compression Plate, 3 Hole, 25 mm   Double Compression Plate, 3 Hole, 30 mm   Double Compression Plate, 4 Hole, Straight, 20 mm   Double Compression Plate, 4 Hole, Straight, 25 mm   Double Compression Plate, 4 Hole, Straight, 30 mm   Double Compression Plate, 4 Hole, Square, 20 mm   Double Compression Plate, 4 Hole, Square, 25 mm   Double Compression Plate, 4 Hole, Square, 30 mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU164</BillingCode><PriorBillingCodes><PriorBillingCode>DE372</PriorBillingCode></PriorBillingCodes><Name>Low Profile MTP Plate</Name><Description>Athrodesis Plate - 6 hole plates</Description><Size>Contoured small left,contoured small right, contoured standard right,contoured standard left</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU170</BillingCode><Name>MTP Plate</Name><Description>1st MTP Arthrodesis Plate</Description><Size>≤ 6 holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ114</BillingCode><Name>SuperCable Trochanteric Grips and Cable Plate System</Name><Description>Trochanteric Grips - Titanium</Description><Size>Short 50mm, 2 Hole Plate 135mm, 4 Hole Plate 190mm, 6 Hole Plate Straight, Right, Left 245mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>260681</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU166</BillingCode><Name>Locking Third Tubular Plate</Name><Description>Plate for fracture fixation of the Fibula</Description><Size>4-6 holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG><ARTG>350871</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW069</BillingCode><Name>Equinox Trauma Systems </Name><Description>Clavicle Midhsaft Locking Plates </Description><Size>6 holes left, 6 holes right</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ033</BillingCode><Name>Valens Shoulder and Elbow - Plates</Name><Description>Locking Compression Plates</Description><Size>3.5mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX009</BillingCode><Name>ARMAR LPS Cloverleaf Plate</Name><Description>3.5 mm cloverleaf reconstruction plate</Description><Size>MT-PT1303088
MT-PT1304104
MT-PT1305120
MT-PT1306136</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK540</BillingCode><Name>Stryker Plating System</Name><Description>Locking Reconstruction Plates</Description><Size>4.0mm, 4-6 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>119848</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI810</BillingCode><Name>Zimmer Universal Locking System</Name><Description>3.5mm Dual Compression Locking Plates</Description><Size>4 - 6 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM122</BillingCode><Name>TriMed Periarticular Plate</Name><Description>Periarticular Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX006</BillingCode><Name>ARMAR LPS Reconstruction Plates</Name><Description>3.5 mm Reconstruction plates</Description><Size>2-6 holes</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK542</BillingCode><Name>Stryker Plating System</Name><Description>Locking One Third Tubular Plates</Description><Size>3.0mm, 2-6 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>119848</ARTG><ARTG>139635</ARTG><ARTG>269713</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK538</BillingCode><Name>Stryker Plating System</Name><Description>Locking Compression Anatomical Shape</Description><Size>2-6 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>119848</ARTG><ARTG>269713</ARTG></ARTGs><MinimumBenefit>250</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK546</BillingCode><Name>Stryker Plating System</Name><Description>T-Plates, pre-shaped</Description><Size>2-6 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>119848</ARTG><ARTG>269713</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW708</BillingCode><PriorBillingCodes><PriorBillingCode>WR050</PriorBillingCode></PriorBillingCodes><Name>Charlotte MTP Fusion System</Name><Description>MTP plate, stainless steel</Description><Size>Left &amp; Right extended,9 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST738</BillingCode><Name>Leibinger Titanium Implant System</Name><Description>Leibinger profyle hand &amp; small  fragment system, fixation, 3D plate, titanium</Description><Size>1.7mm system, 2x2 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>124318</ARTG><ARTG>64730</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL125</BillingCode><Name>Smith &amp; Nephew Plate and Screw System- EVOS</Name><Description>Small Fragment Plate</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN800</BillingCode><Name>Peri-Loc</Name><Description>3.5mm Recon Plate </Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN938</BillingCode><Name>Peri-Loc VLP</Name><Description>VAL/LK 3.5 1/3 Tubular</Description><Size>≤6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN297</BillingCode><Name>AO/ASIF Plates</Name><Description>3.5 mm LCP Medial Anterior Clavicle Plate  </Description><Size>≤ 6 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU111</BillingCode><PriorBillingCodes><PriorBillingCode>DE525</PriorBillingCode></PriorBillingCodes><Name>Dorsal Distal Radius Plate</Name><Description>Plate for Fracture Fixation</Description><Size>4 Holes Standard (Left &amp; Right)  4 Holes Narrow (Left &amp;  Right)</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU340</BillingCode><Name>Postero-Medial Distal Tibial Plate</Name><Description>Plate for fracture fixation</Description><Size>4-6 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>284416</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU301</BillingCode><Name>Lateral Hook Plate</Name><Description>Plate for fracture fixation</Description><Size>3-5 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER479</BillingCode><Name>Paragon 28 Gorilla Plating System-Plate, small (≤ 6 holes), variable angle locking</Name><Description>Paragon28 Gorilla, small titanium compression plates; universal; variable angle locking; compression; various shapes</Description><Size>Length 15-35 mm; thickness 1.15 - 2.0 mm; multi screw diameter purchage 2.7/3.5/4.2mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV024</BillingCode><Name>VariAx 2 MIS Calcaneal Plating System</Name><Description>Variable Angle Locking Calcaneal Plating System</Description><Size>Small (5-6 Holes)</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>340042</ARTG><ARTG>357433</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN136</BillingCode><Name>TC-100 </Name><Description>Small right angle &amp; T plates </Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL094</BillingCode><Name>Smith &amp; Nephew Plate and Screw System- EVOS</Name><Description>Small Fragment Plate</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW991</BillingCode><Name>VariAx 2 Locking Plate System – Distal Ulna</Name><Description>VAL Fixation Plates for Distal Ulna Fractures</Description><Size>625102  625102S</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>340044</ARTG><ARTG>357433</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM539</BillingCode><Name>Omni Stable AF Plating System</Name><Description>Simple Plates Straight, Y and L shaped plates</Description><Size>2 - 6 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>306780</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW994</BillingCode><Name>Ortholoc Fracture System - Plates</Name><Description>Universal</Description><Size>≤ 6 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM516</BillingCode><Name>OMNI plating system</Name><Description>MTP, Lapidus, Straight, T Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>306780</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO080</BillingCode><Name>APTUS Foot</Name><Description>TriLock Plates</Description><Size>2.8</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>141170</ARTG></ARTGs><MinimumBenefit>1159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER568</BillingCode><Name>Paragon 28 Gorilla Plating System-Plate, tibial (≤ 6 holes)</Name><Description>Paragon 28 Gorilla Silverback tibiotalar posterior(TT) ankle fusion plate, left or right</Description><Size>≤ 6 holes</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW979</BillingCode><Name>Locking Plate</Name><Description>Titanium locking plates anatomically contoured for forefoot and midfoot osteotomies.</Description><Size>Small (screw size 2.71mm – 4.49mm)  ≤ 6 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW535</BillingCode><Name>VariAx Compression Plating System</Name><Description>VAL 1/3 Tubular Plate</Description><Size>&gt;/=6 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>352530</ARTG><ARTG>352531</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH273</BillingCode><Name>ALPS - Anatomic Locked Plating System</Name><Description>3.5mm titanium plate</Description><Size>2-6 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>153056</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN050</BillingCode><Name>VAL plates screw size 2.71-4.49</Name><Description>VAL complex plates</Description><Size>screw size 2.71-4.49 
≤  6 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO135</BillingCode><Name>APTUS</Name><Description>Variable Angle Locking Plate </Description><Size>≤ 6 holes </Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>206157</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN067</BillingCode><Name>Newclip Plating System</Name><Description>VAL Locking plates</Description><Size>≤ 6 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU112</BillingCode><PriorBillingCodes><PriorBillingCode>DE535</PriorBillingCode></PriorBillingCodes><Name>Dorsal L Plate</Name><Description>Plate for Fracture Fixation</Description><Size>5 Holes (Left &amp; Right)</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111936</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB077</BillingCode><Name>Marathon variable angle Fibula plates</Name><Description>Marathon variable angle Fibula plates</Description><Size>7 - 15 holes</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>261562</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO133</BillingCode><Name>APTUS</Name><Description>Variable angle locking plate </Description><Size>7 - 15 holes </Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>206157</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN063</BillingCode><Name>Newclip Locking plates</Name><Description>Variable Angle Locking Plate</Description><Size>7 to 15 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260232</ARTG><ARTG>260229</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB076</BillingCode><Name>Marathon variable angle Fibula Plate</Name><Description>Marathon variable angle Fibula Plate</Description><Size>1 - 6 holes</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>261562</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN044</BillingCode><Name>Newclip Clavicle Plate</Name><Description>Plate for fixation of fractures of the clavicle or Locking Clavicle Plate</Description><Size>7 to 15 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260232</ARTG><ARTG>260229</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN051</BillingCode><Name>VAL plates screw size 2.71-4.49</Name><Description>VAL complex plates screw size 2.71-4.49</Description><Size>7≥ to ≤ 15 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260232</ARTG><ARTG>260229</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX050</BillingCode><Name>ARMAR 3.5 MM Meril Locking Plate system - Lateral Distal Fibula Plate</Name><Description>Plate for Fracture Fixation</Description><Size>4-10 Holes 80-158 mm Length Left and Right</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO136</BillingCode><Name>APTUS </Name><Description>Variable Angle Locking Plates </Description><Size>7 - 15 holes </Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>206157</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU123</BillingCode><PriorBillingCodes><PriorBillingCode>DE531</PriorBillingCode></PriorBillingCodes><Name>Wrist Spanning Plate</Name><Description>Plate for Fracture Fixation</Description><Size>9 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU341</BillingCode><Name>Postero-Medial Distal Tibial Plate</Name><Description>Plate for Fracture Fixation</Description><Size>8 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>284416</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ174</BillingCode><Name>PediFoot Deformity Correction System</Name><Description>3.5mm Plates, Recon</Description><Size>70mm length, 8 holes</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>191530</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU309</BillingCode><Name>Posterolateral Fibula Plate</Name><Description>Plate for fracture fixation</Description><Size>8 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU314</BillingCode><Name>Locking Medial Hook Plate</Name><Description>Plate for fracture fixation</Description><Size>&amp;lt;6 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK543</BillingCode><Name>Stryker Plating System</Name><Description>Locking One Third Tubular Plates</Description><Size>3.0mm, 7-14 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>119848</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN027</BillingCode><Name>Newclip Plating System</Name><Description>Locking Bone Plates</Description><Size>7 to 15 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB017</BillingCode><Name>Ankle Fusion Locking Plate</Name><Description>Ankle Fusion Locking Plate</Description><Size>7 holes</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>261562</ARTG></ARTGs><MinimumBenefit>916</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN032</BillingCode><Name>Newclip Calcaneal Plates</Name><Description>Plates for calcaneus</Description><Size>7 to 15 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>260232</ARTG><ARTG>260229</ARTG></ARTGs><MinimumBenefit>916</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN029</BillingCode><Name>Newclip Plating System</Name><Description>Locking bone plates</Description><Size>7 to 15 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>260232</ARTG></ARTGs><MinimumBenefit>916</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU191</BillingCode><PriorBillingCodes><PriorBillingCode>DE420</PriorBillingCode></PriorBillingCodes><Name>Locking Lateral Hook Plate</Name><Description>Locking Lateral Hook Plate for Fixation of Lateral Malleolus</Description><Size>7 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>916</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU193</BillingCode><PriorBillingCodes><PriorBillingCode>DE418</PriorBillingCode></PriorBillingCodes><Name>Locking Medial Hook Plate</Name><Description>Locking Medial Hook Plate for fixation of Medial malleolus fractures</Description><Size>7 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>916</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN118</BillingCode><Name>TC-100 &amp; Peri-Loc </Name><Description>3.5mm Straight Plates </Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>113</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER684</BillingCode><Name>Paragon 28 Gorilla LisFranc Plating System</Name><Description>Gorilla LisFranc/TMT Plates, dual ray, anatomically contoured, variable angle locking, left or right, small/medium</Description><Size>small/medium, 8 Hole with 2 Compression Slots. thickness 1.4 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM471</BillingCode><Name>TriMed ASET Foot Plating System</Name><Description>Lapidus Plate</Description><Size>≥ 7 Holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW598</BillingCode><Name>VariAx Clavicle Plating System</Name><Description>Locking Plating System</Description><Size>7-10 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>196764</ARTG><ARTG>352530</ARTG></ARTGs><MinimumBenefit>793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER482</BillingCode><Name>Paragon 28 Gorilla Plating System-Plate, small ( ≥ 7 to ≤ 15 holes); variable angle locking, complex</Name><Description>Paragon 28 Gorilla Plating System-Plate, small, titanium, malleus/column/ rescue/stradle/arch (proximal or distal), variable angle locking, complex</Description><Size>Thickness 1.5/2.0 mm; multi screw diameter purchase</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU243</BillingCode><PriorBillingCodes><PriorBillingCode>DE760</PriorBillingCode></PriorBillingCodes><Name>MaxForce MTP</Name><Description>Plate for Arthrodesis</Description><Size>7-8 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV025</BillingCode><Name>VariAx 2 MIS Calcaneal Plating System</Name><Description>Variable Angle Locking Calcaneal Plating System</Description><Size>Small - Large (7-9 Holes)</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>340042</ARTG></ARTGs><MinimumBenefit>793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM213</BillingCode><Name>Fusion Cup</Name><Description>PEEK curved and round plate</Description><Size>7, 9, 10, 11 &amp; 12 hole</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>229707</ARTG></ARTGs><MinimumBenefit>793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW934</BillingCode><PriorBillingCodes><PriorBillingCode>WR420</PriorBillingCode></PriorBillingCodes><Name>MaxLock Extreme System - Small Complex VAL Plates &gt;6 holes</Name><Description>Small complex variable angle lockig plates, Titanium, &gt;6 holes</Description><Size>&gt; 6 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>214671</ARTG></ARTGs><MinimumBenefit>793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY798</BillingCode><Name>AO/ASIF Plates</Name><Description>Variable Angle Locking Specialty Plate</Description><Size>7-15 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ032</BillingCode><Name>Valetis Ankle - Plates</Name><Description>1/3 Tubular Plate</Description><Size>7 to 12 hole</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>284755</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU188</BillingCode><Name>Locking Reconstruction Plate</Name><Description>Reconstruction Plate for communited Fibula Shaft Fractures</Description><Size>7-12 holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG><ARTG>350871</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ102</BillingCode><Name>Austofix Distal Fibula L&amp;C Plates</Name><Description>Distal Fibula Anatomical Locking Plates</Description><Size>7 to 15 holes, left and right</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>284755</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ034</BillingCode><Name>Valens Shoulder and Elbow - Plates</Name><Description>Locking Compression Plates</Description><Size>3.5mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU183</BillingCode><PriorBillingCodes><PriorBillingCode>DE441</PriorBillingCode></PriorBillingCodes><Name>Medial Column Plate</Name><Description>Plate for fusion</Description><Size>Small, Medium, Large (Left and Right)</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL087</BillingCode><Name>PERI-LOC</Name><Description>Clavicle plates</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ100</BillingCode><Name>Austofix Small Fragment L&amp;C Plates</Name><Description>Locking Compression Plates</Description><Size>3.5mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY722</BillingCode><Name>AO/ASIF Plates</Name><Description>LCP T, L, Straight Plates, Stainless Steel, Titanium</Description><Size>7-15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG><ARTG>286609</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN335</BillingCode><Name>AO/ASIF Plates</Name><Description>Locking Specialty Plates, LCP Clavicle, MatrixRIB, Titanium</Description><Size>7-15 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW048</BillingCode><Name>WEGO Trauma Systems</Name><Description>Locking Plate Systems</Description><Size>7-15 Holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ192</BillingCode><Name>PediLoc Plating System</Name><Description>3.5mm Locking Plate</Description><Size>8 Hole</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>191530</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ081</BillingCode><Name>PediLoc-Periarticular Locking Plating System Femur - &gt;7 to &gt;15 holes, screw size 2.71 - 4.49mm</Name><Description>3.5mm Contour or Bowed Locking Compression, 8-14 Hole Plate, Left-Right</Description><Size>3.5mm Bowed, 14 hole
3.5mm contour, 8 - 14 Hole Left-Right</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>191586</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU321</BillingCode><Name>Locking Distal Fibular Plate</Name><Description>Plate for Fracture Fixation</Description><Size>7-15 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU187</BillingCode><Name>Locking Third Tubular Plate</Name><Description>Plate for fracture of the Fibula</Description><Size>7-12 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST051</BillingCode><Name>Stryker Plating System Small Fragment Set</Name><Description>Cloverleaf Plate</Description><Size>8-15 Holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>119848</ARTG><ARTG>25735</ARTG></ARTGs><MinimumBenefit>247</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK547</BillingCode><Name>Stryker Plating System</Name><Description>T-Plates, pre-shaped</Description><Size>7-13 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>295226</ARTG><ARTG>119848</ARTG><ARTG>269713</ARTG></ARTGs><MinimumBenefit>247</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN069</BillingCode><Name> TC-100 </Name><Description>3.5mm Reconstruction Plates </Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>247</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY037</BillingCode><Name>AO/ASIF Plates</Name><Description>Specialty Plate</Description><Size>7-15 hole</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>247</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL126</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Small Fragment Plate</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>247</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN936</BillingCode><Name>TC-100</Name><Description>3.5mm Curved Reconstruction Plate</Description><Size>≥7 to ≤15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>247</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN801</BillingCode><Name>Peri-Loc </Name><Description>3.5mm Recon Plates   </Description><Size>  &gt; 7 to &lt; 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>247</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK539</BillingCode><Name>Stryker Plating System</Name><Description>Locking Compression Anatomical Shape</Description><Size>7-14 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>269713</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI811</BillingCode><Name>Zimmer Universal Locking System</Name><Description>3.5mm Dual Compression Locking Plates</Description><Size>7 - 14 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK541</BillingCode><Name>Stryker Plating System</Name><Description>Locking Reconstruction Plates</Description><Size>4.0mm, 7-14 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>119848</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM123</BillingCode><Name>TriMed Periarticular Plate</Name><Description>Periarticular Plates</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI801</BillingCode><Name>Zimmer Universal Locking System</Name><Description>3.5mm One Third Tubular Locking Plate</Description><Size>7-15 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM309</BillingCode><Name>Osteomed FPS</Name><Description>Tubular Plates</Description><Size>7 to 15 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>202319</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM546</BillingCode><Name>Midshaft Humerus Plates</Name><Description>Midshaft Humerus Plates</Description><Size>136-244mm, narrow and broad versions.   7 to 13 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM517</BillingCode><Name>OMNI Plating System</Name><Description>Straight Plates</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>306780</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH244</BillingCode><Name>ALPS foot system</Name><Description>Fusion Plates – Metatarsal, Lapidus, Single Joint Fusion Closed Compression </Description><Size>small to large</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>275084</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH274</BillingCode><Name>ALPS - Anatomic Locked Plating System</Name><Description>3.5mm Titanium  plates</Description><Size>7 to 15 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>153056</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER604</BillingCode><Name>Paragon 28 Gorilla Plates- ≥ 7 to ≤ 15 holes, medial, anterior, anterolateral</Name><Description>Paragon 28 Gorilla Plates- tibia  ≥ 7 to ≤ 15 holes, medial, anterior, anterolateral. left or right, variable angle locking, complex shapes</Description><Size>≥ 7 to ≤ 15 holes, thickness 1.8 mm; multi screw diameter purchase</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>290443</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER481</BillingCode><Name>Paragon 28 Gorilla Plating System-Plate, small ( ≥ 7 to ≤ 15 holes); variable angle locking</Name><Description>Paragon 28 Gorilla Plating System-Plate, small, titanium, malleus/column rescue/stradle/arch (proximal or distal)</Description><Size>Thickness 1.5/2.0 mm ; multi screw diameter purchase 2.7/3.5/4.2mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL097</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Small Fragment Plate</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>113</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY721</BillingCode><Name>AO/ASIF Plates</Name><Description>Non-Locking Fragment Plates</Description><Size>7-15 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>113</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX007</BillingCode><Name>ARMAR LPS Reconstruction Plates</Name><Description>3.5 mm reconstruction plates</Description><Size>7-15 holes</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM544</BillingCode><Name>Ulnar Shortening Plates</Name><Description>Distal Ulnar Shortening Plates  Proximal Ulnar Shortening Plates</Description><Size>The Distal Ulnar Shortening Plates are available in two lengths, left and right configurations.    The Proximal Ulnar Shortening Plates are available in two  lengths.</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW811</BillingCode><PriorBillingCodes><PriorBillingCode>WR238</PriorBillingCode></PriorBillingCodes><Name>Ortholoc Fracture System - Plates</Name><Description>Universal</Description><Size>8 Hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW992</BillingCode><Name>VariAx 2 Locking Plate System – Distal Ulna</Name><Description>VAL Fixation Plates for Distal Ulna Fractures</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>357433</ARTG><ARTG>340044</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ032</BillingCode><PriorBillingCodes><PriorBillingCode>LM360</PriorBillingCode></PriorBillingCodes><Name>MTP Plate</Name><Description>MTP Plate</Description><Size>7 to 15 holes</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>266216</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM540</BillingCode><Name>Omni Stable AF Plating System</Name><Description>Simple Plates, Straight, L and T plates</Description><Size>7 to 14 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>306780</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW533</BillingCode><Name>VariAx Compression Plating System</Name><Description>Locking Plate System</Description><Size>≥ 7 to ≤ 15</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>352530</ARTG><ARTG>352531</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO134</BillingCode><Name>APTUS </Name><Description>Clavicle Variable Angle Locking Plates </Description><Size>7 - 15 holes </Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>206157</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN071</BillingCode><Name>Periarticular Clavicle plate</Name><Description>Periarticular plate for clavicle    </Description><Size>  ≥ 7 to ≤ 15 holes  </Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI790</BillingCode><Name>ZPS-Zimmer Plate and Screw System</Name><Description>3.5mm Straight Reconstruction Plates</Description><Size>7-15 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>113</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JD023</BillingCode><Name>1/3 Tubular Plate</Name><Description>1/3 Tubular Plate</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40214</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>222648</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ065</BillingCode><PriorBillingCodes><PriorBillingCode>LM376</PriorBillingCode></PriorBillingCodes><Name>Fibular Osteotomy Plates</Name><Description>Fibular Osteotomy Plates</Description><Size>Multiple sizes to suit patient anatomy</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><ARTGs><ARTG>266216</ARTG></ARTGs><MinimumBenefit>113</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ182</BillingCode><Name>VariAx Clavicle Plating System</Name><Description>Locking Plating System</Description><Size>7-10 Holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>352530</ARTG><ARTG>352531</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ064</BillingCode><PriorBillingCodes><PriorBillingCode>LM379</PriorBillingCode><PriorBillingCode>LM379</PriorBillingCode></PriorBillingCodes><Name>Ankle Fusion Plate</Name><Description>Ankle Fusion Plate</Description><Size>Suitable for patient anatomy</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><ARTGs><ARTG>266216</ARTG></ARTGs><MinimumBenefit>113</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN210</BillingCode><Name>AO/ASIF Plates</Name><Description>Variable Angle Locking  Plate</Description><Size>7-15 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN298</BillingCode><Name>AO/ASIF Plates</Name><Description>3.5 mm LCP Medial Anterior Clavicle Plate  </Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ066</BillingCode><PriorBillingCodes><PriorBillingCode>LM377</PriorBillingCode></PriorBillingCodes><Name>Fibular Osteotomy Plates</Name><Description>Fibular Osteotomy Plates</Description><Size>Sizes to suit patient anatomy</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><ARTGs><ARTG>266216</ARTG></ARTGs><MinimumBenefit>113</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK549</BillingCode><Name>Stryker Plating System Small Fragment Set</Name><Description>3.5mm Reconstruction Plate</Description><Size>7-14 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><ARTGs><ARTG>295226</ARTG><ARTG>119848</ARTG></ARTGs><MinimumBenefit>113</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ047</BillingCode><PriorBillingCodes><PriorBillingCode>LM372</PriorBillingCode></PriorBillingCodes><Name>Tibial Osteotomy Plates</Name><Description>Tibial Osteotomy Plates</Description><Size>Multiple sizes to suit patient anatomy</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><ARTGs><ARTG>266216</ARTG></ARTGs><MinimumBenefit>113</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN939</BillingCode><Name>Peri-Loc VLP</Name><Description>VAL/LK 3.5mm 1/3 Tubular Plates</Description><Size>≥7 to ≤15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL216</BillingCode><PriorBillingCodes><PriorBillingCode>IG115</PriorBillingCode></PriorBillingCodes><Name>TIBIAXYS Distal Tibial Osteotomy System - Medial osteotomy plate</Name><Description>Inverted T-shape medial osteotomy plate to fit medial malleolus</Description><Size>8 hole; 70mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>173932</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN296</BillingCode><Name>AO/ASIF Plates</Name><Description>VA-LCP Anterior Clavicle Plates</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN980</BillingCode><Name>Peri-Loc</Name><Description>Fibula Plates</Description><Size>≥ 7 to   ≤15 Holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU312</BillingCode><Name>Locking Medial Hook Plate</Name><Description>Plate for fracture fixation</Description><Size>7-15 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU343</BillingCode><Name>Postero-Lateral Distal Tibial Plate</Name><Description>Plate for Fracture Fixation</Description><Size>9-13 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>284416</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU310</BillingCode><Name>Anatomic Posterolateral Distal Fibula Plate</Name><Description>Plate for fracture fixation</Description><Size>4-6 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU365</BillingCode><Name>Patella SuturePlate II Arrow Plate</Name><Description>Titanium Plate for Patella Fracture Fixation</Description><Size>One size only</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>355042</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU342</BillingCode><Name>Vertical Shear Distal Tibial Plate</Name><Description>Plate for Fracture Fixation</Description><Size>9 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>284416</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU177</BillingCode><PriorBillingCodes><PriorBillingCode>DE505</PriorBillingCode></PriorBillingCodes><Name>MTP Plate, Straight , Long</Name><Description>1st MTP Arthrodesis Plate , Straight, Long - 8 Holes</Description><Size>8 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>351000</ARTG><ARTG>350871</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU308</BillingCode><Name>Posterolateral Fibula Plate</Name><Description>Plate for Fracture fixation</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU299</BillingCode><Name>Locking Distal Fibula Plate</Name><Description>Plate for Fracture Fixation</Description><Size>7-15 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL095</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Small Fragment plate</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO081</BillingCode><Name>APTUS Foot</Name><Description>TriLock Plates</Description><Size>2.8</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>141170</ARTG></ARTGs><MinimumBenefit>793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN066</BillingCode><Name>Newclip Plating System</Name><Description>VAL Locking plates</Description><Size>7 to  15 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG></ARTGs><MinimumBenefit>793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN074</BillingCode><Name>Newclip Foot Plate</Name><Description>Variable-Angle Locking anatomic plates</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG></ARTGs><MinimumBenefit>793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM519</BillingCode><Name>OMNI Plating System</Name><Description>Lisfranc Plates</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>306780</ARTG></ARTGs><MinimumBenefit>793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO445</BillingCode><Name>Acumed Small Fragment Plates</Name><Description>One Third Tubular Plates</Description><Size>7 to 15 Holes</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>113</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN130</BillingCode><Name>TC-100 &amp; Peri-Loc </Name><Description> 3.5mm Straight Plates</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>113</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK099</BillingCode><Name>Stryker Plating System Small Fragment Set</Name><Description>One Third Tubular Plate with Collar</Description><Size>7-14 Holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><ARTGs><ARTG>269713</ARTG><ARTG>295226</ARTG></ARTGs><MinimumBenefit>113</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN059</BillingCode><Name>Periarticular Clavicle plate</Name><Description>Periarticular plate for clavicle</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG></ARTGs><MinimumBenefit>113</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW066</BillingCode><Name>WEGO Trauma Systems</Name><Description>1/3 Tubular Plate</Description><Size>7-15 holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>113</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ238</BillingCode><Name>Posterolateral distal fibula plate, locking </Name><Description>Distal fibula locking plate used for open reduction and internal fixation for fractures of the fibula. </Description><Size>10 hole plate</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>284416</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU311</BillingCode><Name>Anatomic Posterolateral Distal Fibula Plate</Name><Description>Plate for fracture fixation</Description><Size>7-15 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ291</BillingCode><Name>CASCELLA 3.5mm Superior Clavicle Plate</Name><Description>Superior Clavicle Plate</Description><Size>7 to 12 holes</Size><SupplierCode>40482</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>433150</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN797</BillingCode><Name>Peri-Loc</Name><Description>Locking 1/3 Tubular &amp; 3.5mm Straight Plates</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL138</BillingCode><Name>Smith &amp; Nephew Plate and Screw System- EVOS</Name><Description>Small Fragment plate</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>916</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM126</BillingCode><Name>TriMed Sidewinder</Name><Description>Ankle Fixation Plate</Description><Size>7 hole sidewinder plate</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>916</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN209</BillingCode><Name>AO/ASIF Plates</Name><Description>Locking Specialty Plate</Description><Size>7-15 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>157069</ARTG><ARTG>286609</ARTG></ARTGs><MinimumBenefit>916</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM337</BillingCode><Name>Trimed Plates</Name><Description>Elbow, Forearm, clavicle and Wrist Plates</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>916</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL219</BillingCode><PriorBillingCodes><PriorBillingCode>IG119</PriorBillingCode></PriorBillingCodes><Name>HALLU-Lock MTP Arthrodesis System - HALLU-Lock S Plate</Name><Description>Titanium contoured Hallu-Lock S plate for revision of Keller osteotomy, failed arthroplasty, failed fusion</Description><Size>7 holes, sizes 0 to 3, length 40 to 55mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>173932</ARTG></ARTGs><MinimumBenefit>793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL222</BillingCode><PriorBillingCodes><PriorBillingCode>IG131</PriorBillingCode></PriorBillingCodes><Name>TIBIAXYS Distal Tibia System - Ankle Arthrodesis - Lateral anterior plate</Name><Description>Titanium lateral anterior plate with 8 holes; left or right</Description><Size>3mm thick, 92mm long</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>173932</ARTG></ARTGs><MinimumBenefit>793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL215</BillingCode><PriorBillingCodes><PriorBillingCode>IG114</PriorBillingCode></PriorBillingCodes><Name>TIBIAXYS Distal Tibial Osteotomy System: Medial right/lateral left osteotomy plate: lateral right/medial left osteotomy plate</Name><Description>Titanium contoured right and left design plates for wedge osteotomy of distal tibia</Description><Size>8 hole; Lateral plates 75.2mm length</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111937</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>173932</ARTG></ARTGs><MinimumBenefit>793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL127</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Small Fragment plate</Description><Size>≥ 16 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111938</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1018</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO427</BillingCode><Name>ACUMED ACU-LOC Wrist Spanning Plate</Name><Description>Wrist Spanning Plate</Description><Size>Plates available in 13 hole configerations.</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111938</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>1397</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL139</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Small Fragment Plate</Description><Size>≥ 16 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111938</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1397</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY809</BillingCode><Name>AO/ASIF Plates</Name><Description>Locking Specialty Plate</Description><Size>≥16 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111938</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1397</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO114</BillingCode><Name>APTUS</Name><Description>Variable angle locking plates</Description><Size>≥ 16 holes </Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111938</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>206157</ARTG></ARTGs><MinimumBenefit>810</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW534</BillingCode><Name>Stryker Locking Plate System</Name><Description>Variable Angle Locking Plates</Description><Size>≥ 16 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111938</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>139635</ARTG><ARTG>237797</ARTG><ARTG>295226</ARTG></ARTGs><MinimumBenefit>810</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN937</BillingCode><Name>TC-100</Name><Description>3.5mm Curved Reconstruction Plate</Description><Size>≥16 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111938</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1018</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN134</BillingCode><Name>TC-100</Name><Description>3.5mm Reconstruction Plates</Description><Size>≥ 16 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111938</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1018</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU124</BillingCode><PriorBillingCodes><PriorBillingCode>DE642</PriorBillingCode></PriorBillingCodes><Name>Dorsal Midfoot Fusion Plate</Name><Description>Plate for fusion</Description><Size>Small, Medium, Large</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111938</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1018</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX008</BillingCode><Name>ARMAR LPS Reconstruction Plates</Name><Description>3.5 mm reconstruction locking plates</Description><Size>16-22 holes</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111938</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>591</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM124</BillingCode><Name>TriMed Periarticular Plate</Name><Description>Periarticular Plates</Description><Size>≥ 16 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111938</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>591</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ329</BillingCode><Name>Omni Stable AF Plating System</Name><Description>Lateral and straight variable angle locking plates</Description><Size>16 - 19 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111938</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>306780</ARTG></ARTGs><ChangeExplanation>New listing</ChangeExplanation><MinimumBenefit>810</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Insert</ActionFlag><CycleStartDate>2024-08-08</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN798</BillingCode><Name>Peri-Loc</Name><Description>Plates, Stainless Steel, Locking, Compression, Lefts and Rights</Description><Size>3.5mm, 20 - 22 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111938</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>591</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY810</BillingCode><Name>AO/ASIF Plates</Name><Description>Locking Specialty Plate</Description><Size>≥16 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111938</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>591</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW058</BillingCode><Name>WEGO Trauma Systems</Name><Description>Locking Compression Plates</Description><Size>≥16 holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111938</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>591</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER605</BillingCode><Name>Paragon 28 Gorilla Plates- ≥ 16 holes, medial, anterolateral</Name><Description>Paragon 28 Gorilla Plates- tibia  ≥ 16 holes, medial, anterolateral, left or right, variable angle locking, complex shapes</Description><Size>≥ 16 holes, thickness 1.8 mm; multi screw diameter purchase</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111938</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>810</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK550</BillingCode><Name>Stryker Plating System Small Fragment Set</Name><Description>3.5mm Reconstruction Plate</Description><Size>16-22 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111938</SubGroupID><ARTGs><ARTG>119848</ARTG></ARTGs><MinimumBenefit>539</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU300</BillingCode><Name>Locking Distal Fibula Plate</Name><Description>Plate for Fracture Fixation</Description><Size>&gt;16 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111938</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>810</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN011</BillingCode><Name>TC-100 &amp;Peri-Loc </Name><Description>Sterile, 14 - 26 hole</Description><Size>≥ 16 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111938</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>539</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY724</BillingCode><Name>AO/ASIF Plates</Name><Description>Non-Locking Fragment Plates</Description><Size>≥16 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111938</SubGroupID><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>539</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ083</BillingCode><Name>PediLoc - Anterolateral and Medial Distal Tibial Paediatric Locking Plate</Name><Description>3.5 mm distal tibial locking compression plate (narrow/wide; 2-5 holes)</Description><Size>3.5mm anterolateral left (2,3,4,5, holes)
3.5mm anterolateral right (2,3,4,5 holes)
3.5mm Narrow Left (2,3,4,5, holes)
3.5mm narrow right (2,3,4,5 holes)
3.5mm wide left (2,3,4,5 holes)
3.5mm wide right (2,3,4,5 holes)</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111938</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>191586</ARTG></ARTGs><MinimumBenefit>591</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU366</BillingCode><Name>Patella SuturePlate II Star Plate</Name><Description>Titanium Plate for Patellar Fracture Fixation</Description><Size>Small, Medium, Large</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111938</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>355042</ARTG></ARTGs><MinimumBenefit>810</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU364</BillingCode><Name>Patella Suture Plate II Star Plate Pole Fracture</Name><Description>Titanium Plate for Fracture Fixation</Description><Size>Small, Medium, Large</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111938</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>355042</ARTG></ARTGs><MinimumBenefit>810</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY736</BillingCode><Name>AO/ASIF Plates</Name><Description>Non-Locking Plates</Description><Size>≤ 6 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>417</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN930</BillingCode><Name>Peri-Loc</Name><Description>2.7mm LK Reconstruction Plates</Description><Size>≤6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>993</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY817</BillingCode><Name>AO/ASIF Plates</Name><Description>Locking plates</Description><Size>Less than 6 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>993</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF123</BillingCode><Name>Islay Opening Wedge Locking plate</Name><Description>Islay Opening Wedge Locking plate</Description><Size>universal locking plate 12 MM - 30mm/
Opening Wedge Locking plate 0MM-7MM
Opening Wedge osteotomy plate OMM-7MM</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>208160</ARTG></ARTGs><MinimumBenefit>993</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN116</BillingCode><Name>TC-100  </Name><Description>2.7mm T Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>417</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN088</BillingCode><Name>TC-100</Name><Description>Semitubular Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>417</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN073</BillingCode><Name>TC-100 </Name><Description>Mini L Plates &amp; T Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>417</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU266</BillingCode><PriorBillingCodes><PriorBillingCode>DE215</PriorBillingCode></PriorBillingCodes><Name>Titanium Metatarsal Opening Wedge Osteotomy Plate </Name><Description>Titanium Metatarsal Opening Wedge Osteotomy Plate with 4 non locking holes and square wedge </Description><Size>2mm - 8mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL136</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Small Fragment Plate</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT087</BillingCode><PriorBillingCodes><PriorBillingCode>OH534</PriorBillingCode></PriorBillingCodes><Name>KLS Martin Hand Fracture System - Plates</Name><Description>Various Size and Shapes plates</Description><Size>1 to 6 hole</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>236206</ARTG><ARTG>276674</ARTG></ARTGs><MinimumBenefit>971</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ234</BillingCode><Name>Mini Comprehensive Fixation System Plates</Name><Description>VAL Plate Mini Comprehensive Fixation System (CFS)</Description><Size>6 holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW792</BillingCode><PriorBillingCodes><PriorBillingCode>WR077</PriorBillingCode></PriorBillingCodes><Name>Charlotte LisfrancReconstruction System - Bridge Plate.</Name><Description>Stainless steel plate for stabilisation of the tarsometatarsal joint.</Description><Size>4, 6, 5 &amp; 9 hole.</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>550</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY806</BillingCode><Name>AO/ASIF Plates</Name><Description>Pre-contoured locking plates</Description><Size>≤6 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>550</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU181</BillingCode><PriorBillingCodes><PriorBillingCode>DE444</PriorBillingCode></PriorBillingCodes><Name>Low Profile Straight Plate</Name><Description>Plate for Fusion</Description><Size>4-6 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG><ARTG>350871</ARTG></ARTGs><MinimumBenefit>550</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ039</BillingCode><Name>Mini-Fragment Plates</Name><Description>Locking Compression Plates</Description><Size>1.5mm, 2.0mm, 2.5mm, 2.7mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>550</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW040</BillingCode><Name>WEGO Trauma Systems</Name><Description>Locking Compression Plates</Description><Size>≤ 6 Holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>550</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU182</BillingCode><PriorBillingCodes><PriorBillingCode>DE443</PriorBillingCode></PriorBillingCodes><Name>Low Profile T-Plate</Name><Description>Plate for fusion</Description><Size>3-6 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>550</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ035</BillingCode><PriorBillingCodes><PriorBillingCode>LM342</PriorBillingCode><PriorBillingCode>LM342</PriorBillingCode></PriorBillingCodes><Name>Orthopaedic Fixation Plate</Name><Description>Orthopaedic Fixation Plates</Description><Size>Screw size 2.7mm or less
6 holes or less</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>266216</ARTG></ARTGs><MinimumBenefit>550</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW829</BillingCode><PriorBillingCodes><PriorBillingCode>WR279</PriorBillingCode></PriorBillingCodes><Name>Biotech Easy Lock System</Name><Description>Easy Lock Plating System</Description><Size>Various</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>291615</ARTG></ARTGs><MinimumBenefit>971</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW013</BillingCode><Name>WEGO Trauma Systems</Name><Description>Locking Compression Plates</Description><Size>≤ 6 Holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>993</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU173</BillingCode><PriorBillingCodes><PriorBillingCode>DE442</PriorBillingCode></PriorBillingCodes><Name>X Plate</Name><Description>Plate for fusion</Description><Size>Small</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>993</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL133</BillingCode><Name>Smith &amp; Nephew Plate and Screw System- EVOS</Name><Description>Small Fragment Plate</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>993</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV005</BillingCode><Name>SternalPlate Closure System - Plates</Name><Description>Titanium Sternal Fixation System</Description><Size>≤ 6 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>386783</ARTG></ARTGs><MinimumBenefit>550</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB028</BillingCode><Name>Mini Locking System - Condylar Locking Plates ≤ 6 holes</Name><Description>Condylar Locking Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>261562</ARTG></ARTGs><MinimumBenefit>550</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB026</BillingCode><Name>Plates ≤ 6 holes</Name><Description>Plates ≤ 6 holes</Description><Size>≤ 6 holes</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>261562</ARTG></ARTGs><MinimumBenefit>550</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BU028</BillingCode><Name>Airlock Plate</Name><Description>Airlock Plating System</Description><Size>Left and Right, Size 0 - 6</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>235766</ARTG></ARTGs><MinimumBenefit>550</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ031</BillingCode><PriorBillingCodes><PriorBillingCode>LM361</PriorBillingCode></PriorBillingCodes><Name>Jones Fracture Plate</Name><Description>Jones Fracture Plate</Description><Size>6 holes or less</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>266216</ARTG></ARTGs><MinimumBenefit>550</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY737</BillingCode><Name>AO/ASIF Plates</Name><Description>Locking Plates</Description><Size>≤6 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>550</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ258</BillingCode><Name>Colink Vallux Plate</Name><Description>MIS Plate for Tri planar Hallux Valgus Correction</Description><Size>4 - Hole</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>971</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ253</BillingCode><Name>Colink Mini Plates VAL up to 6 Hole</Name><Description>Foot and Ankle Mini Plates Titanium, Various designs straight, L, and T Plates.</Description><Size>2 - 6 Hole</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR086</BillingCode><Name>Stryker Locking Plate System</Name><Description>Plates including Locking, Standard and Compression</Description><Size>≤ 6 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>200615</ARTG><ARTG>269713</ARTG><ARTG>295226</ARTG><ARTG>239452</ARTG><ARTG>295882</ARTG><ARTG>237797</ARTG></ARTGs><MinimumBenefit>663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF118</BillingCode><Name>Islay MTP Plate</Name><Description>Islay MTP / TMT Plate</Description><Size>2.7mm Univeral locking plate 18mm (2.7ULP), up to 24mm 
Open wedge locking plate 4mm (OW) up to 7mm
Open wedge locking plate 0mm
Open wedge osteotomy plate 4mm to 7.00mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>208160</ARTG></ARTGs><MinimumBenefit>993</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK591</BillingCode><Name>Diamond Plate/Carpal Button</Name><Description>Carpal Fusion Plate</Description><Size>Large, Small</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>155633</ARTG></ARTGs><MinimumBenefit>663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST787</BillingCode><Name>Leibinger Titanium Implant System</Name><Description>Leibinger Forefoot Reconstruction System, straight plate, Titanium</Description><Size>6 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>64730</ARTG><ARTG>124318</ARTG></ARTGs><MinimumBenefit>663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO395</BillingCode><Name>RibLoc Rib fracture plating System</Name><Description>RibLoc Plate</Description><Size>46mmL X 8-14mm W</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>158695</ARTG></ARTGs><MinimumBenefit>993</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN083</BillingCode><Name>TC-100</Name><Description>2.0mm T Plates </Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>417</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN932</BillingCode><Name>TC-100</Name><Description>2.0mm Straight Plates</Description><Size>≤6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>417</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ139</BillingCode><Name>PediLoc - Plating System ≤ 6 holes, screw size ≤ 2.7mm</Name><Description>2.7mm Locking Plate</Description><Size>3-6 Hole</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>191586</ARTG></ARTGs><MinimumBenefit>993</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN068</BillingCode><Name>TC 100</Name><Description>Plate: Condylar</Description><Size>1.5mm, 2.0mm &amp;2.7mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY747</BillingCode><Name>AO/ASIF Plates</Name><Description>Condylar plates</Description><Size>≤ 6 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU172</BillingCode><PriorBillingCodes><PriorBillingCode>DE554</PriorBillingCode></PriorBillingCodes><Name>LPS Cotton Osteotomy Plates</Name><Description>Wedged Fusion Plate</Description><Size>Flat, 2mm - 8mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI946</BillingCode><Name>Normed fracture fixation plates</Name><Description>Titanium locking foot plates</Description><Size>4/6 hole and 2.7mm screws</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>140687</ARTG></ARTGs><MinimumBenefit>993</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ205</BillingCode><Name>5MS Plantar Plates </Name><Description>Anatomic contoured titanium 4, 5-hole plates for proximal 5th metatarsal fractures.</Description><Size>4, 5 Hole Plates</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>550</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ207</BillingCode><Name>5MS Titanium Locking Plates less than equal to 6 Hole</Name><Description>Anatomic curved titanium 4 - 6 -hole plates for 5th metatarsal fractures.</Description><Size>4, 5, 6, Hole</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>550</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO202</BillingCode><Name>Acumed Bone Plate</Name><Description>MCP Fusion Plate - Titanium</Description><Size> 4 Hole</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>417</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW026</BillingCode><Name>WEGO Trauma Systems</Name><Description>Non-Locking Plate Systems</Description><Size>≤ 6 holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>417</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM209</BillingCode><Name>Jones Fracture Plate</Name><Description>Fracture Fixation Systems</Description><Size>≤ 6 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST786</BillingCode><Name>Leibinger Titanium Implant System</Name><Description>Leibinger Forefoot Reconstruction System, straight plate, Titanium</Description><Size>4 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>64730</ARTG><ARTG>124318</ARTG></ARTGs><MinimumBenefit>663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST788</BillingCode><Name>Leibinger Titanium Implant System</Name><Description>Leibinger System, anatomical shap, Titanium</Description><Size>screw size ≤2.7mm ≤ 6 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><ARTGs><ARTG>340042</ARTG><ARTG>357433</ARTG></ARTGs><MinimumBenefit>417</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU125</BillingCode><PriorBillingCodes><PriorBillingCode>DE575</PriorBillingCode></PriorBillingCodes><Name>Straight Plate</Name><Description>Plate for Fracture Fixation</Description><Size>2-5 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>417</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV006</BillingCode><Name>SternalPlate Closure System - Plates</Name><Description>Titanium Sternal Fixation System</Description><Size>≤ 6 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>386783</ARTG></ARTGs><MinimumBenefit>993</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM470</BillingCode><Name>TriMed ASET Foot Plating System </Name><Description>Lapidus and Universal Plates</Description><Size>≤ 6 holes  </Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>971</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL038</BillingCode><Name>VLP EVOS</Name><Description>VAL mini plates - Hand</Description><Size>Mini Plates ≤2.7mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>417</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB029</BillingCode><Name>Mini Locking System - Condylar Plates ≤ 6 holes</Name><Description>Condylar Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><ARTGs><ARTG>261562</ARTG></ARTGs><MinimumBenefit>417</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO082</BillingCode><Name>APTUS Hand and Foot</Name><Description>TriLock Plates</Description><Size>1.2 - 2.3</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>141170</ARTG></ARTGs><MinimumBenefit>971</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO084</BillingCode><Name>APTUS Hand</Name><Description>Fixation Plates</Description><Size>1.2 - 2.3</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><ARTGs><ARTG>141170</ARTG></ARTGs><MinimumBenefit>417</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN928</BillingCode><Name>TC-100</Name><Description>Quarter Tubular Plates, L/E 6 holes</Description><Size>≤6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>417</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW968</BillingCode><PriorBillingCodes><PriorBillingCode>WR459</PriorBillingCode></PriorBillingCodes><Name>ORTHOLOC 2 Small Bones Plates – Complex and VAL – up to 6 holes</Name><Description>Titanium mini plates, complex, variable angle locking, up to 6 holes, various designs (Hook plate, Y-plates and Pinch plates).</Description><Size>Up to 6 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>971</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KO006</BillingCode><PriorBillingCodes><PriorBillingCode>LM481</PriorBillingCode></PriorBillingCodes><Name>Complex Variable Locking Hand Plates</Name><Description>Complex Variable Locking Hand Plates</Description><Size>6 holes or less</Size><SupplierCode>40387</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>337193</ARTG></ARTGs><MinimumBenefit>971</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER484</BillingCode><Name>Paragon 28 Gorilla Plating System-Plate, mini (≤ 6 holes);variable angle locking, complex</Name><Description>Paragon 28 Gorilla Plating System-Plate, titanium mini plate, compression, variable angle locking, complex</Description><Size>thickness 1.1mm; multi screw diameter purchase</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>971</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO060</BillingCode><Name>Aptus Wrist Arthrodesis</Name><Description>STT Fusion Plate</Description><Size>2.0 system</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>141170</ARTG></ARTGs><MinimumBenefit>971</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW899</BillingCode><PriorBillingCodes><PriorBillingCode>WR375</PriorBillingCode></PriorBillingCodes><Name>Mini MaxLock Extreme System - Mini Plates ≤ 6 holes</Name><Description>Mini variable angle locking plates, Titanium, ≤ 6 holes</Description><Size>≤ 6 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>214671</ARTG></ARTGs><MinimumBenefit>993</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW563</BillingCode><Name>Leibinger Titanium Implant System</Name><Description>Profyle hand and small fragment plate system</Description><Size>screw size ≤2.7mm   ≤ 6 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>340042</ARTG><ARTG>357433</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KO014</BillingCode><PriorBillingCodes><PriorBillingCode>LM479</PriorBillingCode></PriorBillingCodes><Name>Variable Locking Hand Plates</Name><Description>Variable Locking Hand Plates</Description><Size>6 holes or less</Size><SupplierCode>40387</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>337193</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER492</BillingCode><Name>Paragon 28 Proximal Rotational Metatarsal Osteotomy (“PROMO”) Plating System</Name><Description>PROMO left or right contoured plates designed specifically around the angle of the osteotomy, allowing space for optimal cross screw trajectory. Plates are used with  Paragon 28 Baby Gorilla or Mini Monster screws.</Description><Size>Size 1-4, osteotomy angles 13-55°</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER483</BillingCode><Name>Paragon 28 Gorilla Plating System-Plate, mini (≤ 6 holes); variable angle locking</Name><Description>Paragon 28 Gorilla Plating System-Plate, titanium mini plate, compression, variable angle locking, variable sizes and shapes</Description><Size>thickness 1.1/1.3 mm; multi screw diameter purchase 2.0/2.5mm or 2.7/3.5/4.2 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM254</BillingCode><Name>OsteoMed FPS</Name><Description>Titanium locking footplates</Description><Size>2mm and 2.7mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>202319</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU290</BillingCode><Name>T-Plate, Wide</Name><Description>Plate for fracture fixation</Description><Size>6 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ182</BillingCode><Name>PediFoot Deformity Correction System</Name><Description>2.7mm Plates, Compression/Neutral, Recon, Angle Iron, Wedge, Clover</Description><Size>5-56mm length, 2-4mm wedge length, 2-6 holes</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>191530</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU351</BillingCode><Name>Mini Fragment System - Tine Plate</Name><Description>Plate for Fracture Fixation</Description><Size>2.7mm, 6 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>284416</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ073</BillingCode><PriorBillingCodes><PriorBillingCode>EF019</PriorBillingCode></PriorBillingCodes><Name>Arix Hand Plating System</Name><Description>Mini Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40063</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>239812</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY808</BillingCode><Name>AO/ASIF Plates</Name><Description>Pre-contoured locking plates</Description><Size>≤6 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>993</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU287</BillingCode><Name>Bridge Plate</Name><Description>Plate for fracture fixation</Description><Size>6 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW969</BillingCode><PriorBillingCodes><PriorBillingCode>WR460</PriorBillingCode></PriorBillingCodes><Name>ORTHOLOC 2 Small Bones Plates – VAL – up to 6 holes</Name><Description>Titanium mini plates, variable angle locking, up to 6 holes, various designs (Straight plates, T-plate and Jones Fracture Plates).</Description><Size>Up to 6 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM473</BillingCode><Name>TriMed ASET Foot Plating System</Name><Description>Straight and T Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU291</BillingCode><Name>Straight Plate, Reinforced</Name><Description>Plate for fracture fixation</Description><Size>6 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO436</BillingCode><Name>Acumed Hand Fracture System</Name><Description>Straight Plates Variable Angle Locking</Description><Size>6 hole</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO447</BillingCode><Name>Acumed Small Fragment Plates</Name><Description>2.7mm Fragment Plates</Description><Size>6 Hole</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU281</BillingCode><Name>Straight Plate</Name><Description>Plate for fracture fixation</Description><Size>6 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT086</BillingCode><PriorBillingCodes><PriorBillingCode>OH533</PriorBillingCode></PriorBillingCodes><Name>KLS Martin Hand Fracture System - Plates</Name><Description>Various Size and Shaped Plates</Description><Size>1 to 6 Hole</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>236206</ARTG><ARTG>276674</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB085</BillingCode><Name>Marathon Mini VAL System</Name><Description>Marathon Mini VAL System</Description><Size>6 holes or less</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>261562</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN072</BillingCode><Name>Newclip Anatomic Locking plates</Name><Description>Variable Angle Anatomic Locking Plate</Description><Size>≤6 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260232</ARTG><ARTG>260229</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN046</BillingCode><Name>VAL plates screw size ≤2.7mm</Name><Description>Variable angle locking complex plates</Description><Size>Mini : screw size ≤2.7mm  &lt;= 6 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260232</ARTG><ARTG>260229</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB056</BillingCode><Name>Marathon VA System</Name><Description>Variable Angle Bone Plates</Description><Size>&lt;6 Holes</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>261562</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU293</BillingCode><Name>T-Plate, Reinforced</Name><Description>Plate for fracture fixation</Description><Size>6 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU276</BillingCode><Name>V-Plate</Name><Description>Plate for fracture fixation</Description><Size>6 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU286</BillingCode><Name>Rotation Correction Plate</Name><Description>Plate for arthrodesis</Description><Size>5 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU359</BillingCode><Name>Mini Fragment System - Straight Plates</Name><Description>Plates for Fracture Fixation</Description><Size>&lt;6 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>284416</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU289</BillingCode><Name>T- Plate</Name><Description>Plate for fracture fixation</Description><Size>6 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL068</BillingCode><Name>VLP</Name><Description>VAL mini plates - Hand</Description><Size>Mini Plates ≤2.7mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL218</BillingCode><PriorBillingCodes><PriorBillingCode>IG118</PriorBillingCode></PriorBillingCodes><Name>HALLU-Lock MTP Arthrodesis System - HALLU-Lock C Plate</Name><Description>Titanium contoured plate for 1st MTP arthrodesis, fixation of fractures and osteotomies</Description><Size>4, 5 or 6 holes; sizes 0 to 3, length 35 to 50mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>173932</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL039</BillingCode><Name>VLP EVOS</Name><Description>Mini Plates Straight</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN940</BillingCode><Name>Peri-Loc VLP</Name><Description>VAL/LK, 2.7mm Quarter Tubular Plates</Description><Size>≤6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY804</BillingCode><Name>AO/ASIF Plates</Name><Description>Locking Plates</Description><Size>≤6 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY821</BillingCode><Name>AO/ASIF Plates</Name><Description>Anatomic Locking Hand Plates</Description><Size>2-6 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU294</BillingCode><Name>Y-Plate</Name><Description>Plate for Arthrodesis</Description><Size>6 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ074</BillingCode><PriorBillingCodes><PriorBillingCode>EF020</PriorBillingCode></PriorBillingCodes><Name>Arix Hand Plating System</Name><Description>Mini Locking Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40063</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>239812</ARTG></ARTGs><MinimumBenefit>971</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU244</BillingCode><PriorBillingCodes><PriorBillingCode>DE755</PriorBillingCode></PriorBillingCodes><Name>Hook Plate</Name><Description>Plate for Fracture Fixation</Description><Size>6 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>971</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO433</BillingCode><Name>ACUMED Hand Fracture System</Name><Description>0.8mm Avulsion Hook Plate</Description><Size>0.8mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>971</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB023</BillingCode><Name>Mallet Finger Plate</Name><Description>Finger Plates</Description><Size>1 &amp; 2 Holes</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>229660</ARTG></ARTGs><MinimumBenefit>971</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL035</BillingCode><Name>VLP</Name><Description>VAL mini plates</Description><Size>Mini Plates ≤2.7mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>971</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY713</BillingCode><Name>AO/ASIF Plates</Name><Description>LCP, Condylar, Mini Fragment Plates - Various</Description><Size>≤6 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>971</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW825</BillingCode><PriorBillingCodes><PriorBillingCode>WR266</PriorBillingCode></PriorBillingCodes><Name>Locking Plate</Name><Description>Titanium locking plates anatomically contoured for forefoot and midfoot osteotomies.</Description><Size>2.7mm &amp; 3.5mm. Neutral, 1mm, 2mm, 3mm, 4mm, 4.5mm, 5mm, 5.5mm, 6mm, 6.5mm, 7mm, 8mm, 10mm. 4-6Holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111939</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>971</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM262</BillingCode><Name>Osteomed Plates</Name><Description>Low Profile plates</Description><Size>1.2/1.6/2.0/2.4mm 4-12 hole; straight, L, T</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>202319</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW970</BillingCode><PriorBillingCodes><PriorBillingCode>WR461</PriorBillingCode></PriorBillingCodes><Name>ORTHOLOC 2 Small Bones Plates – VAL – 7 to 15 holes</Name><Description>Titanium mini plates, variable angle locking, 7-15 holes, various designs (Straight plate, T-plates).</Description><Size>From 7 to 15 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ294</BillingCode><Name>Y-Plate, 2.4mm, 11 hole</Name><Description>Plate used for fracture fixation or fusion</Description><Size>2.4mm plate 11 hole plate</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN087</BillingCode><Name>TC-100</Name><Description>Semi-tubular plates</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY735</BillingCode><Name>AO/ASIF Plates</Name><Description>Non-Locking Plates</Description><Size>7-15 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN929</BillingCode><Name>TC-100</Name><Description>Quarter Tubular Plates, G/E 7 to L/E 15 holes</Description><Size>≥7 to ≤15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN934</BillingCode><Name>TC-100</Name><Description>1.5mm Mini Plates</Description><Size>≥7 to ≤15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW004</BillingCode><Name>WEGO Trauma Systems</Name><Description>Non-Locking Plate Systems</Description><Size>7-15 Holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM472</BillingCode><Name>TriMed ASET Foot Plating System </Name><Description>MTP Plates</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR089</BillingCode><Name>Stryker Locking Plate System</Name><Description>Periarticular Plates, Locking</Description><Size>4-6</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>119848</ARTG><ARTG>124319</ARTG><ARTG>357433</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH366</BillingCode><Name>ALPS Hand Fracture System - Locking Plate</Name><Description>1.5mm and 2.5mm titanium hand plates</Description><Size>7 to 15 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>209306</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KO003</BillingCode><PriorBillingCodes><PriorBillingCode>LM480</PriorBillingCode></PriorBillingCodes><Name>Variable Locking Hand Plates</Name><Description>Variable Locking Hand Plates</Description><Size>7 to 15 holes</Size><SupplierCode>40387</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>337193</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW564</BillingCode><Name>Leibinger Titanium Implant System</Name><Description>Profyle hand and small fragment plate system</Description><Size>size ≤2.7mm ≥ 7 to ≤ 15 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>340042</ARTG><ARTG>357433</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER485</BillingCode><Name>Paragon 28 Gorilla Plating System-Plate, mini (≥ 7 to ≤ 15 holes); variable angle locking</Name><Description>Paragon 28 Gorilla Plating System-Plate, mini, Titanium, compression, variable angle locking, various shapes (e.g. straight/oblique, right/left)</Description><Size>thickness 1.1 mm, multi screw diameter purchase 2.0/2.5mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH297</BillingCode><Name>ALPS Hand Fracture System - Locking Plate</Name><Description>1.0 - 2.5mm titanium hand plates</Description><Size>7 to 25 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>153056</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR090</BillingCode><Name>Stryker Locking Plates System</Name><Description>Locking Plates</Description><Size>7-13</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>35241</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW826</BillingCode><PriorBillingCodes><PriorBillingCode>WR267</PriorBillingCode></PriorBillingCodes><Name>Locking Plate</Name><Description>Titanium locking plates anatomically contoured for forefoot and midfoot osteotomies.</Description><Size>2.7mm &amp; 3.5mm, neutral, 1mm, 2mm, 3mm, 4mm, 5mm, 6mm, 7mm, 7-9 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL069</BillingCode><Name>VLP</Name><Description>VAL mini plates - Hand</Description><Size>Mini Plates ≤2.7mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN306</BillingCode><Name>AO/ASIF Plate</Name><Description>VA Locking Patella Plating System, Stainless Steel, Titanium</Description><Size>13 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN941</BillingCode><Name>Peri-Loc VLP</Name><Description>VAL/LK, 2.7mm Quarter Tubular Plates</Description><Size>≥7 to ≤15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL098</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Small Fragment Plate</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN309</BillingCode><Name>AO/ASIF Plates</Name><Description>VA-LCP Clavicle Plates, Shaft</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>286609</ARTG><ARTG>157069</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU275</BillingCode><Name>Triangle Plate</Name><Description>Plate for fracture fixation</Description><Size>8 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU284</BillingCode><Name>Cage Plate</Name><Description>Plate for fracture fixation</Description><Size>10 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU352</BillingCode><Name>Mini Fragment System - Tine Plate</Name><Description>Plate for Fracture Fixation</Description><Size>2.7mm, 10 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>284416</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU350</BillingCode><Name>Mini Fragment System - T-Plate</Name><Description>Plate for Fracture Fixation</Description><Size>&gt;7-15 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU246</BillingCode><PriorBillingCodes><PriorBillingCode>DE754</PriorBillingCode></PriorBillingCodes><Name>Wide T-Plate</Name><Description>Plate for Fracture Fixation</Description><Size>10 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL040</BillingCode><Name>VLP EVOS</Name><Description>Mini Plates Straight</Description><Size>≥7 to ≤15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU277</BillingCode><Name>V-Plate</Name><Description>Plate for fracture fixation</Description><Size>10 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ177</BillingCode><Name>PediFoot Deformity Correction System</Name><Description>2.7mm Plates, Recon</Description><Size>56mm length, 8 holes</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>191530</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU283</BillingCode><Name>Z-Plate</Name><Description>Plate for fracture fixation</Description><Size>10 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY822</BillingCode><Name>AO/ASIF Plates</Name><Description>VA Locking Plates</Description><Size>7-12 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU361</BillingCode><Name>Mini Fragment System - Straight Plates</Name><Description>Plate for Fracture Fixation</Description><Size>2.7mm; 8 holes, 8 holes reinforced, 10 holes, 10 holes reinforced</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>284416</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ075</BillingCode><PriorBillingCodes><PriorBillingCode>EF021</PriorBillingCode></PriorBillingCodes><Name>Locking Plate System</Name><Description>Variable Locking Plate</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40063</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>239812</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR087</BillingCode><Name>Stryker Locking Plate System</Name><Description>Plates including Locking, Standard and Compression</Description><Size>7-15 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><ARTGs><ARTG>124319</ARTG><ARTG>340042</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO085</BillingCode><Name>APTUS Hand</Name><Description>Fixation Plates</Description><Size>1.2 - 2.3</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><ARTGs><ARTG>141170</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB031</BillingCode><Name>Mini Locking System - Non Locking Plates</Name><Description>Non Locking Plate</Description><Size>screw size ≤ 2.7mm, ≥ 7 to ≤ 15 holes</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><ARTGs><ARTG>261562</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO430</BillingCode><Name>ACUMED Hand Fracture System, plates</Name><Description>Hand plating System, including plates and screws</Description><Size>Plates available in 7 to 12 hole configurations</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU295</BillingCode><Name>Y-Plate</Name><Description>Plate for Arthrodesis</Description><Size>8 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU345</BillingCode><Name>Mini Fragment System - Wide T-Plate</Name><Description>Plate for Fracture Fixation</Description><Size>2.7mm; 11 and 15 holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>284416</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU360</BillingCode><Name>Mini Fragment System - Triangular Plate</Name><Description>Plate for Fracture Fixation</Description><Size>&gt;7-15 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>284416</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU282</BillingCode><Name>Straight Plate</Name><Description>Plate for fracture fixation</Description><Size>10 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU292</BillingCode><Name>Straight Plate, Reinforced</Name><Description>Plate for fracture fixation</Description><Size>8 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO448</BillingCode><Name>Acumed Small Fragment Plates</Name><Description>2.7mm Fragment Plates</Description><Size>7 to 15 Holes</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT094</BillingCode><Name>RECOS Ulna </Name><Description>Ulna Plate</Description><Size>Short 80mm, Long 90mm x 10mm  </Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>236206</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB084</BillingCode><Name>Marathon Mini VAL System</Name><Description>Marathon Mini VAL System</Description><Size>7 - 15 Holes</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>261562</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB058</BillingCode><Name>Marathon VA System</Name><Description>Variable Angle Bone plates</Description><Size>&gt;7 - &lt;15 holes</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>261562</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT084</BillingCode><PriorBillingCodes><PriorBillingCode>OH531</PriorBillingCode></PriorBillingCodes><Name>KLS Martin Hand Fracture System - Plates</Name><Description>Various size and shaped plates</Description><Size>7 to 15 hole</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>236206</ARTG><ARTG>276674</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM253</BillingCode><Name>OsteoMed FPS</Name><Description>Titanium locking footplates</Description><Size>2mm and 2.7mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>202319</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB030</BillingCode><Name>Mini Locking System - Condylar Plates ≥ 7 to ≤ 15 holes</Name><Description>Condylar Plates</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><ARTGs><ARTG>261562</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ252</BillingCode><Name>Colink Mini Plates VAL from 7 Hole to 15 Hole</Name><Description>Foot and Ankle Mini Plates Titanium, Various designs straight, L, and T Plates.</Description><Size>7 - 8 Hole</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU126</BillingCode><PriorBillingCodes><PriorBillingCode>DE587</PriorBillingCode></PriorBillingCodes><Name>5th Metatarsal Fracture Plate</Name><Description>Hook Plate for Fracture fixation</Description><Size>2 Sizes Side Specific  Long Left - 7 Holes  Long Right - 7 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV007</BillingCode><Name>SternalPlate Closure System - Plates</Name><Description>Titanium Sternal Fixation System  </Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>386783</ARTG></ARTGs><MinimumBenefit>489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH064</BillingCode><Name>Sternalock</Name><Description>plates, various shapes</Description><Size>7-15 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW900</BillingCode><PriorBillingCodes><PriorBillingCode>WR376</PriorBillingCode></PriorBillingCodes><Name>Mini MaxLock Extreme System - Mini Plates &gt; 6 holes</Name><Description>Mini Variable angle locking plates, Titanium, &gt; 6 holes</Description><Size>&gt; 6 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>214671</ARTG></ARTGs><MinimumBenefit>489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO434</BillingCode><Name>ACUMED Hand Fracture System</Name><Description>1.3mm Rolando Fracture Hook Plate</Description><Size>1.3mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU245</BillingCode><PriorBillingCodes><PriorBillingCode>DE753</PriorBillingCode></PriorBillingCodes><Name>Reinforced T-Plate</Name><Description>Plate for Fracture Fixation</Description><Size>8 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ076</BillingCode><PriorBillingCodes><PriorBillingCode>EF022</PriorBillingCode></PriorBillingCodes><Name>Arix Hand Plating System</Name><Description>Mini Locking Plate</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40063</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>239812</ARTG></ARTGs><MinimumBenefit>812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO094</BillingCode><Name>APTUS Hand and Foot</Name><Description>TriLock Plates</Description><Size>1.2 - 2.3</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>206157</ARTG></ARTGs><MinimumBenefit>812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO061</BillingCode><Name>Aptus Wrist Arthrodesis</Name><Description>RSL Fusion Plate</Description><Size>7 to 15 holes</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>141170</ARTG></ARTGs><MinimumBenefit>812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH367</BillingCode><Name>ALPS Hand Fracture System - Locking Plate</Name><Description>1.5mm and 2.5mm titanium hand plates</Description><Size>7 to 15 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>209306</ARTG></ARTGs><MinimumBenefit>812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM263</BillingCode><Name>OsteoMed HPS</Name><Description>Low Profile hand plates</Description><Size>1.2/1.6/2.0/2.4mm 4-12 hole; Complex</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>202319</ARTG></ARTGs><MinimumBenefit>812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT085</BillingCode><PriorBillingCodes><PriorBillingCode>OH532</PriorBillingCode></PriorBillingCodes><Name>KLS Martin Hand Fracture System - Plates</Name><Description>Various size and shaped plates</Description><Size>7 to 15 hole</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>236206</ARTG><ARTG>276674</ARTG></ARTGs><MinimumBenefit>812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO432</BillingCode><Name>ACUMED Hand Fracture System</Name><Description>0.8mm Offset Plate</Description><Size>0.8mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY799</BillingCode><Name>AO/ASIF Plates</Name><Description>LCP, Condylar, Mini Fragment Plates - Various</Description><Size>7-15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>157069</ARTG><ARTG>286609</ARTG></ARTGs><MinimumBenefit>812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER486</BillingCode><Name>Paragon 28 Gorilla Plating System-Plate, mini (≥ 7 to ≤ 15 holes); variable angle locking, complex</Name><Description>Paragon 28 Gorilla Plating System-Plate, mini, Titanium, compression, variable angle locking, complex shapes</Description><Size>thickness 1.1mm; multi screw diameter purchase</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU288</BillingCode><Name>T- Plate</Name><Description>Plate for fracture fixation</Description><Size>8 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN336</BillingCode><Name>AO/ASIF Plate</Name><Description>VA Locking Patella Plate Titanium</Description><Size>13 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ140</BillingCode><Name>PediLoc - Plating System ≥ 7 to ≤ 15 holes, screw size ≤ 2.7mm</Name><Description>2.7mm Locking Plate</Description><Size>7-15 Hole</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>191586</ARTG></ARTGs><MinimumBenefit>489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY818</BillingCode><Name>AO/ASIF Plates</Name><Description>Locking plates</Description><Size>7 to 15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL140</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Small Fragment Plate</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KO007</BillingCode><PriorBillingCodes><PriorBillingCode>LM482</PriorBillingCode></PriorBillingCodes><Name>Complex Variable Locking Hand Plates</Name><Description>Complex Variable Locking Hand Plates</Description><Size>7 to 15 holes</Size><SupplierCode>40387</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>337193</ARTG></ARTGs><MinimumBenefit>812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW033</BillingCode><Name>WEGO Trauma Systems</Name><Description>Locking Compression Plate</Description><Size>7 - 15 Holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN931</BillingCode><Name>Peri-Loc</Name><Description>2.7mm LK Reconstruction Plates</Description><Size>≥7 to ≤15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB027</BillingCode><Name>Mini Locking System - Locking Plates ≥ 7 to ≤ 15 holes</Name><Description>Foot &amp; hand plates - steel - titanium multiple hole</Description><Size>2-2.7 mm, ≥ 7 to ≤ 15 holes</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>261562</ARTG></ARTGs><MinimumBenefit>489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO428</BillingCode><Name>ACUMED Total Wrist Fusion Plating System</Name><Description>Total Wrist Fusion System</Description><Size>Plates available in 9 and 10 hole configurations</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU195</BillingCode><PriorBillingCodes><PriorBillingCode>DE373</PriorBillingCode></PriorBillingCodes><Name>Low Profile MTP Plate</Name><Description>Arthodesis Plate - 8 Hole plate</Description><Size>8 Hole plate</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY628</BillingCode><Name>AO/ASIF Plates</Name><Description>LCP, Condylar , mini Fragment Plates - Various</Description><Size>7 - 15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW017</BillingCode><Name>WEGO Trauma Systems</Name><Description>Locking Compression Plate</Description><Size>7 - 15 Holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ040</BillingCode><Name>Mini Fragment Plates</Name><Description>Locking Compression Plates</Description><Size>1.5mm, 2.0mm, 2.5mm, 2.7mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL032</BillingCode><Name>VLP</Name><Description>VAL mini plates</Description><Size>Mini Plates ≤2.7mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>797</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ151</BillingCode><Name>PediLoc Plating System</Name><Description>PediFrag Wrist Fusion Plates</Description><Size>2.7/3.5mm
99-112mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>191530</ARTG></ARTGs><MinimumBenefit>354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU180</BillingCode><PriorBillingCodes><PriorBillingCode>DE454</PriorBillingCode></PriorBillingCodes><Name>Low Profile T-Plate</Name><Description> Plate for fusion</Description><Size>7-9 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU179</BillingCode><PriorBillingCodes><PriorBillingCode>DE456</PriorBillingCode></PriorBillingCodes><Name>Low Profile Straight Plate</Name><Description>Plate for fusion</Description><Size>7-8 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ129</BillingCode><PriorBillingCodes><PriorBillingCode>LM343</PriorBillingCode><PriorBillingCode>LM343</PriorBillingCode></PriorBillingCodes><Name>Orthopaedic Fixation Plate</Name><Description>Orthopaedic Fixation Plate</Description><Size>Screw size 2.7mm or less
7 to 15 holes</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>266216</ARTG></ARTGs><MinimumBenefit>354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV004</BillingCode><Name>SternalPlate Closure System - Plates</Name><Description>Titanium Sternal Fixation System</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>386783</ARTG></ARTGs><MinimumBenefit>354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL137</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Small Fragment Plate</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>308</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY748</BillingCode><Name>AO/ASIF Plates</Name><Description>Condylar plates</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>308</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM210</BillingCode><Name>Jones Fracture Plate</Name><Description>Fracture Fixation Systems</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>308</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ206</BillingCode><Name>5MS Titanium Locking Plates greather than and equal to 7 Hole</Name><Description>Anatomic curved titanium 8-hole plates for 5th metatarsal fractures and osteotomies</Description><Size>7 -15 Hole Plate</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ262</BillingCode><Name>DALVAZZA 2.5mm Distal Ulna Plate</Name><Description>Distal Ulna Plate</Description><Size>One size only</Size><SupplierCode>40482</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111940</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>433150</ARTG></ARTGs><MinimumBenefit>812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY819</BillingCode><Name>AO/ASIF Plates</Name><Description>Pre-contoured Locking plate</Description><Size>≥16 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN339</BillingCode><Name>AO/ASIF Plates</Name><Description>VA Locking Patella Plating System Titanium</Description><Size>≥ 16 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1207</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL141</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Small Fragment Plate</Description><Size>≥ 16 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER500</BillingCode><PriorBillingCodes><PriorBillingCode>ER420</PriorBillingCode></PriorBillingCodes><Name>Paragon 28 Gorilla Plating System-Plate, mini (≥ 16 holes);variable angle locking, complex</Name><Description>Paragon 28 Gorilla Plating System-Plate, mini, titanium, compression, variable angle locking, various complex shapes and sizes, left or right</Description><Size>thickness 2.0mm; multi screw diameter purchase</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>1180</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL099</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Small Fragment Plate</Description><Size>≥ 16 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1207</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY111</BillingCode><Name>AO/ASIF Plates</Name><Description>Specially manufactured plate</Description><Size>1.0mm - 6.5mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1207</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL033</BillingCode><Name>VLP</Name><Description>VAL mini plates</Description><Size>Mini Plates ≤2.7mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1207</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU354</BillingCode><Name>Mini Fragment System - Straight Plates 2.4mm</Name><Description>Plates for Fracture Fixation</Description><Size>2.4mm; 20 holes and 20 holes reinforced</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>284416</ARTG></ARTGs><MinimumBenefit>1207</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN305</BillingCode><Name>AO/ASIF Plates</Name><Description>VA Locking Patella Plating System, Stainless Steel, Titanium</Description><Size>≥ 16 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1207</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL041</BillingCode><Name>VLP EVOS</Name><Description>Mini Plates Straight</Description><Size>≥ 16 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1207</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU346</BillingCode><Name>Mini Fragment System - Straight Plates</Name><Description>Plate for Fracture Fixation</Description><Size>2.7mm; 20 holes and 20 holes reinforced</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>284416</ARTG></ARTGs><MinimumBenefit>1207</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV009</BillingCode><Name>SternalPlate Closure System - Plates</Name><Description>Titanium Sternal Fixation System</Description><Size>≥ 16 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>386783</ARTG></ARTGs><MinimumBenefit>893</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY820</BillingCode><Name>AO/ASIF Plates</Name><Description>Pre-contoured Locking plate</Description><Size>≥16 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1180</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO062</BillingCode><Name>Aptus Wrist Arthrodesis</Name><Description>Total Wrist Fusion Plate, Straight, long bend and short bend</Description><Size>&gt;16 holes</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>141170</ARTG></ARTGs><MinimumBenefit>1180</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR088</BillingCode><Name>Stryker Locking Plate System</Name><Description>Plates including Locking, Standard, and Compression</Description><Size>16 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>124319</ARTG></ARTGs><MinimumBenefit>1180</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW015</BillingCode><Name>WEGO Trauma Systems</Name><Description>Non-Locking Plate Systems</Description><Size>≥ 16 holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>431</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO086</BillingCode><Name>APTUS Hand</Name><Description>Fixation Plates</Description><Size>1.2 - 2.3</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><ARTGs><ARTG>141170</ARTG></ARTGs><MinimumBenefit>431</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN935</BillingCode><Name>TC-100</Name><Description>1.5mm Mini Plates</Description><Size>≥16 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>431</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN933</BillingCode><Name>TC-100</Name><Description>2.0mm Straight Plates</Description><Size>≥16 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>431</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KO008</BillingCode><PriorBillingCodes><PriorBillingCode>LM483</PriorBillingCode></PriorBillingCodes><Name>Complex Variable Locking Hand Plates</Name><Description>Complex Variable Locking Hand Plates</Description><Size>16 holes or more</Size><SupplierCode>40387</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><Suffix>Com, VAL</Suffix><ARTGs><ARTG>337193</ARTG></ARTGs><MinimumBenefit>1180</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW788</BillingCode><Name>Stryker Plating System</Name><Description>Non-locking Plates</Description><Size>≥ 16 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><ARTGs><ARTG>340042</ARTG><ARTG>357433</ARTG></ARTGs><MinimumBenefit>431</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL131</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Small Fragment plate</Description><Size>≥ 16 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>431</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR091</BillingCode><Name>Stryker Locking Plate System</Name><Description>Locking Plates</Description><Size>≥16 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>357433</ARTG></ARTGs><MinimumBenefit>1207</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY629</BillingCode><Name>'AO/ASIF Plates</Name><Description>Non-locking Plates</Description><Size>≥ 16 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>431</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER499</BillingCode><PriorBillingCodes><PriorBillingCode>ER420</PriorBillingCode></PriorBillingCodes><Name>Paragon 28 Gorilla Plating System-Plate, mini (≥ 16 holes);variable angle locking</Name><Description>Paragon 28 Gorilla Plating System-Plate, mini, titanium, compression, variable angle locking, various shapes and sizes (small-extra large)</Description><Size>thickness 1.1-2.0 mm; multi screw diameter purchase</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>1207</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU353</BillingCode><Name>Mini Fragment System - Wide T-Plate</Name><Description>Plate for Fracture Fixation</Description><Size>2.7mm; 24 holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111941</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>284416</ARTG></ARTGs><MinimumBenefit>1207</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN493</BillingCode><Name>Paediatric Osteotomy System</Name><Description> Paediatric Osteotomy System</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111942</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>274</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL158</BillingCode><PriorBillingCodes><PriorBillingCode>SN471</PriorBillingCode><PriorBillingCode>SN473</PriorBillingCode><PriorBillingCode>SN476</PriorBillingCode><PriorBillingCode>SN926</PriorBillingCode></PriorBillingCodes><Name>Compression Hip Screw System</Name><Description>Compression Hip Screw Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111942</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>274</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN488</BillingCode><Name>Intermediate Osteotomy System</Name><Description>Compressing</Description><Size>One size only</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111942</SubGroupID><ARTGs><ARTG>108429</ARTG></ARTGs><MinimumBenefit>274</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY606</BillingCode><Name>AO/ASIF Plates</Name><Description>DHS Plates</Description><Size>2-6 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111942</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>324</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY609</BillingCode><Name>AO/ASIF Plates</Name><Description>DHS Plates</Description><Size>2-6 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111942</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>324</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK551</BillingCode><Name>Omega3 Compression Hip Screw System</Name><Description>Omega3 Locking Plate</Description><Size>2-6 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111942</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>139622</ARTG></ARTGs><MinimumBenefit>324</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI768</BillingCode><Name>Zimmer Internal Fixation System: Compression Hip Screw</Name><Description>Versa Fx II CHS Tube Plates</Description><Size>2-6 holes left and right</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111942</SubGroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>274</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN912</BillingCode><Name>Intermediate Osteotomy System</Name><Description>Plate (hip screw)</Description><Size>≤6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111942</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>274</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY607</BillingCode><Name>AO/ASIF Plates</Name><Description>DHS Plates</Description><Size>7-15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111943</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>360</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY610</BillingCode><Name>AO/ASIF Plates</Name><Description>DHS Plates</Description><Size>8-14 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111943</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>360</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK552</BillingCode><Name>Omega3 Compression Hip Screw System</Name><Description>Omega3 Locking Plate</Description><Size>7-14 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111943</SubGroupID><ARTGs><ARTG>139622</ARTG></ARTGs><MinimumBenefit>509</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI769</BillingCode><Name>Versa Fx II Compression Hip Screw</Name><Description>Versa Fx II CHS Tube Plates</Description><Size>7-15 holes left and right</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111943</SubGroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>509</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN913</BillingCode><Name>Intermediate Osteotomy System</Name><Description>Plate (hip screw)</Description><Size>≥7 to ≤15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111943</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>509</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL157</BillingCode><PriorBillingCodes><PriorBillingCode>SN470</PriorBillingCode><PriorBillingCode>SN475</PriorBillingCode><PriorBillingCode>SN927</PriorBillingCode></PriorBillingCodes><Name>Compression Hip Screw System</Name><Description>Compression Hip Screw Plates</Description><Size>  ≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111943</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>509</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY608</BillingCode><Name>AO/ASIF Plates</Name><Description>DHS Plates</Description><Size>≥ 16 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111944</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>745</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY611</BillingCode><Name>AO/ASIF Plates</Name><Description>DHS Plates</Description><Size>≥ 16-20 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111944</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>745</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK553</BillingCode><Name>Stryker Compression Hip Screw System</Name><Description>Omega3 Supracondylar Plate</Description><Size>6 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111945</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>139622</ARTG></ARTGs><MinimumBenefit>850</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW055</BillingCode><Name>WEGO Trauma Systems </Name><Description>Supracondylar Femur Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111945</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>850</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY641</BillingCode><Name>AO/ASIF Plates</Name><Description>DCS DHS plate</Description><Size>≤ 6 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111945</SubGroupID><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>480</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN922</BillingCode><Name>Compression Hip Screw System</Name><Description>Classic Supracondylar Plate</Description><Size>≤6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111945</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>480</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI770</BillingCode><Name>Versa Fx II Compression Hip Screw</Name><Description>Versa Fx II CHS Tube Plates</Description><Size>2-6 holes left and right</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111945</SubGroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>480</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW014</BillingCode><Name>WEGO Trauma Systems</Name><Description>Supracondylar Femur Plates</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111946</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>850</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK554</BillingCode><Name>Stryker Compression Hip Screw System</Name><Description>Omega3 Supracondylar Plate</Description><Size>8-14 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111946</SubGroupID><Suffix>Com, LK</Suffix><ARTGs><ARTG>139622</ARTG></ARTGs><MinimumBenefit>850</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN923</BillingCode><Name>Compression Hip Screw System</Name><Description>Classic Supracondylar Plate</Description><Size>≥7 to ≤15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111946</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>386</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY642</BillingCode><Name>AO/ASIF Plates</Name><Description>DCS DHS plate</Description><Size>7- 15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111946</SubGroupID><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>386</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI771</BillingCode><Name>Versa Fx II Compression Hip Screw</Name><Description>Versa Fx II CHS Tube Plates</Description><Size>7-15 holes left and right</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111946</SubGroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>386</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY643</BillingCode><Name>AO/ASIF Plates</Name><Description>DCS DHS plate</Description><Size>≥ 16 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111947</SubGroupID><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1009</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW067</BillingCode><Name>WEGO Trauma Systems - Titanium Alloy</Name><Description>Clavicle Plating System - Titanium Alloy</Description><Size>≤ 6 holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111948</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>1208</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN323</BillingCode><Name>AO/ASIF Plates</Name><Description>VA-LCP Clavicle Plate 2.7 System - Button Hook Plate</Description><Size> ≤ 6 holes, 9-, 12- and 15-mm hook depth</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111948</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW595</BillingCode><Name>Stryker Locked Plating System</Name><Description>Periarticular variable angle locking plate - clavicle</Description><Size>1-6 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111948</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>196764</ARTG></ARTGs><MinimumBenefit>1261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB082</BillingCode><Name>VA Clavicle Plate</Name><Description>VA Clavicle Plating System</Description><Size>less than 6 holes</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111948</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>261562</ARTG></ARTGs><MinimumBenefit>1261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO384</BillingCode><Name>Acumed Locking Clavical Plating System</Name><Description>Locking Clavicle Plates Mid Shaft Anterior and Distal</Description><Size>≥ 6 holes</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111948</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>1208</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO371</BillingCode><Name>Acumed Locking Scapula Plate System</Name><Description>Locking Bone Plate, Scapula</Description><Size>≤6 hole</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111948</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>1208</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ005</BillingCode><Name>Valens Shoulder and Elbow - Clavicle</Name><Description>Clavicle - Superior, Anterior, Hook, Locking Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111948</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>1208</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN294</BillingCode><Name>AO/ASIF Plates</Name><Description>LCP Clavicle Hook Plate</Description><Size>≤ 6 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111948</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1208</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ074</BillingCode><PriorBillingCodes><PriorBillingCode>AE148</PriorBillingCode><PriorBillingCode>AE148</PriorBillingCode></PriorBillingCodes><Name>ASDM Clavicle Plating System - Plates</Name><Description>Clavicle fracture plating system consisting of anatomic pre-contoured stainless steel locking compression plates and screws (cortical, cancellous &amp; locking)</Description><Size>6 holes(L&amp;R),</Size><SupplierCode>40480</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111948</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>258572</ARTG></ARTGs><MinimumBenefit>1208</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX022</BillingCode><Name>ARMAR LPS Clavicle Hook Plates</Name><Description>3.5 mm anatomical clavicle hook locking plate</Description><Size>4-6 holes</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111948</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>1208</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX023</BillingCode><Name>ARMAR Superior Anterior Clavicle Plates</Name><Description>Superior Anterior Clavicle anatomical plates</Description><Size>3-6 holes</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111948</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>1208</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL142</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>VAL Periarticular Anatomical Small Fragment plate - Clavicle</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111948</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ194</BillingCode><Name>ARIX Clavicle System-Hook Plates</Name><Description>3.5mm clavicle hook plate</Description><Size>5-6 holes</Size><SupplierCode>40063</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111948</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>409165</ARTG></ARTGs><MinimumBenefit>1261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ006</BillingCode><Name>Valens Shoulder and Elbow - Clavicle</Name><Description>Clavicle – Superior, Anterior, Hook, Locking Plates</Description><Size>7-15 Holes</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111948</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>1261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ101</BillingCode><Name>Austofix Clavicle L&amp;C Plates</Name><Description>Hook Clavicle Locking Plates</Description><Size>7-15 Holes</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111949</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>1260</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO372</BillingCode><Name>Acumed Locking Scapula plate System</Name><Description>Locking Bone Plate, Scapula</Description><Size>≥7 to ≤15 holes</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111949</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>1260</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW049</BillingCode><Name>WEGO Trauma Systems</Name><Description>Clavicle Plating System</Description><Size>7 - 15 Holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111949</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>1260</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO385</BillingCode><Name>Acumed Locking Clavical Plating System</Name><Description>Locking Clavicle Plates Mid Shaft, Anterior and Distal</Description><Size>≥7 to  ≤15 holes</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111949</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>1260</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN019</BillingCode><Name>NewClip Clavicle Plate</Name><Description>Locking Clavicle plates</Description><Size>7 to 15 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111949</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG><ARTG>260233</ARTG><ARTG>260234</ARTG></ARTGs><MinimumBenefit>1260</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW597</BillingCode><Name>Stryker Locked Plate System</Name><Description>Periarticular variable angle locking plate - clavicle</Description><Size>7-15 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111949</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>196764</ARTG></ARTGs><MinimumBenefit>1320</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB083</BillingCode><Name>VA Clavicle Plate</Name><Description>VA Clavicle Plating System</Description><Size>7 - 15 holes</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111949</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>261562</ARTG></ARTGs><MinimumBenefit>1320</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO126</BillingCode><Name>APTUS Shoulder Clavicle</Name><Description>Lateral clavicle plates</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111949</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>206157</ARTG></ARTGs><MinimumBenefit>1320</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY618</BillingCode><Name>AO/ASIF Plates</Name><Description>LCP Clavicle - superior, anterior, hook</Description><Size>7-15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111949</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1260</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL088</BillingCode><Name>PERI-LOC</Name><Description>Clavicle plates</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111949</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1260</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ073</BillingCode><PriorBillingCodes><PriorBillingCode>AE153</PriorBillingCode><PriorBillingCode>AE153</PriorBillingCode></PriorBillingCodes><Name>ADSM Clavicle Plating System - Plates</Name><Description>Clavicle fracture plating system consisting of anatomic pre-contoured stainless steel locking compression plates and screws (cortical, cancellous &amp; locking)</Description><Size>8-13 holes (L &amp; R),</Size><SupplierCode>40480</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111949</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>258572</ARTG></ARTGs><MinimumBenefit>1260</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW907</BillingCode><PriorBillingCodes><PriorBillingCode>WR384</PriorBillingCode></PriorBillingCodes><Name>MaxLock Extreme System - Clavicle Plates</Name><Description>Clavicle Variable angle locking plates, Titanium</Description><Size>9 to 13 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111949</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>214671</ARTG></ARTGs><MinimumBenefit>1320</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL153</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>VAL Periarticular Anatomical Small Fragment plate - Clavicle</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111949</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1320</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN327</BillingCode><Name>AO/ASIF Plates</Name><Description>VA-LCP Clavicle Plate 2.7 System - Short and Long Hook Plates</Description><Size>9, 11  holes; 9-, 12- and 15-mm hook depths</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111949</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1320</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN308</BillingCode><Name>AO/ASIF Plates</Name><Description>VA-LCP Clavicle Plates, Lateral &amp; Medial</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111949</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>286609</ARTG><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1320</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN062</BillingCode><Name>Newclip Clavicle plates</Name><Description>Locking Clavicle plates</Description><Size>7 to 15 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111949</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG></ARTGs><MinimumBenefit>1320</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX025</BillingCode><Name>ARMAR Superior Anterior Clavicle Plate</Name><Description>3.5mm anatomical clavicle plate</Description><Size>7-8 holes</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111949</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>1260</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX024</BillingCode><Name>ARMAR LPS Clavicle Hook Plates</Name><Description>3.5mm anatomical clavicle hook plates</Description><Size>7 holes</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111949</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>1260</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN295</BillingCode><Name>AO/ASIF Plates</Name><Description>LCP Clavicle Hook Plates</Description><Size>≥7 to ≤ 15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111949</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1260</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM184</BillingCode><Name>Trimed Clavicle Fixation Plates</Name><Description>Plates for fixation of fractures of the clavicle</Description><Size>7-15 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111949</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>1260</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO386</BillingCode><Name>Acumed Locking Clavical Plating System</Name><Description>Lockinh Clavicle Plates Mid Shaft, Anterior and Distal.</Description><Size>≥ 16 holes</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111950</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>1338</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX003</BillingCode><Name>ARMAR Distal Humerus Plates</Name><Description>TiCP anatomic humeral locking plates</Description><Size>3-6 holes and left and right</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111951</SubGroupID><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>972</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX001</BillingCode><Name>ARMAR LPS Humerus Plates</Name><Description>TiCP humeral locking plates</Description><Size>3-6 holes</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111951</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>1205</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ001</BillingCode><Name>Valens Shoulder and Elbow - Elbow</Name><Description>Distal Humerus, Lateral, Medial, Olecranon, Locking Plates</Description><Size>1-6 Holes</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111951</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>1205</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW035</BillingCode><Name>WEGO Trauma Systems</Name><Description>Distal Humerus Plating System</Description><Size>≤ 6 Holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111951</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>1205</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN916</BillingCode><Name>Peri-Loc</Name><Description>Humerus Plates</Description><Size>≤6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111951</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1205</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL184</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Periarticular Anatomical Plate - Humerus</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111951</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG><ARTG>368492</ARTG></ARTGs><MinimumBenefit>1205</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL143</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>VAL Periarticular Anatomical Small Fragment plate - Humerus</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111951</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1488</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO352</BillingCode><Name>Acumed Tap Loc Elbow plates</Name><Description>Variable angle locking plate system</Description><Size>≤6 holes lateral</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111951</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>1488</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ073</BillingCode><Name>Austofix Proximal Humeral Plating System - Austofix Proximal Humeral Plate</Name><Description>Anatomic Periarticular Humeral Variable Angle Locking Plate, Titanium</Description><Size>3-5 holes</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111951</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>1488</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM547</BillingCode><Name>Periarticular Distal Humerus Plates</Name><Description>Direct Medial Plates</Description><Size>75mm Left and Right  6 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111951</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>1488</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW551</BillingCode><Name>VariAx Elbow Plating System</Name><Description>Periarticular anatomic humerus</Description><Size>≤ 6 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111951</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>269713</ARTG></ARTGs><MinimumBenefit>1488</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI929</BillingCode><Name>Proximal Humerus Plating System</Name><Description>Proximal Humerus Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111951</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>275084</ARTG></ARTGs><MinimumBenefit>1488</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM548</BillingCode><Name>Skeletal Dynamics Distal Humerus Plates</Name><Description>Medial Direct, Lateral Direct, Lateral Capitellar, Lateral Helical, Supracondylar plates</Description><Size>Medial Direct - 105 to 165mm,   Lateral Direct - 85 to 115mm  Lateral Capitellar - 70 to 160mm  Lateral Helical - 85 to 175mm  Supracondylar - 142 to 250mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW953</BillingCode><PriorBillingCodes><PriorBillingCode>WR443</PriorBillingCode></PriorBillingCodes><Name>ORTHOLOC SPS Humeral Plates - Standard &amp; Posterior</Name><Description>Stainless steel variable angle locking periarticular anatomic humeral plate, standard and posterior.</Description><Size>≥ 7 to ≤ 15 holes, right &amp; left</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>370409</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM275</BillingCode><Name>PANTERA Proximal Humerus Fracture Fixation Plate System - Plates</Name><Description>Proximal Humerus Plate</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>182168</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI930</BillingCode><Name>Proximal Humerus Plating System</Name><Description>Proximal Humerus Plates</Description><Size>7-15 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>209306</ARTG><ARTG>275084</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO353</BillingCode><Name>Acumed Tap Loc Elbow plates</Name><Description>Variable angle locking plate system</Description><Size>≥7 to ≤15 holes medial lateral</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>199824</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ002</BillingCode><Name>Valens Shoulder and Elbow - Elbow</Name><Description>Distal Humerus, Lateral, Medial, Olecranon, Locking Plates</Description><Size>7-15 Holes</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW803</BillingCode><PriorBillingCodes><PriorBillingCode>WR225</PriorBillingCode></PriorBillingCodes><Name>Evolve Ortholco EPS System - Distal Humerus</Name><Description>Stainless Steel, Polyaxial Locking Plate, Straight, Coronal, Medial, Lateral, Posterolateral</Description><Size>Right &amp; left, 2.7 &amp; 3.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW957</BillingCode><PriorBillingCodes><PriorBillingCode>WR447</PriorBillingCode></PriorBillingCodes><Name>ORTHOLOC SPS Greater Tuberosity Plate</Name><Description>Stainless steel peri-articular anatomic variable angle locking plate for greater tuberosity fixation</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>370409</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH290</BillingCode><Name>ALPS Elbow System</Name><Description>Humeral Titanium Plates</Description><Size>Small - Large, 7 to 15 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>209306</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK569</BillingCode><Name>Stryker Plating System</Name><Description>Stryker locked plating system</Description><Size>7-15 Holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>119848</ARTG><ARTG>139635</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY763</BillingCode><Name>AO/ASIF Plate</Name><Description>Locking Perarticular Anatomic Humerus plate</Description><Size>≥ 7 - ≤ 15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JD006</BillingCode><Name>CarboFix Piccolo Proximal Humerus Plate Systems – Plate component</Name><Description>CFR-PEEK proximal humerus plate</Description><Size>100mm, 120mm, 154mm, 190mm, 262mm</Size><SupplierCode>40214</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>222648</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ261</BillingCode><Name>LORRAINE 3.5mm Distal Humerus Plate</Name><Description>Distal Humerus Plate</Description><Size>Posterolateral and Extraarticular, 8 to 13 holes</Size><SupplierCode>40482</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>433150</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ260</BillingCode><Name>LORRAINE 3.5mm Distal Humerus Plate</Name><Description>Distal Humerus Plate</Description><Size>Medial and Posterolateral, 4 and 5 holes</Size><SupplierCode>40482</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>433150</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL135</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>VAL Periarticular Anatomical Small Fragment plate - Humerus</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ025</BillingCode><Name>Austofix PHP - Proximal Humeral Plating System</Name><Description>Anatomic Periarticular Humeral Variable Angle Locking Plate, Titanium</Description><Size>7-15 Hole</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN020</BillingCode><Name>Newclip Proximal Humerus Plate</Name><Description>Proximal Humerus Plate</Description><Size>1/2/3</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260232</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO078</BillingCode><Name>Aptus Elbow</Name><Description>Distal Humerus Plpates, Lateral,Middle and Posterolateral</Description><Size>2.8mm</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>141170</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW036</BillingCode><Name>WEGO Trauma Systems</Name><Description>Humerus Plating Systems</Description><Size>7 - 15 Holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>1330</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO425</BillingCode><Name>ACUMED POLARUS® 3 Solution Plates</Name><Description>ACUMED POLARUS 3 SOLUTION, includes plates, intramedullary nails, screws and accessories designed to address fractures, fusions and osteotomies of the humerus</Description><Size>12 and 14 hole plates</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>1330</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK555</BillingCode><Name>Stryker Plating System</Name><Description>Proximal Humerus Anatomical Locking Plates</Description><Size>11-14 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>295226</ARTG><ARTG>269713</ARTG><ARTG>119848</ARTG></ARTGs><MinimumBenefit>1330</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN033</BillingCode><Name>Newclip Humerus Plates</Name><Description>Plates for fixation of fractures of the distal humerus and proximal ulnar</Description><Size>7 - 15 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG></ARTGs><MinimumBenefit>1330</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN013</BillingCode><Name>Newclip Distal Humerus Plates - Periarticular 7-15 holes</Name><Description>Plates for the fixation of fractures of the elbow</Description><Size>Periarticular anatomic - Humerus ≥ 7 to ≤ 15 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260232</ARTG><ARTG>260229</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX002</BillingCode><Name>ARMAR LPS Humerus Plates</Name><Description>TiCP anatomical humeral locking plates</Description><Size>7-15 holes</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>1330</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY762</BillingCode><Name>AO/ASIF Plate</Name><Description>Locking Perarticular Anatomic Humerus plate</Description><Size>≥ 7 - ≤ 15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1330</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL185</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Periarticular Anatomical Plate - Humerus</Description><Size> ≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>368492</ARTG><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1330</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN917</BillingCode><Name>Peri-Loc</Name><Description>Humerus Plates</Description><Size>≥7 to ≤15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1330</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ281</BillingCode><Name>TAMINA 3.5mm Proximal Humerus Plate</Name><Description>Proximal Humerus Plate</Description><Size>Standard and TF Plates, 3 to 5 holes</Size><SupplierCode>40482</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>433150</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX004</BillingCode><Name>ARMAR Distal Humerus Plates</Name><Description>TiCP distal humeral anatomical locking plates</Description><Size>7-15 holes</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111952</SubGroupID><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>1033</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW804</BillingCode><PriorBillingCodes><PriorBillingCode>WR226</PriorBillingCode></PriorBillingCodes><Name>Evolve Ortholco EPS System - Distal Humerus</Name><Description>Stainless Steel, Polyaxial Locking Plate, Straight, Coronal, Medial, Lateral, Posterolateral</Description><Size>Right &amp; left, 2.7 &amp; 3.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111953</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>1643</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM276</BillingCode><Name>PANTERA Proximal Humerus Fracture Fixation Plate System - Plate ≥ 16 holes</Name><Description>Proximal Humerus Plate</Description><Size>≥ 16 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111953</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>182168</ARTG></ARTGs><MinimumBenefit>1643</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK570</BillingCode><Name>Stryker Plating System</Name><Description>Stryker locked plating system</Description><Size>16-17 Hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111953</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>119848</ARTG><ARTG>139635</ARTG></ARTGs><MinimumBenefit>1643</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA116</BillingCode><Name>ALPS Elbow System</Name><Description>Humeral Titanium Plates</Description><Size>≥ 16 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111953</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>209306</ARTG></ARTGs><MinimumBenefit>1643</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX005</BillingCode><Name>ARMAR Distal Humerus Plates</Name><Description>TiCP distal humeral locking plates</Description><Size>16-18 holes</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111953</SubGroupID><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>1074</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA114</BillingCode><Name>Proximal Humerus Plating System</Name><Description>Proximal Humerus Plates</Description><Size>&gt;15 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111953</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>209306</ARTG><ARTG>275084</ARTG></ARTGs><MinimumBenefit>1643</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL128</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>VAL Periarticular Anatomical Small Fragment plate - Humerus</Description><Size>≥ 16 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111953</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1643</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY755</BillingCode><Name>AO/ASIF Plates</Name><Description>Anatomical Locking Humerus Plate</Description><Size>≥ 16 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111953</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1643</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO354</BillingCode><Name>Acumed Tap Loc Elbow plates</Name><Description>Variable angle locking plate system</Description><Size>≥16 holes</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111953</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>1643</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN012</BillingCode><Name>Newclip Disal Humerus Plates - Perarticular 16+ holes</Name><Description>Plates for the fixation of fractures of the elbow</Description><Size>Periarticular anatomic - Humerus ≥ 16 holes, VAL</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111953</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG></ARTGs><MinimumBenefit>1643</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO079</BillingCode><Name>Aptus Elbow</Name><Description>Distal Humerus Plates Posterolateral</Description><Size>2.8mm System</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111953</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>141170</ARTG></ARTGs><MinimumBenefit>1643</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN070</BillingCode><Name>Newclip Humerus Plates</Name><Description>Periarticular plate for humerus</Description><Size>≥ 16 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111953</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG></ARTGs><MinimumBenefit>1643</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO087</BillingCode><Name>Aptus Shoulder (Proximal Humerus Plates)</Name><Description>Proximal Humerus Fixation plates</Description><Size>3.5mm System</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111953</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>141170</ARTG></ARTGs><MinimumBenefit>1643</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN042</BillingCode><Name>Newclip Humerus Plates</Name><Description>Plates for fixation of fractures of the distal humerus and proximal ulna</Description><Size>≥ 16 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111953</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>260232</ARTG><ARTG>260229</ARTG></ARTGs><MinimumBenefit>1330</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ297</BillingCode><Name>TAMINA 3.5mm Proximal Humerus Plate</Name><Description>Proximal Humerus Plate</Description><Size>Standard and TF Plates 5, 9 to 13 holes, long</Size><SupplierCode>40482</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111953</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>433150</ARTG></ARTGs><MinimumBenefit>1643</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW958</BillingCode><PriorBillingCodes><PriorBillingCode>WR448</PriorBillingCode></PriorBillingCodes><Name>ORTHOLOC SPS Humeral Plates - Standard (Long)</Name><Description>Stainless steel variable angle locking periarticular anatomic humeral plate</Description><Size>≥ 16 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111953</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>370409</ARTG></ARTGs><MinimumBenefit>1643</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY754</BillingCode><Name>AO/ASIF Plates</Name><Description>Anatomical Locking Humerus Plate</Description><Size>≥ 16 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111953</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1330</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK556</BillingCode><Name>Stryker Plating System</Name><Description>Proximal Humerus Anatomical Locking Plates</Description><Size>16-27 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111953</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>119848</ARTG><ARTG>269713</ARTG><ARTG>295226</ARTG></ARTGs><MinimumBenefit>1330</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW023</BillingCode><Name>WEGO Trauma Systems</Name><Description>Humerus Plating Systems</Description><Size>≥ 16 Holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111953</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>1330</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO429</BillingCode><Name>ACUMED POLARUS* 3 Solution, Humeral Plates, Sterile and Non-Sterile</Name><Description>ACUMED POLARUS 3 SOLUTION, includes plates, intramedullary nails, screws and accessories designed to address fractures, fusions and osteotomies of the humerus</Description><Size>16 , 18 , 22 , 26  and 30 hole plates</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111953</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>1330</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO366</BillingCode><Name>Acu-Loc Distal Radius Plating System</Name><Description>Volar, Dorsal, Distal Ulna, Standard, Long, Extra long, wide, narrow, left, right, extra-articular plates</Description><Size>Radius ≤6 holes`</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>1113</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW038</BillingCode><Name>WEGO Trauma Systems</Name><Description>Periarticular Radius Plating Systems</Description><Size>≤ 6 Holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>1113</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA112</BillingCode><Name>ALPS Elbow System</Name><Description>Proximal Radius Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>209306</ARTG></ARTGs><MinimumBenefit>1113</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM211</BillingCode><Name>Trimed Volar &amp; Dorsal Hook Plate</Name><Description>Wrist Fixation System - Volar &amp; Dorsal Hook Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>1113</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX026</BillingCode><Name>ARMAR 2.4 Locking Distal Radial Plate System - ≤ 6 holes</Name><Description>TiCP Distal Radial Locking Plates</Description><Size>3-6 Holes
40-57 Length
Left, Straight and Right</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>1113</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN920</BillingCode><Name>Peri-Loc</Name><Description>Radius Plates</Description><Size>≤6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1113</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY675</BillingCode><Name>AO/ASIF Plates</Name><Description>Locking Distal Radius; Ulna Column Plate System</Description><Size>≤ 6 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1113</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU178</BillingCode><PriorBillingCodes><PriorBillingCode>DE470</PriorBillingCode></PriorBillingCodes><Name>Titanium Volar Distal Radius Plating System</Name><Description>Fixation Plate for Distal Radius Fractures</Description><Size>6 holes or less</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1372</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU128</BillingCode><PriorBillingCodes><PriorBillingCode>DE579</PriorBillingCode></PriorBillingCodes><Name>Radial Styloid Plate</Name><Description>Plate for Fracture Fixation</Description><Size>5 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1372</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ003</BillingCode><Name>Valens Shoulder and Elbow - Elbow</Name><Description>Locking Compression Plate Proximal Radius</Description><Size>1-6 Holes</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>1372</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL075</BillingCode><Name>VLP</Name><Description>Distal Radius Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1372</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY676</BillingCode><Name>AO/ASIF Plates</Name><Description>Locking Distal Radius Ulna Column Plate System</Description><Size>≤ 6 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1372</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL148</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>VAL Periarticular anatomic Radius Plate</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1372</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO067</BillingCode><Name>Aptus Wrist</Name><Description>2.5 TriLock Distal Radius Small Fragment Plates</Description><Size>2.5mm diameter system</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>141170</ARTG></ARTGs><MinimumBenefit>1372</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN021</BillingCode><Name>Xpert 2.4 Distal Radius Platform</Name><Description>Fragment specific radius plates</Description><Size>≤ 6 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG></ARTGs><MinimumBenefit>1372</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM321</BillingCode><Name>GEMINUS Volar Distal Radius Plates</Name><Description>Fixation Plate for Distal Radius Fractures</Description><Size>3 and 4 hole</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>1372</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM140</BillingCode><Name>TriMed Wrist Fixation System</Name><Description>TriMed Volar Bearing Plate</Description><Size>3 and 5 hole</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>1372</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER543</BillingCode><Name>Osteomed ExtremiLock Plate (≤ 6 holes)</Name><Description>VDR Radial/Intermediate Column; Standard; Left or Right and Styloid Plates; 6 hole  </Description><Size>6 holes</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>337239</ARTG></ARTGs><MinimumBenefit>1372</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT072</BillingCode><PriorBillingCodes><PriorBillingCode>OH472</PriorBillingCode></PriorBillingCodes><Name>IXOS Radius Plating System</Name><Description>Straight/L plate R&amp;L</Description><Size>7.5-15mm x 43-52mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>236206</ARTG><ARTG>276674</ARTG></ARTGs><MinimumBenefit>1372</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV002</BillingCode><Name>VariAx Wrist Plating System – Distal Radius</Name><Description>VAL Fixation Plates for Distal Radius Fractures</Description><Size>≤ 6 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>340042</ARTG><ARTG>357433</ARTG></ARTGs><MinimumBenefit>1372</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK571</BillingCode><Name>Universal Distal Radius System</Name><Description>SMARTLock Column Locking Plates</Description><Size>4-6 Hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>124319</ARTG></ARTGs><MinimumBenefit>1372</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU127</BillingCode><PriorBillingCodes><PriorBillingCode>DE563</PriorBillingCode></PriorBillingCodes><Name>Volar Hook PLate</Name><Description>Plate for Fracture Fixation</Description><Size>4 Holes  6 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1372</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM119</BillingCode><Name>TriMed Ulna Column Plates</Name><Description>Ulna Column Plate</Description><Size>3 &amp; 5 hole</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>869</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM117</BillingCode><Name>TriMed Radial Column Plates</Name><Description>Radial Column Plate</Description><Size>3 &amp; 5 hole</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>869</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK590</BillingCode><Name>SCS Distal Radius Plate System</Name><Description>Left and Right, Tined</Description><Size>Small and Large 3 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><ARTGs><ARTG>141005</ARTG></ARTGs><MinimumBenefit>869</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW913</BillingCode><PriorBillingCodes><PriorBillingCode>WR392</PriorBillingCode></PriorBillingCodes><Name>NexFix MTP Fusion System</Name><Description>A bendable stainless steel bone plate and screw system with unique low profile locking screw option.  Indicated for use in primary MTP fusion</Description><Size>Left 2 + 3; Right 2 + 3</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><ARTGs><ARTG>177214</ARTG></ARTGs><MinimumBenefit>869</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO362</BillingCode><Name>Anatomic Midshaft Forearm Plates</Name><Description>Internal Fixation Plate Anatomic Forearm, Radius</Description><Size>≤6 holes</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>1113</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO194</BillingCode><Name>Acumed Congruent Plate System</Name><Description>Elbow plate  titanium, locking radial head</Description><Size>Locking radial head, 3 hole std curve 31mm, 5 hole std curve 46mm, 3 hole curve 31mm, 5 hole curve 46mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111954</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>126428</ARTG></ARTGs><MinimumBenefit>1113</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX027</BillingCode><Name>ARMAR 2.4 Locking Distal Radial Plate System - ≥ 7 to ≤ 15 holes</Name><Description>TiCP Distal Radial Locking Plates</Description><Size>7-15 Holes
43-120mm Length
Left, Straight and Right</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>1126</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM318</BillingCode><Name>PROTEAN Plate</Name><Description>Plate</Description><Size>One size</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>1126</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ280</BillingCode><Name>SALGINA 2.5mm Volar Distal Radius Plate</Name><Description>Volar Distal Radius Plate</Description><Size>Narrow, wide, long narrow and long wide</Size><SupplierCode>40482</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>433150</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU358</BillingCode><Name>Titanium Volar Distal Radius Plating System</Name><Description>Plate for fracture fixation</Description><Size>10 and 13 holes, Narrow, Standard and Wide, Left and Right</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>284416</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM118</BillingCode><Name>TriMed Radial Column Plates</Name><Description>Radial Column Plate</Description><Size>7 hole</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>869</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM120</BillingCode><Name>TriMed Ulna Column Plates</Name><Description>Ulna Column Plate</Description><Size>7 hole</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>869</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM033</BillingCode><Name>Trimed Wrist Fixation System,</Name><Description> Volar Fixed Angle Plates</Description><Size>Narrow, standard and wide plates, 10 to 14 hole</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>869</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU153</BillingCode><PriorBillingCodes><PriorBillingCode>DE471</PriorBillingCode></PriorBillingCodes><Name>Titanium Volar Radius Plating System</Name><Description>Fixation Plate for Distal Radius Fractures</Description><Size>7- 15 holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>351000</ARTG><ARTG>350871</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB057</BillingCode><Name>Distal Radius Plate</Name><Description>Distal Radius Plating System</Description><Size>7 - 15 holes</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>261562</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN035</BillingCode><Name>Newclip Radius Plates</Name><Description>Variable Angle plates for the radius</Description><Size>7-15 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK572</BillingCode><Name>Universal Distal Radius System</Name><Description>SMARTLock Column Locking Plates</Description><Size>7 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>124319</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ024</BillingCode><PriorBillingCodes><PriorBillingCode>LM365</PriorBillingCode></PriorBillingCodes><Name>Distal Radius Plates</Name><Description>Distal Radius Plates</Description><Size>Multiple Sizes</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>266216</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN057</BillingCode><Name>Periarticular radius plate</Name><Description>Periarticular VAL radius plate</Description><Size>≥7 to ≤15 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK573</BillingCode><Name>Universal Distal Radius System</Name><Description>Universal SMARTLock Locking plates</Description><Size>9-15 Hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>119848</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM322</BillingCode><Name>GEMINUS Volar Plating System</Name><Description>Plates</Description><Size>7 hole, Long (207mm) and Short (160mm)</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM141</BillingCode><Name>TriMed Wrist Fixation System</Name><Description>TriMed Volar Bearing Plate</Description><Size>Narrow, Standard, Wide; 3, 5, and 7 Holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK632</BillingCode><Name>VariAx Volar plates</Name><Description>Volar Plate Polyaxial Locking</Description><Size>Radius 7-15 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>155633</ARTG><ARTG>119848</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER558</BillingCode><Name>Osteomed ExtremiLock Plate (≥ 7 to ≤ 15 holes)</Name><Description>VDR Narrow, standard, PQ sparing plates, left or right    </Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>337239</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV003</BillingCode><Name>VariAx Wrist Plating System – Distal Radius</Name><Description>VAL Fixation Plates for Distal Radius Fractures</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>340042</ARTG><ARTG>357433</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH253</BillingCode><Name>Distal Radius Plating System</Name><Description>DVR titanium radius plates</Description><Size>7 to 15 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>209306</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT070</BillingCode><PriorBillingCodes><PriorBillingCode>OH470</PriorBillingCode></PriorBillingCodes><Name>IXOS Radius Plating System</Name><Description>Titanium Radial Plates</Description><Size>23-27mm x 43-71mm - &gt;7 to &amp;lt;15 Holes</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>236206</ARTG><ARTG>276674</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM057</BillingCode><Name>Ascension Radial Head Locking Plate and Screws</Name><Description>Titanium pre-formed anatomical radial head plate</Description><Size>small and large</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>118638</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN075</BillingCode><Name>Newclip distal radius plates</Name><Description>Pariarticular anatomic radius plates</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260232</ARTG><ARTG>260229</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT099</BillingCode><Name>Recos Radial Plating System</Name><Description>Titanium Volar Locking Radius Plates</Description><Size>21mm - 24mm (Width) x 70mm (Length): 7-15 Holes</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>236206</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ022</BillingCode><Name>VRP Distal Radius Fixation System</Name><Description>Volar Distal Radius Plate</Description><Size>Standard, wide, narrow, long, short - left, right and universal</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>149433</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO068</BillingCode><Name>APTUS Wrist</Name><Description>2.5 TriLock Distal Radius Plates, Adaptive, Volar, Dorsal, Correction, Extra-articular</Description><Size>2.5mm diameter system</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>141170</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU373</BillingCode><Name>2.4mm Sterile Distal Radius Plate    </Name><Description>2.4 Volar Distal Radius Kit Convenience Packs include the Volar plate, screws, and other accessories for insertion </Description><Size>2.4mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350871</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW022</BillingCode><Name>WEGO Trauma Systems</Name><Description>Periarticular Radius Plating Systems</Description><Size>7 - 15 Holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW973</BillingCode><PriorBillingCodes><PriorBillingCode>WR048</PriorBillingCode></PriorBillingCodes><Name>Evolve Radial Head Plate</Name><Description>Evolve Radial Plate System Stainless Steel</Description><Size>32mm x 20-26mm in 2mm increments, 7 &amp; 8 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>1126</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM212</BillingCode><Name>Trimed Volar &amp; Dorsal Hook Plate</Name><Description>Wrist Fixation System - Volar &amp; Dorsal Hook Plate</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>1126</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO363</BillingCode><Name>Anatomic Midshaft Forearm Plates</Name><Description>Internal Fixation Plate Anatomic Forearm, Radius</Description><Size>≥7 to ≤15 holes</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>1126</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW041</BillingCode><Name>WEGO Trauma Systems</Name><Description>Periarticular Radius Plating Systems</Description><Size>7 - 15 Holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>1126</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO406</BillingCode><Name>Acu-Loc Distal Radius Plating System</Name><Description>Volar, Dorsal, Distal Ulna, Standard, Long, Extra long, wide, narrow, left, right, extra-articular plates</Description><Size>&gt;7 - &gt;15</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>1126</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN921</BillingCode><Name>Peri-Loc</Name><Description>Radius Plates</Description><Size>≥7 to ≤15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1126</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JD005</BillingCode><Name>CarboFix Piccolo Distal Radius Plate System – Plate component</Name><Description>CFR-PEEK distal volar radius plate</Description><Size>Right 52mm, 60mm, 90mm
Left 52mm, 60mm, 90mm
Narrow Right 50mm, 58mm
Narrow Left 50mm, 58mm</Size><SupplierCode>40214</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>222648</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY678</BillingCode><Name>AO/ASIF Plates</Name><Description>Anatomical Variable Angle Locking Radial Plates</Description><Size>7-15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL027</BillingCode><Name>D-RAD SMART PACK</Name><Description>D-RAD SMART PACK Plate Kit</Description><Size>Standard, Wide</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>104369</ARTG><ARTG>214894</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL149</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>VAL Periarticular anatomic Radius Plate</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL076</BillingCode><Name>VLP</Name><Description>Distal Radius Plates</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY677</BillingCode><Name>AO/ASIF Plates</Name><Description>Anatomical Locking Radial Plates</Description><Size>7-15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1126</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO407</BillingCode><Name>Acu-Loc Distal Radius Plating System</Name><Description>Volar, Dorsal, Distal Ulna, Standard, Long, Extra long, wide, narrow, left, right, extra articular plates</Description><Size>≥ 7 to ≤ 15</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111955</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT071</BillingCode><PriorBillingCodes><PriorBillingCode>OH471</PriorBillingCode></PriorBillingCodes><Name>IXOS Radius Plating System</Name><Description>Titanium Radial Plates</Description><Size>23mm - 32mm x 60mm - 95mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111956</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>236206</ARTG><ARTG>276674</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO069</BillingCode><Name>APTUS Wrist</Name><Description>2.5 TriLock Distal Radius Plates, Volar, Dorsal, Correction</Description><Size>2.5mm diameter system</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111956</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>141170</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN047</BillingCode><Name>Periarticular anatomic plates VAL Radius &gt;=16 holes</Name><Description>Periarticular anatomic plates VAL Radius</Description><Size>≥16 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111956</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260232</ARTG><ARTG>260229</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN201</BillingCode><Name>AO/ASIF Plates</Name><Description>Anatomical  Radial Plates</Description><Size>≥ 16 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111956</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK574</BillingCode><Name>Universal Distal Radius System</Name><Description>Universal SMARTLock Locking Plates</Description><Size>17 Hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111956</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>124319</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH254</BillingCode><Name>Distal Radius Fracture Repair System</Name><Description>DVR-A, distal volar radius locking plate, titanium</Description><Size>16 to 20 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111956</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>153056</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM382</BillingCode><Name>Volar Distal Radius Plates</Name><Description>Fixation Plate for Distal Radius Fractures</Description><Size>16 holes or more</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111956</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK576</BillingCode><Name>VariAx Plate</Name><Description>Volar Plate, Polyaxial Locking</Description><Size>16-22 Hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111956</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>124319</ARTG></ARTGs><MinimumBenefit>1513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY679</BillingCode><Name>AO/ASIF Plates</Name><Description>Anatomical Locking Radial Plates</Description><Size>≥ 16 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111956</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1234</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO364</BillingCode><Name>Acumed Acu-Loc Radius Plating system</Name><Description>Volar, Dorsal, Distal Ulna, Standard, Long, Extra long, wide, narrow, left, right, extra-articular plates</Description><Size>≥16 holes</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111956</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>1234</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW030</BillingCode><Name>WEGO Trauma Systems</Name><Description>Periarticular Radius Plating Systems</Description><Size>≥ 16 Holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111956</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>1234</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX030</BillingCode><Name>ARMAR 2.4 Locking Distal Radial Plate System - ≥ 16 holes</Name><Description>TiCP Distal Radial Locking Plate</Description><Size>16 Holes
140mm Length</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111956</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>1234</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX020</BillingCode><Name>ARMAR 3.5 LPS Olecranon Plates</Name><Description>3.5 mm anatomical olecranon locking plates</Description><Size>2- 6 holes</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111957</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>778</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY743</BillingCode><Name>AO/ASIF Plates</Name><Description>Anatomic Locking Ulna Plates</Description><Size>≤6  Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111957</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>778</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN918</BillingCode><Name>Peri-Loc</Name><Description>Olecranon Plates</Description><Size>≤6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111957</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>778</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO059</BillingCode><Name>APTUS</Name><Description>Ulna Plates</Description><Size>&lt;  or = 6 holes</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111957</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>206157</ARTG></ARTGs><MinimumBenefit>1287</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO361</BillingCode><Name>Anatomic Midshaft Forearm Plates</Name><Description>Internal Fixation Plate Anatomic Forearm, Ulna</Description><Size>≤6 holes</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111957</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>778</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW042</BillingCode><Name>WEGO Trauma Systems</Name><Description>Periarticular Ulna Plating System</Description><Size>≤ 6 Holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111957</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>778</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL144</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>VAL Periarticular Anatomical Small Fragment plate - Ulna</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111957</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1287</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO349</BillingCode><Name>Acumed Tap Loc Elbow plates</Name><Description>Variable angle locking plates</Description><Size>≤6 holes Coronoid</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111957</SubGroupID><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>869</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH292</BillingCode><Name>ALPS Elbow System</Name><Description>Ulna Titanium Plates</Description><Size>Small – Large, 3 to 6 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111957</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>153056</ARTG></ARTGs><MinimumBenefit>1287</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW025</BillingCode><Name>WEGO Trauma Systems</Name><Description>Perarticular Ulna Plating Systems</Description><Size>7 - 15 holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111958</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>1126</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO360</BillingCode><Name>Anatomic Midshaft Forearm Plates</Name><Description>Internal Fixation Plate Anatomic Forearm, Ulna</Description><Size>≥7 to ≤15 holes</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111958</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>1126</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ257</BillingCode><Name>LEPORELLO 3.5mm Olecranon Plate</Name><Description>3.5mm Olecranon Plate</Description><Size>5 and 9 holes</Size><SupplierCode>40482</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111958</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>433150</ARTG></ARTGs><MinimumBenefit>1198</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN919</BillingCode><Name>Peri-Loc</Name><Description>Olecranon Plates</Description><Size>≥7 to ≤15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111958</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1126</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW802</BillingCode><PriorBillingCodes><PriorBillingCode>WR221</PriorBillingCode></PriorBillingCodes><Name>Evolve Ortholoc EPS System - Olecranon Plate</Name><Description>Stainless Steel, Polyaxial Locking Plate, Olecranon, Right &amp; Left</Description><Size>Right &amp; Left, 2.7 &amp; 3.5mm, 9-16 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111958</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>1126</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ212</BillingCode><Name>ARIX Elbow System- Olecranon</Name><Description>Olecranon, Medial, Lateral, Posterolateral</Description><Size>5-17 holes </Size><SupplierCode>40063</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111958</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>409165</ARTG></ARTGs><MinimumBenefit>1198</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX021</BillingCode><Name>ARMAR 3.5 LPS Olecranon Plates</Name><Description>3.5mm anatomical olecranon locking plates</Description><Size>7-15 holes</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111958</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>1126</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY767</BillingCode><Name>AO/ASIF Plates</Name><Description>Locking Periarticular Ulna Plates</Description><Size>≥7 to ≤15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111958</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1126</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY766</BillingCode><Name>AO/ASIF Plates</Name><Description>Variable Angle Locking Perarticular Ulna Plates</Description><Size>≥7 to ≤15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111958</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1198</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL145</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>VAL Periarticular Anatomical Small Fragment plate - Ulna</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111958</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1198</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ004</BillingCode><Name>Valens Shoulder and Elbow - Elbow</Name><Description>Ulna Hook Locking Compression Plate</Description><Size>7 Holes</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111958</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>1198</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO350</BillingCode><Name>Acumed Tap Loc Elbow plates</Name><Description>Variable angle locking plate system</Description><Size>≥7 to ≤15 holes Olecranon</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111958</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>1198</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM525</BillingCode><Name>Proximal Ulna Plate</Name><Description>Proximal Ulna Plate</Description><Size>73 to 151 mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111958</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>1198</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK499</BillingCode><Name>Stryker Locking Plate system</Name><Description>Variable angle locking plate for olecranon fractures</Description><Size>7-15 Hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111958</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>119848</ARTG></ARTGs><MinimumBenefit>1198</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH293</BillingCode><Name>ALPS Elbow System</Name><Description>Ulna Titanium Plates</Description><Size>10-13 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111958</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>209306</ARTG></ARTGs><MinimumBenefit>1198</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO063</BillingCode><Name>Aptus Elbow</Name><Description>Olecranon Plates Right, Left, Straight and Tension</Description><Size>&gt; 7 to &lt; 15 holes</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111958</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>141170</ARTG></ARTGs><MinimumBenefit>1198</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO070</BillingCode><Name>APTUS Wrist</Name><Description>2.5 TriLock Y Plate</Description><Size>2.5mm diameter system</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111958</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>141170</ARTG></ARTGs><MinimumBenefit>1198</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN010</BillingCode><Name>Newclip Plating System</Name><Description>Plates for fixation of fractures of the elbow and/or ulna</Description><Size>Periarticular anatomic - Ulna ≥ 7 to ≤ 15 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111958</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG></ARTGs><MinimumBenefit>1198</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY765</BillingCode><Name>AO/ASIF Plates</Name><Description>Anatomic Locking Ulna Plates</Description><Size>≥16 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111959</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1433</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO351</BillingCode><Name>Acumed Tap Loc Elbow plates</Name><Description>Variable angle locking plate system</Description><Size>≥16 holes Olecranon</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111959</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>1433</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA118</BillingCode><Name>ALPS Elbow System</Name><Description>Ulna Titanium Plates</Description><Size>≥16 holes  </Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111959</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>209306</ARTG></ARTGs><MinimumBenefit>1433</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW059</BillingCode><Name>WEGO Trauma Systems</Name><Description>Periarticular Ulan Plating System</Description><Size>≥ 16 Holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111959</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>1159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KO013</BillingCode><PriorBillingCodes><PriorBillingCode>LM484</PriorBillingCode></PriorBillingCodes><Name>Periarticular Hand Plates</Name><Description>Periarticular Hand Plates</Description><Size>Multiple sizes to suit patient anatomy</Size><SupplierCode>40387</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111960</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>337193</ARTG></ARTGs><MinimumBenefit>2238</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY623</BillingCode><Name>AO/ASIF Plates</Name><Description>Anatomical Pelvic Locking Plates</Description><Size>≤ 6 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111961</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>809</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK577</BillingCode><Name>Stryker Plating System</Name><Description>Matta Pelvic Plates</Description><Size>2-6 Holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111961</SubGroupID><ARTGs><ARTG>119848</ARTG></ARTGs><MinimumBenefit>679</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT101</BillingCode><Name>Nexos Anatomic Pelvic Plates</Name><Description>Nexos Anatomic Pelvic Plates</Description><Size>6 holes or less</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111961</SubGroupID><ARTGs><ARTG>236206</ARTG></ARTGs><MinimumBenefit>679</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY725</BillingCode><Name>AO/ASIF Plates</Name><Description>Non-Locking Anatomical Pelvic Plates</Description><Size>≤6 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111961</SubGroupID><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>679</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK578</BillingCode><Name>Stryker Plating System</Name><Description>Matta Pelvic Plates</Description><Size>7-15 Holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111962</SubGroupID><ARTGs><ARTG>119848</ARTG></ARTGs><MinimumBenefit>727</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT102</BillingCode><Name>Nexos Anatomic Pelvic Plates</Name><Description>Nexos Anatomic Pelvic Plates</Description><Size>7-15 Holes</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111962</SubGroupID><ARTGs><ARTG>236206</ARTG></ARTGs><MinimumBenefit>727</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ169</BillingCode><Name>Intrapelvic Acetabular System</Name><Description>Intrapelvic Acetabular Plate</Description><Size>small and large</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111963</SubGroupID><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>760</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW532</BillingCode><Name>Pelvis II Plating System</Name><Description>Quadrilateral Surface Plates</Description><Size>Small/Large</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111963</SubGroupID><ARTGs><ARTG>139635</ARTG></ARTGs><MinimumBenefit>760</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK579</BillingCode><Name>Stryker Plating System</Name><Description>ocking Compression Anatomical Shape</Description><Size>16-22 Hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111963</SubGroupID><ARTGs><ARTG>119848</ARTG></ARTGs><MinimumBenefit>760</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT100</BillingCode><Name>Nexos Anatomic Pelvic Plates</Name><Description>Nexos Anatomic Pelvic Plates</Description><Size>16 holes or more  </Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111963</SubGroupID><ARTGs><ARTG>236206</ARTG></ARTGs><MinimumBenefit>760</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL079</BillingCode><Name>Conquest FN</Name><Description>Anatomic Locking Femur Plate</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111964</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX045</BillingCode><Name>ARMAR 4.5mm Meril Locking Plate System - Distal Femur Plate 5 Holes</Name><Description>TAN Distal Femur Locking Plates</Description><Size>5 Holes
156mm Length
Left and Right Variants</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111964</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>1143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL186</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Periarticular Anatomical Plate - Femur</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111964</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG><ARTG>368492</ARTG></ARTGs><MinimumBenefit>1143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI746</BillingCode><Name>NCB Polyaxial Locking Plate System</Name><Description>NCB Variable Angle Locking Plate - Femur - Ti Alloy</Description><Size>5 holes Left &amp; Right</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111964</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>100349</ARTG><ARTG>100337</ARTG></ARTGs><MinimumBenefit>1710</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM180</BillingCode><Name>Peri-Loc</Name><Description>Proximal Femur Plates</Description><Size>&lt; 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111964</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL175</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Large and Periprosthetic Femur Plate – Variable Angle Locking</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111964</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>368492</ARTG><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1710</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY682</BillingCode><Name>AO/ASIF Plates</Name><Description>Anatomic Non-Locking Femur Plates</Description><Size>≤ 6 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111964</SubGroupID><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>643</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW305</BillingCode><Name>Dall Miles Cable Grip System - Stainless Steel</Name><Description>Stainless Steel Plate:5 hole -  Stainless Steel</Description><Size>6 inches</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111964</SubGroupID><ARTGs><ARTG>312160</ARTG></ARTGs><MinimumBenefit>643</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW016</BillingCode><Name>WEGO Trauma Systems</Name><Description>Periarticular Femur Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111964</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>1143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ133</BillingCode><Name>PediLoc - Plating System, ≤ 6 Holes, Periarticular Femoral Plates</Name><Description>Periarticular Femoral Plates</Description><Size>3.5mm-4.5mm, 4-6 Holes</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111964</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>191586</ARTG></ARTGs><MinimumBenefit>1143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN972</BillingCode><Name>Peri-Loc</Name><Description>Distal Femur Plates</Description><Size>≤6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111964</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY711</BillingCode><Name>AO/ASIF Plates</Name><Description>Anatomic Locking Femur Plates</Description><Size>≤6 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111964</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN337</BillingCode><Name>AO/ASIF Plates</Name><Description>Anatomic Locking Femur Plates Titanium</Description><Size>7-15 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111965</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1710</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI747</BillingCode><Name>NCB Polyaxial Locking Plate System</Name><Description>NCB Periprosthetic Variable Angle Locking Plate - Femur - Ti Alloy</Description><Size>7 holes - 15 holes Left &amp; Right</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111965</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>100337</ARTG><ARTG>100349</ARTG></ARTGs><MinimumBenefit>1710</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY709</BillingCode><Name>AO/ASIF Plates</Name><Description>Anatomic Locking Femur Plates</Description><Size>7-15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111965</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW056</BillingCode><Name>WEGO Trauma Systems </Name><Description>Periarticular Femur Plates</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111965</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>1171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ134</BillingCode><Name>PediLoc - Plating System, ≥ 7 to ≤ 15 holes, Periarticular Femoral Plates</Name><Description>Periarticular Femoral Plates</Description><Size>3.5mm-4.5mm, 8-14 Holes</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111965</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>191586</ARTG></ARTGs><MinimumBenefit>1171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ023</BillingCode><Name>Femoral Closing Wedge Osteotomy</Name><Description>Symmetric plate, with locking screw technology for femoral distal closing wedge Osteotomy.</Description><Size>87.5mm x 27.5mm</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111965</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>276245</ARTG></ARTGs><MinimumBenefit>1171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JD008</BillingCode><Name>Distal Femur Plate</Name><Description>Distal Femoral Locking Plates</Description><Size>≥7 to  ≤15 holes</Size><SupplierCode>40214</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111965</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>222648</ARTG></ARTGs><MinimumBenefit>1710</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL187</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Periarticular Anatomical Plate - Femur</Description><Size> ≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111965</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>368492</ARTG><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW307</BillingCode><Name>Dall Miles Cable Grip System - Stainless Steel</Name><Description>Stainless Steel Plate:9 hole -  Stainless Steel</Description><Size>10 inches</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111965</SubGroupID><ARTGs><ARTG>312160</ARTG></ARTGs><MinimumBenefit>864</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW308</BillingCode><Name>Dall Miles Cable Grip System - Stainless Steel</Name><Description>Stainless Steel Plate:11 hole -  Stainless Steel</Description><Size>12 inches</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111965</SubGroupID><ARTGs><ARTG>312160</ARTG></ARTGs><MinimumBenefit>864</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK557</BillingCode><Name>Stryker Plating System</Name><Description>Femur Anatomical Locking Plates</Description><Size>12-14 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111965</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>269713</ARTG><ARTG>119848</ARTG></ARTGs><MinimumBenefit>1171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI749</BillingCode><Name>NCB Polyaxial Locking Plate System</Name><Description>NCB Variable Angle Locking Plate - Femur - Ti Alloy</Description><Size>9 holes - 13 holes Left &amp; Right</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111965</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>100349</ARTG><ARTG>100337</ARTG></ARTGs><MinimumBenefit>1171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RV007</BillingCode><Name>PS Distal Femoral Osteotomy Plate</Name><Description>Distal Femoral Osteotomy Anatomic VAL Plate</Description><Size>Medial - Left     Medial - Right    Lateral - Left    Lateral - Right</Size><SupplierCode>39940</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111965</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>330187</ARTG></ARTGs><MinimumBenefit>1710</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY710</BillingCode><Name>AO/ASIF Plates</Name><Description>Anatomic Locking Femur Plates</Description><Size>7-15 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111965</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1710</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL173</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Large and Periprosthetic Femur Plate – Variable Angle Locking</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111965</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG><ARTG>368492</ARTG></ARTGs><MinimumBenefit>1710</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN973</BillingCode><Name>Peri-Loc</Name><Description>Distal Femur Plates</Description><Size>≥7 to  ≤15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111965</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU197</BillingCode><PriorBillingCodes><PriorBillingCode>DE078</PriorBillingCode></PriorBillingCodes><Name>Osteotomy Plates</Name><Description>Osteotomy, Femoral - Stainless Steel</Description><Size>7.5mm - 17.5 mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111965</SubGroupID><ARTGs><ARTG>351000</ARTG><ARTG>350871</ARTG></ARTGs><MinimumBenefit>864</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM181</BillingCode><Name>Peri-Loc</Name><Description>Proximal Femur Plates</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111965</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX046</BillingCode><Name>ARMAR 4.5mm Meril Locking Plate System - Distal Femur Plate ≥ 7 to ≤ 15 holes LK</Name><Description>TAN Distal Femur Locking Plates</Description><Size>7-13 Holes
196-316 mm Length
Left and Right variants</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111965</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>1171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JD009</BillingCode><Name>Distal Femur Plate</Name><Description>Distal Femoral Locking Plates</Description><Size>≥16 Holes</Size><SupplierCode>40214</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111966</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>222648</ARTG></ARTGs><MinimumBenefit>1947</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY769</BillingCode><Name>AO/ASIF Plates</Name><Description>Anatomic Locking Femur Plates</Description><Size>≥16 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111966</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1947</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI748</BillingCode><Name>NCB Polyaxial Locking Plate System</Name><Description>NCB Periprosthetic Variable Angle Locking Plate - Femur - Ti Alloy</Description><Size>Over 16 holes Left &amp; Right</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111966</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>100337</ARTG><ARTG>100349</ARTG></ARTGs><MinimumBenefit>1947</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN338</BillingCode><Name>AO/ASIF Plates</Name><Description>Anatomic Locking Femur Plates Titanium</Description><Size>≥16 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111966</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1947</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL174</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Large and Periprosthetic Femur Plate – Variable Angle Locking</Description><Size>≥ 16 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111966</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG><ARTG>368492</ARTG></ARTGs><MinimumBenefit>1947</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK558</BillingCode><Name>Stryker Plating System</Name><Description>Femur Anatomical Locking Plates</Description><Size>16-24 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111966</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>139635</ARTG><ARTG>119848</ARTG><ARTG>269713</ARTG></ARTGs><MinimumBenefit>1498</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW057</BillingCode><Name>WEGO Trauma Systems </Name><Description>Periarticular Femur Plates</Description><Size>≥ 16 holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111966</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>1498</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ135</BillingCode><Name>PediLoc - Plating System ≥ 16 holes, Periarticular Femoral Plates</Name><Description>Periarticular Femoral Plates</Description><Size>3.5mm-4.5mm, 16-20 Holes</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111966</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>191586</ARTG></ARTGs><MinimumBenefit>1498</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM182</BillingCode><Name>Peri-Loc</Name><Description>Proximal Femur Plates</Description><Size>&gt;16 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111966</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1498</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN974</BillingCode><Name>Peri-Loc</Name><Description>Distal Femur Plates</Description><Size>≥ 16 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111966</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1498</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL188</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Periarticular Anatomical Plate - Femur</Description><Size>≥ 16 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111966</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>368492</ARTG><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1498</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY768</BillingCode><Name>AO/ASIF Plates</Name><Description>Anatomic Locking Femur Plates</Description><Size>≥16 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111966</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1498</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM135</BillingCode><Name>TriMed Hook Plate</Name><Description>Hook Plate</Description><Size>≤ 6 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111967</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>1184</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU129</BillingCode><PriorBillingCodes><PriorBillingCode>DE556</PriorBillingCode></PriorBillingCodes><Name>Posterolateral Anatomic Distal Fibula Plate</Name><Description>Plate for fracture fixation</Description><Size>4-6 Holes Left and Right Side Specific</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111967</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1184</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW813</BillingCode><Name>Ortholoc Fracture System - Plates</Name><Description>Syndesmosis</Description><Size>4 Holes, Right and Left</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111967</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>1362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER421</BillingCode><Name>Paragon 28 Gorilla Plating System-Plate, fibular (≤ 6 holes)</Name><Description>Paragon 28 Gorilla Plating System-Plate, fibular, tubular,anatomic, titanium</Description><Size>thickness 1.5mm; multi screw diameter purchase 2.7/3.5/4.2mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111967</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>1362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK580</BillingCode><Name>Stryker Locked Plate system</Name><Description>Periarticular variable angle locking plate - fibula</Description><Size>1-6 Holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111967</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>119848</ARTG><ARTG>139635</ARTG></ARTGs><MinimumBenefit>1362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH307</BillingCode><Name>ALPS Fibula Plating System</Name><Description>Anatomic Fibular Plating System</Description><Size>≤ 6 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111967</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>275084</ARTG></ARTGs><MinimumBenefit>1362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL129</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>VAL Periarticular Anatomical Small Fragment plate - Fibula</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111967</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY815</BillingCode><Name>AO/ASIF Plates</Name><Description>LCP Lateral Distal Fibula</Description><Size>7 to 15 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111968</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1238</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL146</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>VAL Periarticular Anatomical Small Fragment plate - Fibula</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111968</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1238</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH308</BillingCode><Name>ALPS Fibula Plating System</Name><Description>Anatomic Fibular Locking Plate</Description><Size>7-15 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111968</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>275084</ARTG></ARTGs><MinimumBenefit>1238</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM308</BillingCode><Name>Osteomed FPS</Name><Description>Fibular Fracture Plates</Description><Size>7 to 15 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111968</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>202319</ARTG></ARTGs><MinimumBenefit>1238</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER422</BillingCode><Name>Paragon 28 Gorilla Plating System-Plate, fibular (≥ 7 to ≤ 15 holes)</Name><Description>Paragon 28 Gorilla Plating System-Plate, fibular, tubular, anatomic, titanium</Description><Size>thickness 1.5mm; multi screw diameter purchase 2.7/3.5/4.2mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111968</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>1238</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW812</BillingCode><Name>Ortholoc Fracture System - Plates</Name><Description>Lateral Fibula, Posterior Fibula</Description><Size>8-15 Holes, Right and Left</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111968</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>1238</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JD004</BillingCode><Name>CarboFix Piccolo Distal Fibula Plate System – Plate component</Name><Description>CFR-PEEK distal fibula plate</Description><Size>Left 72mm, 83mm, 96mm, 112mm, 153mm, 182mm
Right 72mm, 83mm, 96mm, 112mm, 153mm, 182mm</Size><SupplierCode>40214</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111968</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>222648</ARTG></ARTGs><MinimumBenefit>1238</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU189</BillingCode><Name>Locking Distal Fibula Plate</Name><Description>Locking Distal Fibula Plate for Fracture Fixation</Description><Size>8 -14 Holes ( Left and Right Specific)</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111968</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1194</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU130</BillingCode><PriorBillingCodes><PriorBillingCode>DE578</PriorBillingCode></PriorBillingCodes><Name>Posterolateral Anatomic Distal Fibula Plate</Name><Description>Plate for fracture fixation</Description><Size>8-10 holes Left and Right Side Specific</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111968</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1194</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW060</BillingCode><Name>WEGO Trauma Systems</Name><Description>Periarticular Fibula Plating System</Description><Size>7 - 15 Holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111968</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>1194</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY811</BillingCode><Name>AO/ASIF Plates</Name><Description>Distal fibula; lateral, posterolateral locking plates</Description><Size>7 to 15 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111968</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1194</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU190</BillingCode><PriorBillingCodes><PriorBillingCode>DE421</PriorBillingCode></PriorBillingCodes><Name>Locking distal Fibula plate</Name><Description>Locking Distal Fibula Plate For Fracture Fixation</Description><Size>4-6 Holes ( Left and Right Specific)</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111968</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG><ARTG>350871</ARTG></ARTGs><MinimumBenefit>1194</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW898</BillingCode><PriorBillingCodes><PriorBillingCode>WR374</PriorBillingCode></PriorBillingCodes><Name>MaxLock Extreme System - Distal Fibula Plate</Name><Description>Distal Fibula variable angle locking plate, Titanium</Description><Size>Long, Medium, Short, Right and Left</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111968</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>214671</ARTG></ARTGs><MinimumBenefit>1194</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM136</BillingCode><Name>TriMed Periarticular Ankle Plates</Name><Description>TriMed Periarticular Ankle Plates</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111968</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>1194</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK581</BillingCode><Name>Stryker Locked Plate System</Name><Description>Periartiicular variable angle locking plate - fibula</Description><Size>7-15 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111968</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>139635</ARTG></ARTGs><MinimumBenefit>1238</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO102</BillingCode><Name>APTUS Foot &amp; Ankle</Name><Description>Fibula Plates</Description><Size>7 to 15 holes</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111968</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>206157</ARTG></ARTGs><MinimumBenefit>1238</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN006</BillingCode><Name>Newclip Activ Ankle Plate</Name><Description>Variable Angle Locking Fibular Plate</Description><Size>7 to 15 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111968</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG></ARTGs><MinimumBenefit>1238</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO443</BillingCode><Name>Acumed Ankle 3 Plating System</Name><Description>Periarticular variable angle locking plate fibula</Description><Size>7-15 holes, left and right</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111968</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>1238</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN037</BillingCode><Name>Newclip Activ Ankle Plate</Name><Description>Periarticular distal fibular VAL Plate</Description><Size>L75-187mm</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111969</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG></ARTGs><MinimumBenefit>1102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY812</BillingCode><Name>AO/ASIF Plates</Name><Description>Distal fibula; lateral, posterolateral locking plates</Description><Size>&gt;16 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111969</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>892</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM375</BillingCode><Name>Cluster Plates</Name><Description>Cluster Plates</Description><Size>18 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111969</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>892</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW061</BillingCode><Name>WEGO Trauma Systems</Name><Description>Periarticular Fibula Plating Systems</Description><Size>≥ 16 Holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111969</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>892</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO104</BillingCode><Name>APTUS Foot &amp; Ankle</Name><Description>Fibula Plates</Description><Size>≥ 16 holes</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111969</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>206157</ARTG></ARTGs><MinimumBenefit>1102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY816</BillingCode><Name>AO/ASIF Plates</Name><Description>LCP Lateral Distal Fibula</Description><Size>&gt;16 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111969</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO449</BillingCode><Name>Acumed Ankle 3 Plating System</Name><Description>Periarticular variable angle locking plate fibula</Description><Size>16-18 holes</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111969</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>1102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER423</BillingCode><Name>Paragon 28 Gorilla Plating System-Plate, fibular (≥ 16 holes)</Name><Description>Paragon 28 Gorilla Plating System-Plate, fibular, tubular, anatomic, titanium</Description><Size>thickness 1.5mm; multi screw diameter purchase 2.7/3.5/4.2mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111969</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>1102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL134</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>VAL Periarticular Anatomical Small Fragment plate - Fibula</Description><Size>≥ 16 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111969</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX042</BillingCode><Name>ARMAR 3.5 LPS Tibial Plates</Name><Description>3.5 mm anatomical tibial plates</Description><Size>4 - 6 holes</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>1365</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX047</BillingCode><Name>ARMAR 4.5mm Meril Locking Plate System - Proximal Tibial Plates ≤ 6 holes</Name><Description>TAN Proximal Tibial Locking Plates</Description><Size>5 Holes
140mm Length
Left and Right</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>1365</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN031</BillingCode><Name>Newclip Activ Ankle Plate</Name><Description>Locking Tibial Plate</Description><Size>≤ 6 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG></ARTGs><MinimumBenefit>1365</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ022</BillingCode><Name>Lateral closing wedge Tibial</Name><Description>Shifting the mechanical axis from the lateral to the medial compartment in patients with lateral Osteoarthritis in combination with Valgus deformity</Description><Size>61mm-24mm</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>276245</ARTG></ARTGs><MinimumBenefit>1365</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB024</BillingCode><Name>Low Profile Distal Medial Tibial Locking Plate - ≤ 6 Holes</Name><Description>Low Profile Distal Medial Tibial Locking Plate</Description><Size>≤ 6 Holes</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>261562</ARTG></ARTGs><MinimumBenefit>1365</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU132</BillingCode><PriorBillingCodes><PriorBillingCode>DE549</PriorBillingCode></PriorBillingCodes><Name>Posterior Distal Tibia Plate</Name><Description>Plate for Fracture Fixation</Description><Size>3-5 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1365</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU133</BillingCode><PriorBillingCodes><PriorBillingCode>DE552</PriorBillingCode></PriorBillingCodes><Name>Anterolateral Distal Tibia Plate</Name><Description>Plate for Fracture Fixation</Description><Size>4-6 Holes Left and Right Side Specific</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1365</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW018</BillingCode><Name>WEGO Trauma Systems</Name><Description>Periarticular Tibia Plating Systems</Description><Size>≤ 6 Holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>1365</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU134</BillingCode><PriorBillingCodes><PriorBillingCode>DE557</PriorBillingCode></PriorBillingCodes><Name>Medial Distal Tibia Plate</Name><Description>Plate for Fracture Fixation</Description><Size>4-6 Holes Left and Right Side Specific</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1365</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ027</BillingCode><Name>Valetis Ankle - Tibial</Name><Description>Distal Tibial Anatomical Locking Plates</Description><Size>3 to 6 hole, left and right</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>284755</ARTG></ARTGs><MinimumBenefit>1365</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ233</BillingCode><Name>Colink Afx Posterior Tibia Plates</Name><Description>Periarticular VAL Posterior Tibia Plates</Description><Size>3, 5 Hole</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>1474</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH445</BillingCode><Name>Hinge Pediatric Plating System - Hinge Plate</Name><Description>Articulated growth-correction fixation plate</Description><Size>12mm, 16mm, 20mm (distance between anchoring points)</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><ARTGs><ARTG>161505</ARTG></ARTGs><MinimumBenefit>929</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO105</BillingCode><Name>APTUS Foot &amp; Ankle</Name><Description>Tibia Plates</Description><Size>≤ 6 holes</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>206157</ARTG></ARTGs><MinimumBenefit>1474</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW809</BillingCode><Name>Ortholoc Ankle Plating</Name><Description>Anterior, Posterior, Lateral or Medial</Description><Size>4-6 holes  50-155mm Length</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>1474</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK530</BillingCode><Name>Stryker Plating System.</Name><Description>T-Plate, pre-shaped</Description><Size>5-6 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><ARTGs><ARTG>139635</ARTG></ARTGs><MinimumBenefit>929</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN581</BillingCode><Name>TC-100</Name><Description>Tibia Plates, L:/E 6 Holes</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>929</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY729</BillingCode><Name>AO/ASIF Plates</Name><Description>Anatomic Tibial Plates</Description><Size>≤ 6 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>929</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL230</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Large and Periprosthetic Tibia Plate – Variable Angle Locking</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>368492</ARTG><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1474</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN975</BillingCode><Name>Peri-Loc</Name><Description>Tibia Plates</Description><Size>≤6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1474</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL132</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>VAL Periarticular Anatomical Small Fragment plate - Tibia</Description><Size>≤ 6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1474</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO442</BillingCode><Name>Acumed Ankle 3 Plating System</Name><Description>Periarticular Anatomic variable angle locking tibial plates</Description><Size>2 to 6 Holes</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>1474</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY732</BillingCode><Name>AO/ASIF Plates</Name><Description>Anatomic Locking Tibial Plates</Description><Size>≤ 6 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1365</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL101</BillingCode><PriorBillingCodes><PriorBillingCode>SN985</PriorBillingCode></PriorBillingCodes><Name>Peri-Loc</Name><Description>Tibia Plates</Description><Size>≤6 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1365</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM305</BillingCode><Name>Extremilock FPS</Name><Description>Ankle Plating System</Description><Size>3.5mm and 4mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>202319</ARTG></ARTGs><MinimumBenefit>1474</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN052</BillingCode><Name>Periarticular anatomic tibia VAL ≤ 6 holes</Name><Description>Periarticular anatomic tibia VAL ≤ 6 holes</Description><Size>≤ 6 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260229</ARTG><ARTG>260232</ARTG></ARTGs><MinimumBenefit>1474</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU131</BillingCode><PriorBillingCodes><PriorBillingCode>DE529</PriorBillingCode></PriorBillingCodes><Name>Anterior Distal Tibia Plate</Name><Description>Plate for Fracture Fixation</Description><Size>3-5 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111970</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1365</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB025</BillingCode><Name>Low Profile Distal Medial Tibial Locking Plate - 7 to 15 Holes</Name><Description>Low Profile Distal Medial Tibial Locking Plate</Description><Size>7 to 15 Holes</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>261562</ARTG></ARTGs><MinimumBenefit>1182</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX043</BillingCode><Name>ARMAR 3.5 LPS Tibial Plates</Name><Description>3.5mm anatomical tibial plates</Description><Size>7-15 holes</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>1182</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK531</BillingCode><Name>Stryker Plating System</Name><Description>T-Plate, pre-shaped</Description><Size>7-13 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><ARTGs><ARTG>119848</ARTG><ARTG>139635</ARTG></ARTGs><MinimumBenefit>925</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN582</BillingCode><Name>TC-100</Name><Description>Tibia Plates</Description><Size>7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>925</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY730</BillingCode><Name>AO/ASIF Plates</Name><Description>Anatomic Tibial Plates</Description><Size>7 - 15 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>925</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK561</BillingCode><Name>Stryker Plating System</Name><Description>Tibial Anatomical Locking Plates</Description><Size>7-15 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>119848</ARTG><ARTG>269713</ARTG><ARTG>139635</ARTG></ARTGs><MinimumBenefit>1182</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX048</BillingCode><Name>ARMAR 4.5mm Meril Locking Plate System - Proximal Tibial Plates ≥ 7 to ≤ 15 holes</Name><Description>TAN Proximal Tibial Locking Plates</Description><Size>7-13 Holes
180-300 Length
Left and Right</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>1182</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW897</BillingCode><PriorBillingCodes><PriorBillingCode>WR373</PriorBillingCode></PriorBillingCodes><Name>MaxLock Extreme System - Medial Distal Tibia Plate</Name><Description>Medial distal tibia variable angle locking plate, Titanium</Description><Size>Short, Medium, Long, Left and Right</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>214671</ARTG></ARTGs><MinimumBenefit>1182</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU137</BillingCode><PriorBillingCodes><PriorBillingCode>DE569</PriorBillingCode></PriorBillingCodes><Name>Posterior Distal Tibia Plate</Name><Description>Plate for Fracture Fixation</Description><Size>7-9 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1182</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ264</BillingCode><Name>POYA 3.5mm Lateral Proximal Tibia Plate</Name><Description>Lateral Proximal Tibia Plate</Description><Size>4 to 9 holes</Size><SupplierCode>40482</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>433150</ARTG></ARTGs><MinimumBenefit>1489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ265</BillingCode><Name>POYA 3.5mm Posteromedial Tibia Plate</Name><Description>Posteromedial Tibia Plate</Description><Size>Left and Right</Size><SupplierCode>40482</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>433150</ARTG></ARTGs><MinimumBenefit>1489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY758</BillingCode><Name>AO/ASIF Plates</Name><Description>Anatomic Locking Tibial Plates</Description><Size>7 to 15 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286609</ARTG><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1182</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW062</BillingCode><Name>WEGO Trauma Systems </Name><Description>Periarticular Tibia Plating Systems</Description><Size>7 - 15 Holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>1182</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ103</BillingCode><Name>Austofix Proximal Tibia L&amp;C Plates</Name><Description>Posterior, Lateral, Medial Proximal Tibial Plates</Description><Size>7 to 15 holes </Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>284755</ARTG></ARTGs><MinimumBenefit>1182</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU135</BillingCode><PriorBillingCodes><PriorBillingCode>DE547</PriorBillingCode></PriorBillingCodes><Name>Medial Distal Tibia Plate</Name><Description>Plate for Fracture Fixation</Description><Size>8-14 Holes Left and Right Side Specific</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1182</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU138</BillingCode><PriorBillingCodes><PriorBillingCode>DE571</PriorBillingCode></PriorBillingCodes><Name>Anterior Distal Tibia Plate</Name><Description>Plate for Fracture Fixation</Description><Size>7-9 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1182</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU136</BillingCode><PriorBillingCodes><PriorBillingCode>DE562</PriorBillingCode></PriorBillingCodes><Name>Anterolateral Distal Tibia Plate</Name><Description>Plate for Fracture Fixation</Description><Size>8-14 Holes Left and Right Side Specific</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1182</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY759</BillingCode><Name>AO/ASIF Plates</Name><Description>Anatomic Variable Angle Locking Tibial Plates</Description><Size>7 to 15 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>286609</ARTG><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL231</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Large and Periprosthetic Tibia Plate – Variable Angle Locking</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG><ARTG>368492</ARTG></ARTGs><MinimumBenefit>1489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RV006</BillingCode><Name>PS High Tibial Osteotomy Plate</Name><Description>High Tibial Osteotomy Anatomic VAL Plate </Description><Size>Left - Medial  Right - Medial</Size><SupplierCode>39940</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>330187</ARTG></ARTGs><MinimumBenefit>1489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN986</BillingCode><Name>Peri-Loc</Name><Description>Tibia Plates</Description><Size>&gt;7 to &lt;15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL154</BillingCode><Name>Smith &amp; Nephew Plate and Screw System- EVOS</Name><Description>VAL Periarticular Anatomical Small Fragment plate - Tibia</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN054</BillingCode><Name>Periarticular anatomic tibia VAL ≥ 16 holes</Name><Description>Periarticular anatomic tibia VAL ≥ 16 holes</Description><Size>≥ 16 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260232</ARTG><ARTG>260229</ARTG></ARTGs><MinimumBenefit>1489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO106</BillingCode><Name>APTUS Foot &amp; Ankle</Name><Description>Tibia Plates</Description><Size>7 - 15 holes</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>206157</ARTG></ARTGs><MinimumBenefit>1489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB081</BillingCode><Name>Marathon VAL Tibia Plates</Name><Description>Variable angle periarticular tibia plates </Description><Size>7 - 15 Holes</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>261562</ARTG></ARTGs><MinimumBenefit>1489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER502</BillingCode><Name>Paragon 28 Gorilla Plating System-Plate, tibial ( ≥ 7 to ≤ 15 holes)</Name><Description>Paragon 28 Gorilla Silverback tibiotalar (TT) anterior or lateral ankle fusion plate, left or right</Description><Size>( ≥ 7 to ≤ 15 holes); 65-109 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>289308</ARTG></ARTGs><MinimumBenefit>1489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM307</BillingCode><Name>Osteomed FPS</Name><Description>Anterior Lateral Plates</Description><Size>7 to 15 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>202319</ARTG></ARTGs><MinimumBenefit>1489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM537</BillingCode><Name>Omni Stable AF Plating System</Name><Description>Tibia Plates</Description><Size>7 to 15 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>306780</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>1489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW810</BillingCode><Name>Ortholoc Fracture System - Plates</Name><Description>Anterolateral Tibia, Medial Tibia Plates or 1/3 Tubular</Description><Size>7-13 Holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>1489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH287</BillingCode><Name>ALPS Anatomic Locked plating system</Name><Description>Distal and Proximal Tibial Plates, Titanium</Description><Size>7 to 15 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>153056</ARTG><ARTG>97981</ARTG></ARTGs><MinimumBenefit>1489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK559</BillingCode><Name>Stryker Plating System</Name><Description>Distal Tibia Anatomical Locking Plates</Description><Size>10-15 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>119848</ARTG></ARTGs><MinimumBenefit>1182</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL102</BillingCode><PriorBillingCodes><PriorBillingCode>SN985</PriorBillingCode></PriorBillingCodes><Name>Peri-Loc</Name><Description>Tibia Plates</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1182</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ028</BillingCode><Name>Valetis Ankle - Tibial</Name><Description>Distal Tibial Anatomical Locking Plates</Description><Size>7 to 14 hole, left and right</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>284755</ARTG></ARTGs><MinimumBenefit>1489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO444</BillingCode><Name>Acumed Ankle 3 Plating System</Name><Description>Periarticular Anatomic variable angle locking tibial plates</Description><Size>7 to 15 holes</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>1489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN053</BillingCode><Name>Periarticular anatomic tibia VAL ≥ 7 to ≤ 15 holes</Name><Description>Periarticular anatomic tibia VAL ≥ 7 to ≤ 15 holes</Description><Size>≥ 7 to ≤ 15 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260232</ARTG><ARTG>260229</ARTG></ARTGs><MinimumBenefit>1489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN040</BillingCode><Name>Newclip Activ Ankle Plate</Name><Description>Locking Tibial Plate</Description><Size>7 to 15 holes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111971</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>260232</ARTG><ARTG>260229</ARTG></ARTGs><MinimumBenefit>1489</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX044</BillingCode><Name>ARMAR 3.5 LPS Tibial Plates</Name><Description>3.5mm tibial anatomical plates</Description><Size>16-21 holes</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111972</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>1338</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK562</BillingCode><Name>Stryker Plating System</Name><Description>Tibial Anatomical Locking Plates</Description><Size>16-31 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111972</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>269713</ARTG><ARTG>119848</ARTG><ARTG>139635</ARTG></ARTGs><MinimumBenefit>1338</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU139</BillingCode><PriorBillingCodes><PriorBillingCode>DE534</PriorBillingCode></PriorBillingCodes><Name>Anterolateral Distal Tibia Plate</Name><Description>Plate for Fracture Fixation</Description><Size>16-18 Holes Left and Right Side Specific</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111972</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1338</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM538</BillingCode><Name>Omni Stable AF Plating System</Name><Description>Tibia Plates</Description><Size>17 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111972</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>306780</ARTG></ARTGs><MinimumBenefit>1636</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH288</BillingCode><Name>ALPS-Anatomic Locked Plating system</Name><Description>Distal and Proximal Tibial Plates, Titanium</Description><Size>16 - 25 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111972</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>97981</ARTG><ARTG>153056</ARTG></ARTGs><MinimumBenefit>1636</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK560</BillingCode><Name>Stryker Plating System</Name><Description>Distal Tibia Anatomical Locking Plates</Description><Size>16-23 hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111972</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>119848</ARTG></ARTGs><MinimumBenefit>1636</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER503</BillingCode><Name>Paragon 28 Gorilla Plating System-Plate, tibial (≥ 16 holes)</Name><Description>Paragon 28 Gorilla Silverback Plating System-Plate, tibial, lateral TTC, left or right</Description><Size>≥ 16 holes, 113-154 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111972</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>1636</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO103</BillingCode><Name>APTUS Foot &amp; Ankle</Name><Description>Tibia Plates</Description><Size>≥ 16 holes</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111972</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>206157</ARTG></ARTGs><MinimumBenefit>1636</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL232</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Large and Periprosthetic Tibia Plate – Variable Angle Locking</Description><Size>≥ 16 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111972</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG><ARTG>368492</ARTG></ARTGs><MinimumBenefit>1636</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ263</BillingCode><Name>POYA 3.5mm Lateral Proximal Tibia Plate</Name><Description>Lateral Proximal Tibia Plate</Description><Size>14 to 18 holes</Size><SupplierCode>40482</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111972</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>433150</ARTG></ARTGs><MinimumBenefit>1636</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN976</BillingCode><Name>Peri-Loc</Name><Description>Tibia Plates</Description><Size>≥ 16 Holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111972</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1338</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY756</BillingCode><Name>AO/ASIF Plates</Name><Description>Anatomic Locking Tibial Plates</Description><Size>≥16 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111972</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286609</ARTG><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1338</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU140</BillingCode><PriorBillingCodes><PriorBillingCode>DE566</PriorBillingCode></PriorBillingCodes><Name>Medial Distal Tibia Plate</Name><Description>Plate for Fracture Fixation</Description><Size>16 Holes</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111972</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1338</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW063</BillingCode><Name>WEGO Trauma Systems</Name><Description>Periarticular Tibia Plating Systems</Description><Size>≥ 16 Holes</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111972</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>1338</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ104</BillingCode><Name>Austofix Proximal Tibia L&amp;C Plates</Name><Description>Lateral, Medial Proximal Tibial Plates</Description><Size>≥16 Holes</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111972</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>284755</ARTG></ARTGs><MinimumBenefit>1338</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY757</BillingCode><Name>AO/ASIF Plates</Name><Description>Anatomic Variable Locking Tibial Plates</Description><Size>≥16 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111972</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1636</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL147</BillingCode><Name>Smith &amp; Nephew Plate and Screw System- EVOS</Name><Description>VAL Periarticular Anatomical Small Fragment plate - Tibia</Description><Size>≥ 16 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111972</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1636</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB018</BillingCode><Name>Calcaneal Locking Plate MIPO System - Locking Plates</Name><Description>Posterior Tuberosity Calcaneal Locking Plate II, Anterior Process Calcaneal Locking Plate, Posterior Tuberosity Calcaneal Locking Plate</Description><Size>5 &amp; 6 Holes</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111973</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>261562</ARTG></ARTGs><MinimumBenefit>1149</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO405</BillingCode><Name>Acumed Locking Calcaneal Plates</Name><Description>Locking Calcaneal Plates</Description><Size>&lt;6 Hole LK</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111973</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>1149</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR092</BillingCode><Name>Stryker Locking Plate System</Name><Description>Calcaneus Locking Plates</Description><Size>12 Hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111974</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>124319</ARTG></ARTGs><MinimumBenefit>1373</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ213</BillingCode><Name>Colink Cfx Calcaneal Plates</Name><Description>Titanium Locking Calcaneal Plates Various Designs </Description><Size>Small, Medium, Large 9-13 Holes</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111974</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>1149</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK094</BillingCode><Name>Stryker Plating System Small Fragment Set</Name><Description>Calcaneal Plate</Description><Size>70-80mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111974</SubGroupID><ARTGs><ARTG>139635</ARTG></ARTGs><MinimumBenefit>509</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN984</BillingCode><Name>Peri-Loc</Name><Description>Calcaneal Plates</Description><Size>&gt;7 to &lt;15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111974</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1373</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU202</BillingCode><PriorBillingCodes><PriorBillingCode>DE464</PriorBillingCode></PriorBillingCodes><Name>Calcaneal Fracture Plate</Name><Description>Calcaneal Fracture Plate for fixation of Calcaneal fractures</Description><Size>X-small, small, Medium, Large - LEFT and RIGHT side specific plates</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111974</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>1373</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH243</BillingCode><Name>ALPS Foot System</Name><Description>Calcaneal foot plate</Description><Size>small to large</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111974</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>153056</ARTG></ARTGs><MinimumBenefit>1373</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY017</BillingCode><Name>AO/ASIF Plates</Name><Description>Calcaneal Plates</Description><Size>7 - 15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111974</SubGroupID><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>509</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM306</BillingCode><Name>Osteomed FPS</Name><Description>Calcaneal Plates</Description><Size>7 to 15 holes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111974</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>202319</ARTG></ARTGs><MinimumBenefit>1373</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW807</BillingCode><PriorBillingCodes><PriorBillingCode>WR231</PriorBillingCode></PriorBillingCodes><Name>Calcaneus Plate</Name><Description>Titanium locking plate, Tab &amp; Perimeter</Description><Size>14 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111974</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>1373</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER424</BillingCode><Name>Paragon 28 Gorilla Plating System-Plate, Calcaneal ( ≥ 7 to ≤ 15 holes)</Name><Description>Paragon 28 Gorilla Plating System-Plate, Calcaneus fracture, MTP various shapes, Titanium,</Description><Size>thickness 1.1mm; multi screw diameter purchase 2.7/3.5/4.2mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111974</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>289248</ARTG></ARTGs><MinimumBenefit>1373</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO056</BillingCode><Name>Aptus Foot</Name><Description>Calcaneus Plates</Description><Size>Left and right plates, small, medium and large</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111974</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>141170</ARTG></ARTGs><MinimumBenefit>1373</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB080</BillingCode><Name>Marathon VAL Calcaneal Plate</Name><Description>Variable Angle Calcaneal Plates</Description><Size>7 - 15 Holes</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111974</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>261562</ARTG></ARTGs><MinimumBenefit>1373</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB019</BillingCode><Name>Calcaneal Locking Plate -  Locking Plates</Name><Description>Calcaneal Locking Plate I, Calcaneal Locking Plate II, Compound Calcaneal Locking Plate II, Anterior Process Calcaneal Locking Plate II, Anatomical Calcaneal Locking Plate II, Anterior Process and Posterior Tuberosity Calcaneal Locking Plate</Description><Size>≥ 7 to ≤ 15 holes, 
Large, medium and small</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111974</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>261562</ARTG></ARTGs><MinimumBenefit>1149</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX013</BillingCode><Name>ARMAR 3.5mm Meril Locking Plate System - Calcaneal Plate</Name><Description>TiCP calcaneal locking plates</Description><Size>15 Holes
64-81mm Length
Left and Right</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111974</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286842</ARTG></ARTGs><MinimumBenefit>1149</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW895</BillingCode><PriorBillingCodes><PriorBillingCode>WR369</PriorBillingCode></PriorBillingCodes><Name>MaxLock Extreme System - CalcLock Extreme Plate</Name><Description>Calcaneal variable angle locking plate, Titanium</Description><Size>Standard, Large, Extra Large, Right and Left</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111974</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>214671</ARTG></ARTGs><MinimumBenefit>1149</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY188</BillingCode><Name>AO/ASIF Plates</Name><Description>Calcaneal, Locking</Description><Size>7 - 15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111974</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1149</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF121</BillingCode><Name>Islay Calaneal Locking Plate</Name><Description>Islay Calaneal Locking Plate 3.5</Description><Size>Islay Calaneal Locking Plate 3.5, large
Islay Calaneal Locking Plate 3.5, medium
Islay Calaneal Locking Plate 3.5, small</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111974</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>208160</ARTG></ARTGs><MinimumBenefit>1149</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN983</BillingCode><Name>Peri-Loc</Name><Description>Calcaneal Plates</Description><Size>&gt;7 to &lt;15 holes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111974</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>1149</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO404</BillingCode><Name>Acumed Locking Calcaneal Plates</Name><Description>Locking Calcaneal Plates</Description><Size>≥ 7 to ≤ 15 LK</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111974</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>1149</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW808</BillingCode><PriorBillingCodes><PriorBillingCode>WR232</PriorBillingCode></PriorBillingCodes><Name>Calcaneus Plate</Name><Description>Titanium locking plate, Tab &amp; Perimeter</Description><Size>16 &amp; 17 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111975</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>956</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR093</BillingCode><Name>Stryker Locking Plate System</Name><Description>Calcaneus Locking Plates</Description><Size>16 Hole</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111975</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>124319</ARTG></ARTGs><MinimumBenefit>956</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BU014</BillingCode><Name>Airlock Bone plate System</Name><Description>Osteosynthesis bone plate system</Description><Size>Left and right thickness 1.3mm to 1.35 mm, Length from 16mm to 55mm</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111976</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>235766</ARTG></ARTGs><MinimumBenefit>693</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW709</BillingCode><PriorBillingCodes><PriorBillingCode>WR052</PriorBillingCode></PriorBillingCodes><Name>Charlotte MTP Fusion System</Name><Description>MTP plate, stainless steel, SLIM LINE</Description><Size>Left &amp; right</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111976</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>693</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW714</BillingCode><PriorBillingCodes><PriorBillingCode>WR065</PriorBillingCode></PriorBillingCodes><Name>Rearfoot Plate - RPS</Name><Description>Unique extended plate geometry for plating complex rearfoot reconstructions, uses 3.5mm locked screws for optimal bone purchase.</Description><Size>6 hole - 37mm, 8 hole - 50mm, 14 hole - 66mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111976</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>693</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO380</BillingCode><Name>Acumed Congruent Plate System</Name><Description>Foot and Ankle Plate Titanium</Description><Size>≤ 6 hole</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111976</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>693</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO381</BillingCode><Name>Acumed Congruent Plate system</Name><Description>Foort and Ankle Plate titanium</Description><Size>≥7 to ≤15 hole</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111976</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99824</ARTG></ARTGs><MinimumBenefit>693</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW816</BillingCode><PriorBillingCodes><PriorBillingCode>WR244</PriorBillingCode></PriorBillingCodes><Name>Charlotte Claw Locking Plate</Name><Description>Straight, U, T Plates - 2, 3, &amp; 4 Hole</Description><Size>15, 20, 25, 30mm, Sm, Med, Lge</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111976</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>1007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ036</BillingCode><PriorBillingCodes><PriorBillingCode>LM339</PriorBillingCode><PriorBillingCode>LM339</PriorBillingCode></PriorBillingCodes><Name>Orthopaedic Fixation Plate</Name><Description>Orthopaedic Fixation Plates</Description><Size>2 - 8 holes and/or Small, Medium, Large</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111976</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>1007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW459</BillingCode><Name>Variax 2 Foot Plates</Name><Description>Polyaxial Locking plates with compressions holes</Description><Size>Broad Straight – 2-7 Hole  Slim Straight – 2-7 Hole  Broad Y-Plate – 2-7 Shaft Holes  Slim Y-Plate – 2-7 Holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111976</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>269713</ARTG><ARTG>162776</ARTG></ARTGs><MinimumBenefit>1007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW834</BillingCode><PriorBillingCodes><PriorBillingCode>WR292</PriorBillingCode></PriorBillingCodes><Name>SALVATION 3Di Plating System - Plates</Name><Description>Bridge plates and recon plates</Description><Size>Small, medium and large</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111976</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>1007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW796</BillingCode><PriorBillingCodes><PriorBillingCode>WR082</PriorBillingCode></PriorBillingCodes><Name>Ortholoc 3Di Plates</Name><Description>Osteosynthesis Bone Plate System</Description><Size>2-7 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111976</SubGroupID><Suffix>VAL</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>1007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL197</BillingCode><PriorBillingCodes><PriorBillingCode>IG081</PriorBillingCode></PriorBillingCodes><Name>Hallu-Fix Plates</Name><Description>Hallu-C and Hallu-S titanium plates for first MTP arthrodesis </Description><Size>Length: 40 - 55mm 3 sizes: 1, 2, 3 for left or right </Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111976</SubGroupID><ARTGs><ARTG>173932</ARTG></ARTGs><MinimumBenefit>428</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO379</BillingCode><Name>Acumed Congruent Plate System</Name><Description>Foot and Ankle Plate itianium</Description><Size>≤ 6 hole</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111976</SubGroupID><ARTGs><ARTG>98244</ARTG></ARTGs><MinimumBenefit>428</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN731</BillingCode><Name>Accord</Name><Description>Orthopaedic Cable System, Sm Cable Grip</Description><Size>75-255mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111977</SubGroupID><ARTGs><ARTG>140705</ARTG></ARTGs><MinimumBenefit>637</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY378</BillingCode><Name>Trochanteric Reattachment Device</Name><Description>Titanium alloy reattachment device with cables</Description><Size>Standard and Long</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111977</SubGroupID><ARTGs><ARTG>139010</ARTG></ARTGs><MinimumBenefit>637</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI167</BillingCode><Name>Zimmer Internal Fixation Systems: Cable System</Name><Description>Cable-Ready 6 Hole Plate - Stainless Steel</Description><Size>187mm long</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111977</SubGroupID><ARTGs><ARTG>108377</ARTG></ARTGs><MinimumBenefit>637</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI169</BillingCode><Name>Zimmer Internal Fixation Systems: Cable System</Name><Description>Cable-Ready 10 Hole Plate - Stainless Steel</Description><Size>305mm long</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111978</SubGroupID><ARTGs><ARTG>108377</ARTG></ARTGs><MinimumBenefit>751</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN735</BillingCode><Name>Accord</Name><Description>Orthopaedic Cable System, Std Cable Grip</Description><Size>85-265mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111978</SubGroupID><ARTGs><ARTG>140705</ARTG></ARTGs><MinimumBenefit>751</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW896</BillingCode><PriorBillingCodes><PriorBillingCode>WR372</PriorBillingCode></PriorBillingCodes><Name>MaxLock Extreme System - Medial Malleolous Plate</Name><Description>Medial malleolous variable angle locking plate, Titanium</Description><Size>5 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111980</SubGroupID><ARTGs><ARTG>214671</ARTG></ARTGs><MinimumBenefit>1649</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK403</BillingCode><Name>Trochanteric Grip</Name><Description>Trochanteric Grip Plate with 2 cables</Description><Size>Large, 110 - 210mm, 2 -6 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111980</SubGroupID><ARTGs><ARTG>312160</ARTG></ARTGs><MinimumBenefit>1649</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI290</BillingCode><Name>Cable Ready Cable Grip System</Name><Description>Titanium - comes with two cables (Co Cr), Integral Crimps</Description><Size>23 x 53mm, 1.8 x 635mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111980</SubGroupID><ARTGs><ARTG>108377</ARTG></ARTGs><MinimumBenefit>1649</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN730</BillingCode><Name>Accord</Name><Description>Orthopaedic Cable System, Titanium Plate</Description><Size>150-250mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111981</SubGroupID><ARTGs><ARTG>108428</ARTG></ARTGs><MinimumBenefit>2470</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK402</BillingCode><Name>Trochanteric Grip</Name><Description>Trochanteric Grip Plate with 2 cables</Description><Size>Medium 100 - 200mm, 2 -6 Holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111981</SubGroupID><ARTGs><ARTG>312160</ARTG></ARTGs><MinimumBenefit>2470</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI299</BillingCode><Name>Cable Ready Cable Grip System</Name><Description>Titanium</Description><Size>4 hole GTR with 4 cables</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111981</SubGroupID><ARTGs><ARTG>108377</ARTG></ARTGs><MinimumBenefit>2470</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI298</BillingCode><Name>Cable Ready Cable Grip System</Name><Description>Titanium</Description><Size>2 hole GTR with 4 cables</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111981</SubGroupID><ARTGs><ARTG>108377</ARTG></ARTGs><MinimumBenefit>2470</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW306</BillingCode><Name>Dall Miles Cable Grip System - Stainless Steel</Name><Description>Stainless Steel Plate:7 hole -  Stainless Steel</Description><Size>8 inches</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111981</SubGroupID><ARTGs><ARTG>312160</ARTG></ARTGs><MinimumBenefit>2470</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI297</BillingCode><Name>Cable Ready Cable Grip System</Name><Description>Titanium</Description><Size>5 hole GTR with 4 cables</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108787</GroupID><SubGroupID>111981</SubGroupID><ARTGs><ARTG>108377</ARTG></ARTGs><MinimumBenefit>2470</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MZ021</BillingCode><Name>Strasbourg Costal Osteosynthesis System (StraCos/StraTos) - Titanium Connecting Bar,
(partially &amp; completely serrated)</Name><Description>Titanium Connecting Bar for Straight and Angled 3D Rip Clips
partially serrated
completely serrated</Description><Size>Three Sizes of Partially Serrated :
150, 190 &amp; 230mm;
Two sizes of Completely Serrated:
190 &amp; 230mm.</Size><SupplierCode>40155</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111982</SubGroupID><ARTGs><ARTG>235762</ARTG></ARTGs><MinimumBenefit>1190</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MZ020</BillingCode><Name>Strasbourg Costal Osteosynthesis System (StraCos/StraTos) - Titanium 3D Rib Clips, Bar
Mounting</Name><Description>Titanium 3D Rib Clip, Bar Mounting, Straight and Angled 22.5 &amp; 45 degrees, Standard &amp; XL</Description><Size>Two widths: Standard (19mm) &amp; XL (27.5mm)
Three Angles: 0 (Straight), 22.5 &amp; 45 degrees</Size><SupplierCode>40155</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111983</SubGroupID><Suffix>Modified</Suffix><ARTGs><ARTG>235762</ARTG></ARTGs><MinimumBenefit>1183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO438</BillingCode><Name>RibLoc U+ Chest Wall Plate</Name><Description>RibLoc U+ Chest Wall Plate</Description><Size>4 Hole</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111983</SubGroupID><ARTGs><ARTG>158695</ARTG></ARTGs><MinimumBenefit>1010</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO439</BillingCode><Name>RibLOc U+ Chest Wall Plate</Name><Description>RibLoc U+ Chest Wall Plate</Description><Size>16 Hole, 22 Hole</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111983</SubGroupID><ARTGs><ARTG>158695</ARTG></ARTGs><MinimumBenefit>1010</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO440</BillingCode><Name>RibLoc U+ Chest Wall Plate</Name><Description>RibLoc U+ Chest Wall Plate</Description><Size>8 Hole,12 Hole</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111983</SubGroupID><ARTGs><ARTG>158695</ARTG></ARTGs><MinimumBenefit>1010</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN326</BillingCode><Name>MatrixRIB Fixation System</Name><Description>Pre-Contoured Plates; Straight Plates; Universal Plates</Description><Size>7 - 30 holes </Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111983</SubGroupID><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1010</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI928</BillingCode><Name>RibFix Blu</Name><Description>Rib Osteosynthesis Plates</Description><Size>8-24 hole</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111983</SubGroupID><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>1010</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MZ019</BillingCode><Name>Strasbourg Costal Osteosynthesis System (StraCos/StraTos)</Name><Description>Titanium 3D Rib Clip, 6, 9 &amp; 13 Segments, Standard width and XL</Description><Size>6 segments (46 mm)
9 segments (70 mm)
13 segments XL (25.5 mm width)</Size><SupplierCode>40155</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111983</SubGroupID><ARTGs><ARTG>235762</ARTG></ARTGs><MinimumBenefit>1010</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT103</BillingCode><Name>L1® Rib Plates</Name><Description>Rib Osteosynthesis Plates</Description><Size>10-32 hole </Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111983</SubGroupID><ARTGs><ARTG>236206</ARTG></ARTGs><MinimumBenefit>1010</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF031</BillingCode><Name>Embrace Rib Fixation Plate</Name><Description>Rib plate for fixation of thoracic cage fractures, osteotomies, and reconstructions</Description><Size>35mm to 65mm  </Size><SupplierCode>40106</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111983</SubGroupID><ARTGs><ARTG>353890</ARTG></ARTGs><MinimumBenefit>1010</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH335</BillingCode><Name>Small / Large Fragment Set S/S</Name><Description>K/Wire Stainless Steel </Description><Size>0.8 to 3.0 mm x 6-9" or 150-500mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111984</SubGroupID><ARTGs><ARTG>202248</ARTG><ARTG>203768</ARTG><ARTG>200700</ARTG><ARTG>202246</ARTG></ARTGs><MinimumBenefit>11</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN460</BillingCode><Name>Wire</Name><Description>Cerclage</Description><Size>0.6mmx175mm - 0.8mmx200mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111984</SubGroupID><ARTGs><ARTG>108396</ARTG></ARTGs><MinimumBenefit>11</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC506</BillingCode><Name>Orfil</Name><Description>Double Pearl-Tipped Wires</Description><Size>1 - 350mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111984</SubGroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>11</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP045</BillingCode><Name>Isola System (Stainless Steel)</Name><Description>Double Wire</Description><Size>One size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111984</SubGroupID><ARTGs><ARTG>97391</ARTG></ARTGs><MinimumBenefit>11</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ102</BillingCode><PriorBillingCodes><PriorBillingCode>SQ141</PriorBillingCode><PriorBillingCode>SQ141</PriorBillingCode></PriorBillingCodes><Name>NEO Pedicle Screw System - K-wire</Name><Description>Stainless steel</Description><Size>1.5mm</Size><SupplierCode>40483</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111984</SubGroupID><ARTGs><ARTG>289290</ARTG></ARTGs><MinimumBenefit>11</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ142</BillingCode><Name>AO/ASIF Wires</Name><Description>Smooth and reduction wires</Description><Size>1.5 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111984</SubGroupID><ARTGs><ARTG>133927</ARTG></ARTGs><MinimumBenefit>11</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RV012</BillingCode><Name>PS Threaded K-Wire </Name><Description>Threaded K-Wire</Description><Size>2-3.0mm, Length 200 mm</Size><SupplierCode>39940</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>TH</Suffix><ARTGs><ARTG>330187</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RV019</BillingCode><Name>PS K-Wire</Name><Description>K-Wires</Description><Size>Dia 1-3.0 mm, Length 150 mm</Size><SupplierCode>39940</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>TH</Suffix><ARTGs><ARTG>202035</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RV018</BillingCode><Name>PS Threaded K-Wire</Name><Description>Threaded K-Wire</Description><Size>2-3.0mm, Length 200 mm</Size><SupplierCode>39940</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>TH</Suffix><ARTGs><ARTG>202035</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO209</BillingCode><Name>Acumed Congruent Plate System</Name><Description>Threaded K-Wire - Titanium</Description><Size>WT-1606STT: Length 15cm x Diameter 0.62"; WT-0906STT: Length 15cm x Diameter 0.35"; WS-2408STT length 20.32cm x Diameter 0.24cm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>TH</Suffix><ARTGs><ARTG>99820</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ076</BillingCode><Name>K wires</Name><Description>K wire threaded</Description><Size>1.25mm - 4.5mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>TH</Suffix><ARTGs><ARTG>191530</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ127</BillingCode><PriorBillingCodes><PriorBillingCode>AE069</PriorBillingCode><PriorBillingCode>AE069</PriorBillingCode></PriorBillingCodes><Name>Threaded wires &amp; pins</Name><Description>Threaded wires &amp; pins</Description><Size>1.0-5.0mm diameters
various threaded lengths</Size><SupplierCode>40480</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>TH</Suffix><ARTGs><ARTG>164927</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER477</BillingCode><Name>Paragon 28 K wires</Name><Description>Paragon 28, K wire (for Phantom, Gorilla and Monster systems), smooth, grooved  or threaded, trocar/double trocar</Description><Size>dia 0.9-3.0 mm, length (100-250 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>290442</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER545</BillingCode><Name>Osteomed ExtremiLock K-Wire</Name><Description>K-Wire</Description><Size>0.9-1.6 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>337153</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ141</BillingCode><Name>AO/ASIF Pins</Name><Description>Hybrid Pins – Spade Point, trocar point; Kirschner, smooth, compression and reduction wires.</Description><Size>1.6 - 3.2mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>203638</ARTG><ARTG>370937</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI271</BillingCode><Name>EBI XFIX Dynafix System</Name><Description>Wire Straight or Olive with Washer, Chrome Cobalt</Description><Size>0.9-3.2mm, &lt;400mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>TH</Suffix><ARTGs><ARTG>217978</ARTG><ARTG>227787</ARTG><ARTG>210294</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST890</BillingCode><Name>Steinmann Pins</Name><Description>Stainless Steel</Description><Size>7,9"</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>TH</Suffix><ARTGs><ARTG>142054</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK622</BillingCode><Name>SBi K-Wire</Name><Description>K-Wire</Description><Size>1.6mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>155633</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK230</BillingCode><Name>Hansson Pin</Name><Description>Cephalic Implants</Description><Size>Hansson Pin 70-140mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>COM</Suffix><ARTGs><ARTG>94876</ARTG></ARTGs><MinimumBenefit>263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WU001</BillingCode><PriorBillingCodes><PriorBillingCode>VK021</PriorBillingCode></PriorBillingCodes><Name>CPS Bioabsorbable Fixation System</Name><Description>OTPS fixation system: PLGA/TMC copolymer</Description><Size>Pin 1.5 &amp; 2 mm dia x 20-50 mm long</Size><SupplierCode>40389</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>154545</ARTG></ARTGs><MinimumBenefit>257</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO177</BillingCode><Name>Acumed Wires and Pins</Name><Description>Wire Kirschner Stainless Steel</Description><Size>0.70mm to 2.4mm diameter, 4 to 9.25in (10 to 24cm) length</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>99820</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT004</BillingCode><Name>Hawk 6.5mm Cannulated Screw System - Guide Pin</Name><Description>Threaded, Stainless steel</Description><Size>2.5mm in diameter and 200 in length</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>230955</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BU016</BillingCode><Name>MAGNEZIX Pin and Screw</Name><Description>Bioabsorbable bone pin and screw.</Description><Size>Diameter 1.5, 2.0, 2.7 and 3.2mm
Length 8 - 50mm
Diameter 2.0, 2.7 and 3.5mm
Length 6 - 40mm</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>283491</ARTG></ARTGs><MinimumBenefit>257</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV084</BillingCode><Name>SmartNail</Name><Description>Self-reinforced 96L / 4D PLA Bone Fixation Nail</Description><Size>2.4mm O.D x 16, 25, 35 &amp; 45mm L</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>139690</ARTG></ARTGs><MinimumBenefit>257</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV051</BillingCode><Name>Bionx Implants - Rods </Name><Description>PGA, PLA or PLLA</Description><Size>2.0mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>139657</ARTG></ARTGs><MinimumBenefit>257</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TS002</BillingCode><Name>Trewavis Surgical Steinmann Pins</Name><Description>Composition:  Stainless Steel, Model Nos: 200-950-L to 200-970-Q</Description><Size>Dia 3.0 - 5.0mm</Size><SupplierCode>40442</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>123771</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV063</BillingCode><Name>SmartNail</Name><Description>Self-Reinforced 96L/4D PLA Bone Fixation Nail</Description><Size>1.5mm O.D x 16, 20 &amp; 25mm L</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>139690</ARTG></ARTGs><MinimumBenefit>257</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TS001</BillingCode><Name>Trewavis Surgical Kirschner Wires</Name><Description>Composition: Stainless Steel, Model Nos: 200-000-A to 200-930-T, 200-1110-A to 200-1210-Z, 200-370-X to 200-370-Y and TSS200 to TSS241</Description><Size>Dia 0.7-2.8mm, Length 100-370mm</Size><SupplierCode>40442</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>123770</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI323</BillingCode><Name>Zimmer Wires</Name><Description>Stainless Steel Rushpins</Description><Size>Diameter 2.4 - 6.4mm; Length 2.5 - 52.7cm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM383</BillingCode><Name>K-Wire</Name><Description>K-Wire</Description><Size>Multiple sizes to suit patient and surgeon requirements</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>317003</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST007</BillingCode><Name>Stryker Plating System - K Wires</Name><Description>Stainless Steel or Titanium</Description><Size>150mm length in 1.25, 1.6, 2.0mm diameter</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>143230</ARTG><ARTG>139635</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM014</BillingCode><Name>Trimed Marked K-Wire</Name><Description>Stainless Steel</Description><Size>Diameter 0.9 - 1.1mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AE070</BillingCode><Name>ASDM Steinmann Pin</Name><Description>Steinmann Pin</Description><Size>2.8-5.0mm diameter</Size><SupplierCode>40045</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>296136</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB069</BillingCode><Name>BFix Bone Pins</Name><Description>Bone Pins </Description><Size>0.6mm - 5.0mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>322423</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO089</BillingCode><Name>Aptus K-wires</Name><Description>K-wires</Description><Size>0.8mm - 2.2mm Diameter, various lengths</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>200263</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FB001</BillingCode><Name>K-Wire</Name><Description>K-Wire, stainless steel, sterile</Description><Size>0.6mm – 2.8mm   x   75mm – 230mm</Size><SupplierCode>39980</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>226653</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AE052</BillingCode><Name>ASDM K-wire</Name><Description>Stainless steel - sterile</Description><Size>Dia 0.7 - 2.5mm, length 100 - 230mm</Size><SupplierCode>40045</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>296136</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN055</BillingCode><Name>Pins</Name><Description>Stainless steel pins</Description><Size>1.1 to 1.4 mm</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>309175</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV050</BillingCode><Name>Bionx Implants - Rods </Name><Description>PGA, PLA or PLLA</Description><Size>1.5mm x 10-70mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>139657</ARTG></ARTGs><MinimumBenefit>257</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV088</BillingCode><Name>SmartPin Resorbable Bone Fixation Pin, 1.1mm</Name><Description>Self-Reinforced PLLA</Description><Size>10, 20, 30 &amp; 40mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>139657</ARTG></ARTGs><MinimumBenefit>257</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU253</BillingCode><Name>Trim-IT Spin Pin</Name><Description>Trim-IT  Pin Fixation</Description><Size>1.5 - 2.0mm x 100mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>360375</ARTG></ARTGs><MinimumBenefit>257</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO100</BillingCode><Name>APTUS K-wires</Name><Description>Olive K-wires</Description><Size>1.6mm</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>OL</Suffix><ARTGs><ARTG>200263</ARTG></ARTGs><MinimumBenefit>117</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK117</BillingCode><Name>Stryker Kirschner Wires</Name><Description>Olive Wires</Description><Size>1.0- 2.0mm Diameter</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>OL</Suffix><ARTGs><ARTG>139635</ARTG><ARTG>143230</ARTG><ARTG>197935</ARTG></ARTGs><MinimumBenefit>117</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER478</BillingCode><Name>Paragon 28 Olive Wires</Name><Description>Paragon 28 Olive wire (Gorilla Plating System), smooth or threaded, standard or short tip</Description><Size>dia 1.3-1.8 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>OL</Suffix><ARTGs><ARTG>289488</ARTG></ARTGs><MinimumBenefit>117</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN459</BillingCode><Name>Wire</Name><Description>Suture</Description><Size>18Ga - 28Ga</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>OL</Suffix><ARTGs><ARTG>108396</ARTG></ARTGs><MinimumBenefit>117</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN441</BillingCode><Name>Ilizarov</Name><Description>Wires with stopper</Description><Size>300-400 length x 1-1.8mm diameter</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>OL</Suffix><ARTGs><ARTG>157918</ARTG><ARTG>108396</ARTG><ARTG>99767</ARTG></ARTGs><MinimumBenefit>117</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RV011</BillingCode><Name>PS Olive Wires</Name><Description>Olive Wires</Description><Size>2-3.2mm diameter</Size><SupplierCode>39940</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>OL</Suffix><ARTGs><ARTG>330187</ARTG></ARTGs><MinimumBenefit>117</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RV017</BillingCode><Name>PS Olive Wires</Name><Description>Olive Wires</Description><Size>2-3.2mm diameter</Size><SupplierCode>39940</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>OL</Suffix><ARTGs><ARTG>202035</ARTG></ARTGs><MinimumBenefit>117</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ191</BillingCode><Name>Wires Olive</Name><Description>Wire Olive, Bayonet, Drill Tip</Description><Size>Diameter 1.5-1.8mm, Length 300-400mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>OL</Suffix><ARTGs><ARTG>345470</ARTG></ARTGs><MinimumBenefit>117</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FB002</BillingCode><Name>K-Wire</Name><Description>K-Wire, threaded, stainless steel, sterile</Description><Size>1.2mm – 2.8mm   x   100mm – 230mm</Size><SupplierCode>39980</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>226653</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL195</BillingCode><PriorBillingCodes><PriorBillingCode>IG073</PriorBillingCode></PriorBillingCodes><Name>K-Wire (Kirschner)</Name><Description>Stainless steel</Description><Size>70mm, 100mm, 200mm length</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>173964</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY787</BillingCode><Name>AO/ASIF K-Wires</Name><Description>K-Wires</Description><Size>0.6 - 3.2mm, Length 70-500mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>153667</ARTG><ARTG>203637</ARTG><ARTG>203638</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RV010</BillingCode><Name>PS K-Wires</Name><Description>K-Wires</Description><Size>Dia 1-3.0 mm, Length 150 mm</Size><SupplierCode>39940</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>330187</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN451</BillingCode><Name>Wire</Name><Description>Kirschner</Description><Size>Various 1.3 - 304.8mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>118355</ARTG><ARTG>157918</ARTG><ARTG>110986</ARTG><ARTG>108396</ARTG><ARTG>131082</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT005</BillingCode><Name>Hawk 4.0mm Cannulated Screw system - Guide Pin</Name><Description>Threaded, Stainless steel</Description><Size>1.5mm in diameter and length of 200mm</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>230955</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ190</BillingCode><Name>Wires</Name><Description>Wire, Bayonet, HA Coated, Pear Wire, Cone Shape, Drill Tip</Description><Size>Diameter 1.2-2.0mm, Length 200-400mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>345470</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT006</BillingCode><Name>Hawk 3.0mm Cannulated Screw System - guide pin</Name><Description>Threaded, stainless steel</Description><Size>1.0mm in diameter with a length of 200mm</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>230955</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT030</BillingCode><Name>Frame It Wires - Olives</Name><Description>Wires with stopper</Description><Size>Diameter 1mm-3mm
Length 120mm-250mm</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>OL</Suffix><ARTGs><ARTG>282764</ARTG></ARTGs><MinimumBenefit>117</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO162</BillingCode><Name>Tension Band Pin</Name><Description>Stainless Steel</Description><Size>50 to 90mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><Suffix>OL</Suffix><ARTGs><ARTG>99821</ARTG></ARTGs><MinimumBenefit>117</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI293</BillingCode><Name>Zimmer Wires</Name><Description>Stainless Steel</Description><Size>Length 23cm, Thickness 2mm, 0-4mm, 8mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST038</BillingCode><Name>Stryker Plating System -  Reduction Pin</Name><Description>4.5mm Diameter, Stainless Steel</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>139635</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK213</BillingCode><Name>Hoffmann II Micro</Name><Description>K-wire, Steinmann Pins</Description><Size>Diameter: 1.2-2.0mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>143230</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW368</BillingCode><Name>Osteo Kirschner Wire</Name><Description>K wire -  Stainless Steel</Description><Size>Diameter 1.0 - 2.0mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>143230</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HG001</BillingCode><Name>HSP K - Wire</Name><Description>Stainless Steel Wire with Trocar point, single, double.</Description><Size>Diameter - 0.7mm - 2.0mm  Length - 80mm - 250mm</Size><SupplierCode>39942</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>295191</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW975</BillingCode><PriorBillingCodes><PriorBillingCode>WR063</PriorBillingCode></PriorBillingCodes><Name>K Wire</Name><Description>Titanium or stainless steel, single or double trocar</Description><Size>0.9 - 2.0mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>196920</ARTG><ARTG>112287</ARTG><ARTG>113920</ARTG><ARTG>217014</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI895</BillingCode><Name>Zimmer Pins</Name><Description>Stainless steel, Threaded</Description><Size>Length 230mm, Diameter 2.0mm - 4.8mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111985</SubGroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI163</BillingCode><Name>Zimmer Internal Fixation Systems: Cable System</Name><Description>Cable-Ready Plate Cable Stainless Steel</Description><Size>610 mm long</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111986</SubGroupID><ARTGs><ARTG>108377</ARTG></ARTGs><MinimumBenefit>331</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF014</BillingCode><Name>TLS- Tendon Anchoring/Suspension Tape</Name><Description>Suspension tape for anchoring tendon for ACL/PCL reconstruction</Description><Size>One size - 6mm</Size><SupplierCode>40106</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111986</SubGroupID><ARTGs><ARTG>181401</ARTG></ARTGs><MinimumBenefit>331</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW309</BillingCode><Name>Dall Miles Cable Grip System - Vitallium</Name><Description>Vitallium: Cable -  Vitallium</Description><Size>1.6 and 2mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111986</SubGroupID><ARTGs><ARTG>16234</ARTG><ARTG>141273</ARTG></ARTGs><MinimumBenefit>331</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF026</BillingCode><Name>TLS Tape</Name><Description>TLS Suspension Tape for use with TLS ACL reconstruction system</Description><Size>6mm</Size><SupplierCode>40106</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111986</SubGroupID><ARTGs><ARTG>181401</ARTG></ARTGs><MinimumBenefit>331</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI174</BillingCode><Name>Zimmer Internal Fixation Systems: Cable System</Name><Description>Cable-Ready Stainless Steel Cable</Description><Size>1.8mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111987</SubGroupID><ARTGs><ARTG>108377</ARTG></ARTGs><MinimumBenefit>470</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI164</BillingCode><Name>Zimmer Internal Fixation Systems: Cable System</Name><Description>Cable-Ready GTR Distal end Cable - Cobalt Chrome</Description><Size>635 mm long</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111987</SubGroupID><ARTGs><ARTG>108377</ARTG></ARTGs><MinimumBenefit>470</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI146</BillingCode><Name>Atlas Cable System</Name><Description>Single</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111987</SubGroupID><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>470</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL181</BillingCode><Name>EVOS Cabling System</Name><Description>Orthopaedic Cable System, Cable w/Crimp</Description><Size>2.0mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111987</SubGroupID><ARTGs><ARTG>140705</ARTG></ARTGs><MinimumBenefit>470</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN732</BillingCode><Name>Accord</Name><Description>Orthopaedic Cable System, Cable w/clamp</Description><Size>2.0mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111987</SubGroupID><ARTGs><ARTG>140705</ARTG></ARTGs><MinimumBenefit>470</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY377</BillingCode><Name>Orthopaedic Cable System</Name><Description>Cable with Crimp</Description><Size>1.0mm - 1.7mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111987</SubGroupID><ARTGs><ARTG>332243</ARTG><ARTG>332244</ARTG></ARTGs><MinimumBenefit>470</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ115</BillingCode><Name>Iso-Elastic™ Cerclage System</Name><Description>Iso-Elastic™ Cerclage Cable Assembly</Description><Size>One Size Only</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111987</SubGroupID><ARTGs><ARTG>133719</ARTG></ARTGs><MinimumBenefit>470</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU267</BillingCode><Name> Cerclage System</Name><Description>Pre-tied Cerclage System (FiberTape/TigerTape)</Description><Size>One Size Only</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111987</SubGroupID><ARTGs><ARTG>354057</ARTG></ARTGs><Note>The prosthesis is only to be used in a surgical procedure described in item 47450 or 47528 or 47565 in Group T8 of the Regulations.</Note><MinimumBenefit>470</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW524</BillingCode><Name>Dall Miles Cable Grip System</Name><Description>Cable and sleeve</Description><Size>1.6mm and 2.0mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111987</SubGroupID><ARTGs><ARTG>312160</ARTG></ARTGs><MinimumBenefit>470</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI173</BillingCode><Name>Zimmer Internal Fixation Systems: Cable System</Name><Description>Cable-Ready GTR Cable - Proximal </Description><Size>635mm long</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111987</SubGroupID><ARTGs><ARTG>108377</ARTG></ARTGs><MinimumBenefit>470</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI147</BillingCode><Name>Atlas Cable System</Name><Description>Double w/2 crimps</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111988</SubGroupID><ARTGs><ARTG>264077</ARTG></ARTGs><MinimumBenefit>407</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA098</BillingCode><Name>Pioneer Cable System</Name><Description>Pioneer Stainless Steel Sternal Orthopaedic cable and crimp - Single</Description><Size>One diameter size (1.10mm) There are 4 needle types on the cables. Cutting Edge, Blunt Tip, Tapered Tip, Reverse Cutting.</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111988</SubGroupID><ARTGs><ARTG>193369</ARTG></ARTGs><MinimumBenefit>394</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA099</BillingCode><Name>Pioneer Cable System</Name><Description>Pioneer Stainless Steel Sternal Orthopeadic Cable and Crimp - 4 Pack</Description><Size>One diameter size (1.10mm)  There are four needle types on the cables. Cutting edge, Blunt Tip, Tapered Tip, reverse Cutting.</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111988</SubGroupID><ARTGs><ARTG>193369</ARTG></ARTGs><MinimumBenefit>394</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA097</BillingCode><Name>Pioneer Cable System</Name><Description>Pioneer Titanium Sternal Orthopaedic Cable and Crimp - Single</Description><Size>One diameter size (1.10mm) Reverse cutting needle</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111988</SubGroupID><ARTGs><ARTG>193369</ARTG></ARTGs><MinimumBenefit>394</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK401</BillingCode><Name>Trochanteric Grip</Name><Description>Dall-Miles Trochanteric Grip with 2 Chrome Cobalt Cables</Description><Size>Small, Medium and Large</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111988</SubGroupID><ARTGs><ARTG>16232</ARTG><ARTG>145550</ARTG></ARTGs><MinimumBenefit>407</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM323</BillingCode><Name>GEMINUS Hook Plate</Name><Description>GEMINUS Hook Plate</Description><Size>One size</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111989</SubGroupID><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>43</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM001</BillingCode><Name>TriMed Wrist Fixation System</Name><Description>Washer</Description><Size>One size</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111989</SubGroupID><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>43</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY257</BillingCode><Name>A/O/ASIF K-wires</Name><Description>Cerclage Wire - coils with and without eye</Description><Size>0.4-1.5mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111989</SubGroupID><ARTGs><ARTG>332244</ARTG><ARTG>203638</ARTG></ARTGs><MinimumBenefit>43</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH630</BillingCode><PriorBillingCodes><PriorBillingCode>OO044</PriorBillingCode></PriorBillingCodes><Name>IC Cerclage System</Name><Description>IC Bone Cerclage System, pure titanium</Description><Size>8mm wide</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111990</SubGroupID><ARTGs><ARTG>197728</ARTG></ARTGs><MinimumBenefit>434</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM005</BillingCode><Name>TriMed Fixation Systems</Name><Description>Multiple stainless steel wire forms</Description><Size>various sizes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111990</SubGroupID><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>434</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW310</BillingCode><Name>Dall Miles Cable Grip System - Vitallium</Name><Description>Vitallium: Sleeve -  Vitallium</Description><Size>1.6 and 2mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111991</SubGroupID><ARTGs><ARTG>312160</ARTG></ARTGs><MinimumBenefit>100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA106</BillingCode><PriorBillingCodes><PriorBillingCode>MZ018</PriorBillingCode></PriorBillingCodes><Name>Pioneer Cable System Crimps</Name><Description>Crimps - two pack</Description><Size>One size only</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111991</SubGroupID><ARTGs><ARTG>193369</ARTG></ARTGs><MinimumBenefit>100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM243</BillingCode><Name>HK2</Name><Description>Finger Mini Fixator System</Description><Size>1.2mm, 1.5mm, 1.8mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111991</SubGroupID><ARTGs><ARTG>235591</ARTG></ARTGs><MinimumBenefit>100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI148</BillingCode><Name>Atlas Cable System</Name><Description>Crimp</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111991</SubGroupID><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL179</BillingCode><Name>EVOS Cabling System</Name><Description>Cable Locking device – Cable Post</Description><Size>3.5mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111991</SubGroupID><ARTGs><ARTG>368492</ARTG><ARTG>108428</ARTG></ARTGs><MinimumBenefit>100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN733</BillingCode><Name>Accord</Name><Description>Orthopaedic Cable System, SS Button Plate Adapter</Description><Size>One Size Only</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111991</SubGroupID><ARTGs><ARTG>140705</ARTG></ARTGs><MinimumBenefit>100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY057</BillingCode><Name>AO/ASIF K-Wires, Pins, Washers etc</Name><Description>Wire mount &amp; spacer</Description><Size>2mm - 6mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111991</SubGroupID><ARTGs><ARTG>133923</ARTG></ARTGs><MinimumBenefit>100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR072</BillingCode><Name>Dall miles Trochanteric grip with divergent hooks</Name><Description>stainless steel dall miles trochanteric grip with diverging proximal hooks</Description><Size>small, medium, large  43-53mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111992</SubGroupID><ARTGs><ARTG>144002</ARTG><ARTG>145550</ARTG><ARTG>144003</ARTG></ARTGs><MinimumBenefit>508</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW302</BillingCode><Name>Dall Miles Cable Grip System - Stainless Steel</Name><Description>Stainless Steel: Trochanter Grip -  Stainless Steel</Description><Size>Small, Medium, Large</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111992</SubGroupID><ARTGs><ARTG>144003</ARTG><ARTG>312160</ARTG></ARTGs><MinimumBenefit>508</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW311</BillingCode><Name>Dall Miles Cable Grip System - Vitallium</Name><Description>Vitallium: Trochanter Grip -  Vitallium</Description><Size>Small, Medium and Large</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111992</SubGroupID><ARTGs><ARTG>312160</ARTG></ARTGs><MinimumBenefit>508</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN056</BillingCode><Name>Grooved button</Name><Description>Grooved button</Description><Size>3 sizes</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111993</SubGroupID><ARTGs><ARTG>309175</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL180</BillingCode><Name>EVOS Cabling System</Name><Description>Cable Saddle/Button</Description><Size>3.5mm and 4.5mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111993</SubGroupID><ARTGs><ARTG>368492</ARTG><ARTG>108428</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW313</BillingCode><Name>Stryker Plating System</Name><Description>Cable Plug</Description><Size>4.0mm to 5.0mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111993</SubGroupID><ARTGs><ARTG>143230</ARTG><ARTG>119660</ARTG><ARTG>308681</ARTG><ARTG>139635</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI234</BillingCode><Name>Cable System </Name><Description>Cable Ready, Cable Button</Description><Size>2,5mm - 5,0mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111993</SubGroupID><ARTGs><ARTG>108377</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER454</BillingCode><Name>Paragon 28 Titan 3-D Wedge</Name><Description>Paragon 28 Titan 3-D Cotton or Evans Wedge, Anatomical,  Titanium metal scaffold for angular correction,  Sterile</Description><Size>5-8 mm (Cotton); 6-12 mm (Evans)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111994</SubGroupID><ARTGs><ARTG>290444</ARTG></ARTGs><MinimumBenefit>1468</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU209</BillingCode><PriorBillingCodes><PriorBillingCode>DE345</PriorBillingCode></PriorBillingCodes><Name>iBalance HTO System</Name><Description>Medial High Tibial Osteotomy Implant Device System</Description><Size>Small (6mm, 7mm, 8mm, 9mm, 10mm, 11mm, 12mm, 13mm, 14mm, 15mm)  Medium (5mm, 6mm, 7mm, 8mm, 9mm, 10mm, 11mm, 12mm, 13mm, 14mm, 15mm)  Large (5mm, 6mm, 7mm, 8mm, 9mm, 10mm, 11mm, 12mm, 13mm, 14mm, 15mm)</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108788</GroupID><SubGroupID>111994</SubGroupID><ARTGs><ARTG>350871</ARTG></ARTGs><MinimumBenefit>1468</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY837</BillingCode><Name>Nitinol Implant System</Name><Description>Bone staples</Description><Size>Bridge size 9-30</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><Suffix>MM</Suffix><ARTGs><ARTG>95685</ARTG></ARTGs><MinimumBenefit>507</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB061</BillingCode><Name>Compression Staple</Name><Description>Compression Staple</Description><Size>Multiple Sizes</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><Suffix>COMP</Suffix><ARTGs><ARTG>319175</ARTG></ARTGs><MinimumBenefit>396</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW318</BillingCode><Name>Rutherford Staple</Name><Description>Ellison Flat Staple, Vitallium</Description><Size>8,11,14 x 23mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>139631</ARTG><ARTG>16229</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ043</BillingCode><PriorBillingCodes><PriorBillingCode>LM248</PriorBillingCode><PriorBillingCode>LM248</PriorBillingCode></PriorBillingCodes><Name>OS2®-V Varisation Staple</Name><Description>Varisation Staple</Description><Size>8 &amp; 10mm, 26 degrees &amp; 90 degrees</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>236772</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW920</BillingCode><PriorBillingCodes><PriorBillingCode>WR400</PriorBillingCode></PriorBillingCodes><Name>NexFix Compression Staples</Name><Description>The NexFix Compression Staple is made of stailess steel and is used for internal fixation of fractures, fusions, bone grafts and osteotomies in the bones of the hand and foot. It is designed so the surgeon can control the amount of compression depending on the type of osteotomy and on the patient’s bone quality</Description><Size>10 mm in width, leg length varies 13 mm - 20 mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>219433</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM362</BillingCode><Name>X-Clips</Name><Description>X-Clips</Description><Size>Multiple sizes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>164980</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW700</BillingCode><PriorBillingCodes><PriorBillingCode>WR037</PriorBillingCode></PriorBillingCodes><Name>Charlotte Foot &amp; Ankle System</Name><Description>Compression Staple, Stainless Steel</Description><Size>13, 15, 20, 25mm interaxis, leg lengths 11, 13, 15, 17, 20 &amp; 25mm, 10 Sizes in Total</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>122968</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW921</BillingCode><PriorBillingCodes><PriorBillingCode>WR401</PriorBillingCode></PriorBillingCodes><Name>NexFix Closing Wedge Osteotomy Staples</Name><Description>The NexFix Closing wedge osteotomy staples are made of stainless steel and are intended to be used for internal fixation of fusions, bone grafts and osteotomies in the bones of the hand and foot following alignment correction</Description><Size>8mm x 90 deg, 8mm x 64 deg</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>219433</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW701</BillingCode><PriorBillingCodes><PriorBillingCode>WR038</PriorBillingCode></PriorBillingCodes><Name>Charlotte Foot &amp; Ankle System</Name><Description>Quick Staple, Stainless Steel</Description><Size>One Size Only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>122968</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU160</BillingCode><PriorBillingCodes><PriorBillingCode>DE646</PriorBillingCode></PriorBillingCodes><Name>DynaNite</Name><Description>Nitinol Staple for Osteotomy Fixation</Description><Size>Width (9mm-25mm)    Length (7mm-20mm)</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><Suffix>MM</Suffix><ARTGs><ARTG>350734</ARTG></ARTGs><MinimumBenefit>507</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH527</BillingCode><Name>Dynafit System Staples</Name><Description>Nitinol Memory Staples</Description><Size>8mm - 25mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><Suffix>MM</Suffix><ARTGs><ARTG>221403</ARTG></ARTGs><MinimumBenefit>507</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HJ006</BillingCode><Name>MEMODYN Hot Shape Memory Bipode Staple</Name><Description>Nitinol Memory Staple</Description><Size>6mm - 30mm </Size><SupplierCode>40478</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><Suffix>MM</Suffix><ARTGs><ARTG>340094</ARTG></ARTGs><MinimumBenefit>507</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW832</BillingCode><PriorBillingCodes><PriorBillingCode>WR290</PriorBillingCode></PriorBillingCodes><Name>Eleos staple</Name><Description>Foot staple</Description><Size>4-34/38mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><Suffix>MM</Suffix><ARTGs><ARTG>122968</ARTG></ARTGs><MinimumBenefit>507</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER439</BillingCode><Name>Paragon 28 JAWS Nitinol Staple System</Name><Description>Paragon 28 JAWS Nitinol Staple System</Description><Size>bridge width 8-25 mm, angle 0 or 30, step height 4-12 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><Suffix>MM</Suffix><ARTGs><ARTG>291681</ARTG></ARTGs><MinimumBenefit>507</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ023</BillingCode><PriorBillingCodes><PriorBillingCode>LM247</PriorBillingCode><PriorBillingCode>LM247</PriorBillingCode></PriorBillingCodes><Name>Compression Staples</Name><Description>Compression Staples</Description><Size>Multiple sizes</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><Suffix>COMP</Suffix><ARTGs><ARTG>236772</ARTG></ARTGs><MinimumBenefit>396</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA023</BillingCode><Name>Arcus Staple System</Name><Description>Compression Staple</Description><Size>8-20mm width</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><Suffix>COMP</Suffix><ARTGs><ARTG>308503</ARTG></ARTGs><MinimumBenefit>396</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK621</BillingCode><Name>StaFIX</Name><Description>The StaFIX Staples are retained implants and removable used primarily for the following applications: Synthesis of fractures; Synthesis of osteotomies; Arthrodesis; Reattachment of ligaments ot tendons.  The aim of the StaFIX staple is to provide a effective fixation of the bone fragments during healing.</Description><Size>6x6, 6x12,8x8, 8x16, 10x10, 10x20, 12x24</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>140683</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR118</BillingCode><Name>LARS Ligament Staple</Name><Description>CoCr synthetic ligament anchor</Description><Size>Width 8mm &amp; length 20mm</Size><SupplierCode>39996</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>138574</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW462</BillingCode><Name>Memometal Memory Staples</Name><Description>Memory Metal Implants</Description><Size>10 mm to 25 mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><Suffix>MM</Suffix><ARTGs><ARTG>149534</ARTG></ARTGs><MinimumBenefit>507</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ022</BillingCode><PriorBillingCodes><PriorBillingCode>LM355</PriorBillingCode><PriorBillingCode>LM355</PriorBillingCode></PriorBillingCodes><Name>Compression Staple</Name><Description>Memory Metal Compression Staple</Description><Size>Multiple Sizes</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><Suffix>MM</Suffix><ARTGs><ARTG>338955</ARTG></ARTGs><MinimumBenefit>507</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK614</BillingCode><Name>M-Fix</Name><Description>Nitinol</Description><Size>10-19mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><Suffix>MM</Suffix><ARTGs><ARTG>140683</ARTG></ARTGs><MinimumBenefit>507</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM214</BillingCode><Name>Highly Elastic Staples</Name><Description>Nitinol Staples</Description><Size>8-25mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><Suffix>MM</Suffix><ARTGs><ARTG>229705</ARTG></ARTGs><MinimumBenefit>507</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW833</BillingCode><PriorBillingCodes><PriorBillingCode>WR291</PriorBillingCode></PriorBillingCodes><Name>Fuseforce Fixation System</Name><Description>Osteosynthesis Staple Memory Alloy</Description><Size>8-25mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><Suffix>MM</Suffix><ARTGs><ARTG>122968</ARTG></ARTGs><MinimumBenefit>507</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU240</BillingCode><PriorBillingCodes><PriorBillingCode>DE062</PriorBillingCode></PriorBillingCodes><Name>Ligament Staples</Name><Description>Cobalt Chromium Molybdenium Alloy</Description><Size>6mm - 16mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>354063</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM386</BillingCode><PriorBillingCodes><PriorBillingCode>PB061</PriorBillingCode></PriorBillingCodes><Name>Compression Staple</Name><Description>Compression Staple</Description><Size>Multiple Sizes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><Suffix>COMP</Suffix><ARTGs><ARTG>328461</ARTG></ARTGs><MinimumBenefit>396</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM364</BillingCode><PriorBillingCodes><PriorBillingCode>LH518</PriorBillingCode></PriorBillingCodes><Name>Clover Staple</Name><Description>Plate Staple, 3 or 4 leg</Description><Size>(10-16)mm x (8-16)mm plate x (10-15)mm leg length x (3 or 4) leg</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><Suffix>MM</Suffix><ARTGs><ARTG>218346</ARTG></ARTGs><MinimumBenefit>507</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN465</BillingCode><Name>Bone Staple</Name><Description>Fixation - Table</Description><Size>Small -Medium  13mm - 16mm. </Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>120322</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL207</BillingCode><PriorBillingCodes><PriorBillingCode>IG103</PriorBillingCode></PriorBillingCodes><Name>Uni-Clip Compression Staple</Name><Description>Stainless Steel, Notched and Non-Notched</Description><Size>Width 11-30mm, Length 13-32mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>173961</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW319</BillingCode><Name>Rutherford Staple</Name><Description>Ellison Soft Tissue Retainer,  Vitallium</Description><Size>8,11,14mm </Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>16229</ARTG><ARTG>139631</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF089</BillingCode><Name>Speyside Memory Staple</Name><Description>Speyside Memory Staple  - Medium</Description><Size>Width 11-20 mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><Suffix>MM</Suffix><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>507</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB070</BillingCode><Name>Static Staple</Name><Description>Static Staple</Description><Size>8mm - 10mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>332960</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO101</BillingCode><Name>Medartis All-in-One Staples</Name><Description>Orthopaedic Stainless Steel Bone Staple</Description><Size>8 - 10 mm</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>322413</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN466</BillingCode><Name>Bone Staple</Name><Description>Krackow HTO</Description><Size>12,14,16mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>120322</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF125</BillingCode><Name>Speyside STAPLE</Name><Description>STAPLE 90° 10MM, STAPLE 26° 10MM, STAPLE 90° 8MM, STAPLE 26° 8MM</Description><Size>STAPLE 90° 10MM WIDE, STAPLE 26° 10MM WIDE, STAPLE 90° 8MM WIDE, STAPLE 26° 8MM WIDE</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL196</BillingCode><PriorBillingCodes><PriorBillingCode>IG075</PriorBillingCode></PriorBillingCodes><Name>Solustaple Standard Staple</Name><Description>Stainless steel 90 deg &amp; 26 degree</Description><Size>8 &amp; 10mm length</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>173961</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BU015</BillingCode><Name>Arcad osteosynthesis memory staples</Name><Description>Stainless steel static staples</Description><Size>8 to 10 mm</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>235764</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV025</BillingCode><Name>Staplizer Bone Staple Cartridge</Name><Description>5 Titanium staples per cartridge</Description><Size>7 x 7mm, 7 x 10mm, 10 x 7mm, 10 x 10mm, 10 x 15mm, 13 x 7mm, 13 x 10mm, 13 x 15mm, 13 x 20mm, 16 x 10mm, 16 x 15mm, 16 x 20mm, 16 x 25mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><Suffix>MI</Suffix><ARTGs><ARTG>93500</ARTG></ARTGs><MinimumBenefit>255</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN463</BillingCode><Name>Bone Staple</Name><Description>Fixation - Osteotomy</Description><Size>Fixation Staple 5mm- 14mm.  McConnel HTO PF 15mm 0-S</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>120322</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ071</BillingCode><Name>Mini Staple</Name><Description>Varisation Staple
Straight, Angled</Description><Size>26° - 90°
8 x 10 mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>167049</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU263</BillingCode><PriorBillingCodes><PriorBillingCode>DE292</PriorBillingCode></PriorBillingCodes><Name>QuickFix Staple System</Name><Description>Compression Staple for Fusion</Description><Size>8mm 10mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>367491</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW557</BillingCode><Name>Stryker Memometal Varisation Staple</Name><Description>Varisation Staple Stainless Steel</Description><Size>26-90Deg x 8-10mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>149534</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN464</BillingCode><Name>Bone Staple</Name><Description>Fixation - Short Leg</Description><Size>Xsmall - large</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>120322</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH528</BillingCode><Name>Dynafit System Staples</Name><Description>Foot Staples</Description><Size>8-10mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>221403</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN363</BillingCode><Name>Nitinol Implant System</Name><Description>Bone staples</Description><Size>Bridge size: 18-30</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><Suffix>MM</Suffix><ARTGs><ARTG>387415</ARTG></ARTGs><MinimumBenefit>507</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW317</BillingCode><Name>Rutherford Staple</Name><Description>Ellison Arched Staple, Vitallium</Description><Size>9,12,15mm x 23mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><ARTGs><ARTG>139631</ARTG></ARTGs><MinimumBenefit>127</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BU008</BillingCode><Name>Arcad osteosynthesis memory staples</Name><Description>Memory metal implants</Description><Size>8 to 25mm</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108789</GroupID><SubGroupID>111999</SubGroupID><Suffix>MM</Suffix><ARTGs><ARTG>235764</ARTG></ARTGs><MinimumBenefit>507</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK048</BillingCode><Name>Stryker Cuff Anchor</Name><Description>Titanium anchor kit for soft tissue reattachment</Description><Size>Length 5-8mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112000</SubGroupID><ARTGs><ARTG>139736</ARTG><ARTG>78130</ARTG></ARTGs><MinimumBenefit>234</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM455</BillingCode><Name>VIMS ligament anchor, knotless</Name><Description>A device designed to be implanted into bone for the attachment of soft tissues either directly or via a suture attached to the device. It is typically used in shoulder and some lower-limb operations, and functions as an alternative to drilling a hole in bone for passing a suture. The device is made of a material that cannot be chemically degraded or absorbed via natural body processes</Description><Size>Diameter: 2.8mm; 5.0mm; 5.5mm; 6.0mm; 7.0mm; 8.0mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112000</SubGroupID><ARTGs><ARTG>338393</ARTG></ARTGs><MinimumBenefit>234</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW375</BillingCode><Name>Howmedica Mainstay Soft Tissue Anchor</Name><Description>Zip anchor - Titanium</Description><Size>Sip 4.5 anchor with #5 suture and #2 suture 2 strands, zip 3.5 anchor with #2 suture and #0 suture 2 strands, zip 2.7 anchor with #0 suture</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112000</SubGroupID><ARTGs><ARTG>139736</ARTG><ARTG>16234</ARTG></ARTGs><MinimumBenefit>234</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VY004</BillingCode><Name>Apollo Suture Anchor No Suture</Name><Description>Suture Anchor No Suture</Description><Size>All sizes</Size><SupplierCode>40467</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112000</SubGroupID><ARTGs><ARTG>370602</ARTG></ARTGs><MinimumBenefit>234</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU247</BillingCode><Name>Chondral Dart</Name><Description>Polylactide Compositition</Description><Size>Length 18mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112000</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>360372</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ070</BillingCode><PriorBillingCodes><PriorBillingCode>LM491</PriorBillingCode></PriorBillingCodes><Name>Knotless Suture Anchors</Name><Description>Knotless Suture Anchors</Description><Size>Various sizes </Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112000</SubGroupID><ARTGs><ARTG>364759</ARTG></ARTGs><MinimumBenefit>234</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV071</BillingCode><Name>Contour Meniscus Arrow</Name><Description>80L/20D, LPLA &amp; PLLA</Description><Size>1.1mm x 10, 13,16mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112000</SubGroupID><ARTGs><ARTG>139661</ARTG></ARTGs><MinimumBenefit>234</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BW007</BillingCode><Name>Biotek ligament anchor, knotless</Name><Description>A device designed to be implanted into bone for the attachment of soft tissues either directly or via a suture attached to the device. It is typically used in shoulder and some lower-limb operations, and functions as an alternative to drilling a hole in bone for passing a suture. The device is made of a material that cannot be chemically degraded or absorbed via natural body processes</Description><Size>Diameter: 2.8mm</Size><SupplierCode>40418</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112000</SubGroupID><ARTGs><ARTG>314305</ARTG></ARTGs><MinimumBenefit>234</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM467</BillingCode><Name>Soft Anchor</Name><Description>Soft Anchor</Description><Size>≤2.3mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>339014</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ114</BillingCode><PriorBillingCodes><PriorBillingCode>KH069</PriorBillingCode></PriorBillingCodes><Name>Rejoin Peek Anchor</Name><Description>Suture Anchor System</Description><Size>less than 2.4mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>320191</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV005</BillingCode><Name>Ultrafix MiniMite StitchPak Suture Anchor</Name><Description>Soft Tissue Re-attachment - Stainless Steel</Description><Size>2.3mm predeployed diameter</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>136631</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU211</BillingCode><PriorBillingCodes><PriorBillingCode>DE430</PriorBillingCode></PriorBillingCodes><Name>Corkscrew Suture Anchor</Name><Description>Titanium alloy with Fibrewire suture</Description><Size>2.2mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV150</BillingCode><Name>Paradigm ClickLok Anchor</Name><Description> The Paradigm ClickLok Anchor (UHMWPE) is a High Strength Flat Braided Suture Anchor with Hi-Fi (UHMWPE) Braided Suture preloaded on Stainless Steel driver. It may be used in either arthroscopic or open surgical procedures. After the suture is anchored to the bone, it may be used to reattach soft tissue, such as ligaments, tendons, or joint capsules to the bone. The suture anchor system thereby stabilizes the damaged soft tissue, in conjunction with appropriate postoperative immobilization throughout the healing period.   </Description><Size>1.8 mm all suture anchor</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>136631</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF030</BillingCode><Name>ARC Anchors</Name><Description>All Suture Anchor, multiple suture options</Description><Size>Small, Medium</Size><SupplierCode>40106</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>308785</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ421</BillingCode><Name>MicroFix Anchor with Suture</Name><Description>Anchor with suture</Description><Size>Anchor with Suture and Multiple size needles</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>140549</ARTG><ARTG>161091</ARTG></ARTGs><MinimumBenefit>503</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ926</BillingCode><Name>MiniLok Anchor System</Name><Description>Suture Anchor</Description><Size>2.3mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>140353</ARTG><ARTG>154627</ARTG></ARTGs><MinimumBenefit>503</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN906</BillingCode><Name>Smith and Nephew Small Absorbable Anchor</Name><Description>Absorbable suture anchor for repair and reattachment of the soft tissue</Description><Size>≤2.3mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>164725</ARTG><ARTG>164727</ARTG><ARTG>164726</ARTG><ARTG>204889</ARTG><ARTG>204890</ARTG></ARTGs><MinimumBenefit>503</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ109</BillingCode><PriorBillingCodes><PriorBillingCode>KH065</PriorBillingCode></PriorBillingCodes><Name>Rejoin Healfix Suture Anchor</Name><Description>Suture Anchor System</Description><Size>Less than 2.4mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>320191</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ091</BillingCode><Name>Mini Quick Anchor with Suture</Name><Description>Anchor with Suture</Description><Size>Anchor with Suture and Multiple size needles</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>136374</ARTG><ARTG>154626</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM163</BillingCode><Name>DYNOMITE</Name><Description>A non-absorbable polymer (PEEK) anchor for use in ligament/tendon reconstruction in small joint applications</Description><Size>2mm in diameter</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL261</BillingCode><PriorBillingCodes><PriorBillingCode>SL160</PriorBillingCode></PriorBillingCodes><Name>Q-Fix All Suture Anchor  </Name><Description>Soft suture anchor  </Description><Size>1.8mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>271876</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BU026</BillingCode><PriorBillingCodes><PriorBillingCode>PF030</PriorBillingCode></PriorBillingCodes><Name>ARC Anchors</Name><Description>All Suture Anchor, multiple suture options</Description><Size>Small, Medium</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>336706</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU212</BillingCode><Name>FiberTak Suture Anchor</Name><Description>Suture anchor with 2 x #2 FibreWire CL or 1.3mm SutureTape</Description><Size>1.3mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BW009</BillingCode><Name>Biotek Ligament Anchor</Name><Description>Soft tissue ligament anchor loaded with UHMWPE fiber and needle </Description><Size>Diameter: 1.8mm - 2.00mm</Size><SupplierCode>40418</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>314305</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV119</BillingCode><Name>Y-Knot Suture Anchor</Name><Description>Y-Knot All Suture Anchor</Description><Size>1.3mm to 2.1mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>136631</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF147</BillingCode><Name>S-Knot Anchor</Name><Description>All suture anchors</Description><Size>1.3 and 1.8mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>193153</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY417</BillingCode><Name>Titanium Wire, Barb and Needle</Name><Description>Titanium wire surture and needle with titanium alloy barb fixation</Description><Size>One size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>139010</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL260</BillingCode><PriorBillingCodes><PriorBillingCode>SL160</PriorBillingCode></PriorBillingCodes><Name>SUTUREFIX </Name><Description>All Suture Anchor</Description><Size>1.7mm and 1.9mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM457</BillingCode><Name>VIMS Ligament Anchor</Name><Description>Soft tissue ligament anchor loaded with UHMWPE fiber and needle </Description><Size>Diameter: 1.8mm - 2.00mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>338393</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ089</BillingCode><Name>PEEK Suture Anchor</Name><Description>PEEK Suture Anchor</Description><Size>1.5mm, 2.3mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>352376</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ048</BillingCode><PriorBillingCodes><PriorBillingCode>SV078</PriorBillingCode></PriorBillingCodes><Name>Parcus MiTi Titanium Screw In Suture Anchor -Small</Name><Description>Threaded, tapered fastener for use in attachment of soft tissue to bone. The device is made from a Titanium alloy, TI-6A1-4V.</Description><Size>2.0mm</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>177866</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM162</BillingCode><Name>SPYROMITE</Name><Description>A non-absorbable polymer (PEEK) anchor for use in ligament/tendon reconstruction in small joint applications</Description><Size>2mm in diameter</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN330</BillingCode><Name>VERSALOOP Anchor System</Name><Description>All-Suture Anchor</Description><Size>1.5 mm, 1.8 mm, 1.5 mm XL</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>379270</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW542</BillingCode><Name>ICONiX Anchor</Name><Description>ICONiX Anchor soft-tissue fixation </Description><Size>1.4mm, 2.3mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>229717</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ100</BillingCode><Name>Micro Quick Anchor </Name><Description>Titanium Suture Anchor</Description><Size>1.3 x 3.7mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>161092</ARTG><ARTG>136374</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL259</BillingCode><PriorBillingCodes><PriorBillingCode>SL160</PriorBillingCode></PriorBillingCodes><Name>Q-Fix All Suture Anchor  </Name><Description>Soft suture anchor, with MINITAPE and/or with Needle</Description><Size>1.8mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>428211</ARTG><ARTG>109451</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Description</ChangeExplanation><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BW019</BillingCode><Name>Biotek Soft Ligament Anchor</Name><Description>Soft tissue ligament anchor loaded with UHMWPE fiber and needle </Description><Size>Diameter 1.2mm - 2.00mm</Size><SupplierCode>40418</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>314305</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BW014</BillingCode><Name>Biotek Ligament Anchor PEEK</Name><Description>Soft tissue ligament anchor loaded with UHMWPE fiber and needle</Description><Size>Diameter: 1.8mm - 2.00mm</Size><SupplierCode>40418</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>314305</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM146</BillingCode><Name>RAPTOR Anchor</Name><Description>Suture anchor for repair and reattachment of the soft tissue</Description><Size>≤2.3mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ305</BillingCode><Name>Fiberstitch RC</Name><Description>Fiberstitch All Suture Anchor</Description><Size>1.5mm, 1.9mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>328289</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV024</BillingCode><Name>Ultrafix MicroMite Small Joint Anchor</Name><Description>Suture Anchoring Device - Titanium</Description><Size>1.5mm predeployed diameter</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>136631</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV124</BillingCode><Name>PressFT PEEK Suture Anchor 2.1mm</Name><Description>The ConMed Linvatec PressFT Suture Anchors are manufactured from PEEK and are provided, preloaded on a single use driver and pre-threaded with either one or two Hi-Fi Sutures.</Description><Size>2.1mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>136631</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW634</BillingCode><Name>ICONiX Speed Anchor</Name><Description>All Suture</Description><Size>2.3mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>229717</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HV003</BillingCode><Name>OzAnchor All Suture</Name><Description>Anchor with suture</Description><Size>1.4mm</Size><SupplierCode>40231</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>351431</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ067</BillingCode><PriorBillingCodes><PriorBillingCode>LM488</PriorBillingCode></PriorBillingCodes><Name>Fully Threaded Suture Anchor</Name><Description>Fully Threaded Suture Anchor</Description><Size>≤2.3mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>364759</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI969</BillingCode><Name>JuggerStitch</Name><Description>Meniscal Repair Device</Description><Size>one size</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>117747</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA107</BillingCode><Name>JuggerKnot Soft Anchor</Name><Description>Suture Anchor, Ultra-high molecular weight polyethylene (UHMWPE), Polyester</Description><Size>1.4mm, 1.45mm, 1.5mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>368790</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW583</BillingCode><Name>ICONiX w/ Needles</Name><Description>ICONiX w/ Needles Anchor for soft tissue fixation</Description><Size>1.4mm, 2.3mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>229717</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU213</BillingCode><PriorBillingCodes><PriorBillingCode>DE654</PriorBillingCode></PriorBillingCodes><Name>Nano Corkscrew FT Suture Anchor</Name><Description>Suture Anchor</Description><Size>1.7mm x 5mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ112</BillingCode><PriorBillingCodes><PriorBillingCode>KH070</PriorBillingCode></PriorBillingCodes><Name>Rejoin JoinFix All Suture Anchor</Name><Description>Suture Anchor System</Description><Size>less than 2.4mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>320191</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ080</BillingCode><Name>PEEK Suture Anchor</Name><Description>PEEK Suture Anchor</Description><Size>1.5mm, 2.3mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>325207</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU178</BillingCode><Name>All-Suture Anchor Size 1</Name><Description>Suture Anchor</Description><Size>Ø 1.4 and 1.8 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>330998</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV125</BillingCode><Name>GENESYS PressFT Suture Anchor 2.1mm</Name><Description>The ConMed Linvatec GENESYS PressFT (biocomposite) Suture Anchors are manufactured from polylactide copolymer (96L/4D PLA co-polymer) and beta-tricalcium phosphate (B-TCp), and are provided sterile, preloaded on a single-use driver and pre-threaded with either one or two Hi-Fi Sutures</Description><Size>2.1mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>208881</ARTG></ARTGs><MinimumBenefit>503</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU325</BillingCode><Name>DX Knotless FiberTak</Name><Description>Soft Tissue Fixation Anchor</Description><Size>2.4-3.9mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>384730</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ032</BillingCode><Name>Draw Tight Suture Anchors</Name><Description>Suture Anchor</Description><Size>1.8 mm</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>177866</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH360</BillingCode><Name>JuggerKnot/JuggerLoc Soft Anchor</Name><Description>Suture Anchor, Polyester, PE</Description><Size>1.0mm, 1.4mm,1.45mm, 1.5mm, 2.1mm, 2.3mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>208040</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU214</BillingCode><PriorBillingCodes><PriorBillingCode>DE697</PriorBillingCode></PriorBillingCodes><Name>Mini Hip SutureTak</Name><Description>Suture anchor</Description><Size>Diameter: 2mm  Length: 8.6mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV115</BillingCode><Name>Sequent Meniscal Repair Device</Name><Description>The Sequent Meniscal Repair Device is pre-loaded with polyetheretherketone (PEEK) implants threaded onto one size #0 (3.5 metric) HiFi® suture.  The device sequentially deplos the implants and suture that are tightened down to create multiple stitches to create fixation points along a soft tissue tear</Description><Size>7 (5.1mm x 1.3mm Implants)</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><Suffix>MI</Suffix><ARTGs><ARTG>120427</ARTG></ARTGs><MinimumBenefit>755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK583</BillingCode><Name>Nanotack Suture Anchor</Name><Description>1.4mm High Strength PEEK suture anchor pre-loaded with suture and inserter for arthrosopic hip labral reattachment</Description><Size>1.4mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112001</SubGroupID><ARTGs><ARTG>207253</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ025</BillingCode><Name>Parcus Series 3 Peek CF Suture Anchor</Name><Description>Knotless push in Anchor with 2 sutures and suture passer.</Description><Size>3.5mm diameter</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>177866</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB066</BillingCode><Name>Full Thread Suture Anchor</Name><Description>Suture Anchor</Description><Size>2.4mm - 3.9mm </Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>323905</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VY001</BillingCode><Name>Bonecam Suture Anchors with Suture</Name><Description>Suture Anchors with Suture</Description><Size>2.4 - 3.9mm </Size><SupplierCode>40467</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>370602</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ053</BillingCode><Name>Parcus Knotless PEEK push in  suture anchor</Name><Description>Knotless PEEK push in suture anchors w/suture passer</Description><Size>2.8mm</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>177866</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ030</BillingCode><Name>Knotless PEEK CF Suture Anchors</Name><Description>Suture Anchor, PEEK CF</Description><Size>2.8mm   3.5mm</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>177866</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ047</BillingCode><PriorBillingCodes><PriorBillingCode>SV077</PriorBillingCode></PriorBillingCodes><Name>Parcus MiTi Titanium Screw In Suture Anchor - Medium and XL</Name><Description>Threaded, tapered fastener for attachment of soft tissue to bone. The device is made from a Titanium Alloy, Ti-6A1-4V.</Description><Size>2.5mm  3.5mm</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>177866</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ038</BillingCode><PriorBillingCodes><PriorBillingCode>PJ029</PriorBillingCode></PriorBillingCodes><Name>Draw tight</Name><Description>Draw tight suture based anchor with two suture tapes.  Recommended for use in both large and small joint repairs.</Description><Size>3.2</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>177866</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA108</BillingCode><Name>JuggerKnot Soft Anchor</Name><Description>Suture Anchor, Ultra-high molecular weight polyethylene (UHMWPE), Polyester</Description><Size>2.9mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>368790</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH062</BillingCode><Name>Healfix Anchor System</Name><Description>Titanium Suture Anchor</Description><Size>2.4mm - 3.9mm</Size><SupplierCode>40204</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>320191</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW570</BillingCode><Name>CinchLock SS Flex Knotless Anchor</Name><Description>CinchLock SS Flex Knotless Anchor for soft tissue fixation</Description><Size>3mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>229717</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW548</BillingCode><Name>Knotilus Anchor</Name><Description>Knotilus Anchor Soft Tissue Fixation </Description><Size>Knotilus Anchor, 3.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>229722</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM452</BillingCode><Name>VIMS ligament anchor titanium</Name><Description>A device designed to be implanted into bone for the attachment of soft tissues either directly or via a suture attached to the device. It is typically used in shoulder and some lower-limb operations, and functions as an alternative to drilling a hole in bone for passing a suture. The device is made of a material that cannot be chemically degraded or absorbed via natural body processes</Description><Size>Diameter: 2.8mm; 3.5mm;</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>338393</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW841</BillingCode><PriorBillingCodes><PriorBillingCode>WR302</PriorBillingCode></PriorBillingCodes><Name>GRAVITY</Name><Description>Titanium Suture Anchor System</Description><Size>2.7mm - 3.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>175633</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU216</BillingCode><PriorBillingCodes><PriorBillingCode>DE225</PriorBillingCode></PriorBillingCodes><Name>Fastak Anchor</Name><Description>Titanium with fibrewire suture</Description><Size>2.8mm x 11.7mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW639</BillingCode><Name>AIR+ Meniscus System</Name><Description>All Inside Meniscal Device System</Description><Size>2.4mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>229717</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ948</BillingCode><Name>Healix Anchor System</Name><Description>PEEK anchor with suture</Description><Size>3.4 mm anchor diameter</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>196696</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL056</BillingCode><Name>ArthRoCare Anchor System</Name><Description>Anchor fixating soft tissue to bone</Description><Size>2.8 - 3.4mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>271876</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM468</BillingCode><Name>Soft Anchor</Name><Description>Soft Anchor</Description><Size>2.4 – 3.9mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>339014</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM453</BillingCode><Name>VIMS ligament anchor PEEK</Name><Description>A device designed to be implanted into bone for the attachment of soft tissues either directly or via a suture attached to the device. It is typically used in shoulder and some lower-limb operations, and functions as an alternative to drilling a hole in bone for passing a suture. The device is made of a material that cannot be chemically degraded or absorbed via natural body processes</Description><Size>Diameter: 2.8mm; 3.0mm; 3.5mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>338393</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN334</BillingCode><Name>VERSALOOP Anchor System</Name><Description>All-Suture Anchor</Description><Size>2.5 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>379270</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ266</BillingCode><Name>Q-FIX ULTRA All Suture Anchor</Name><Description>Soft suture anchor</Description><Size>2.8mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>428211</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW935</BillingCode><PriorBillingCodes><PriorBillingCode>WR422</PriorBillingCode></PriorBillingCodes><Name>Insite FT PEEK Knotless Suture Anchor</Name><Description>PEEK knotless suture anchor, fully threaded</Description><Size>4.5mm to 6.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>163843</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB071</BillingCode><Name>Peek Suture Anchor</Name><Description>Non-absorbable suture anchor</Description><Size>2.4mm - 3.9mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>323905</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN909</BillingCode><Name>RAPTOR Anchor</Name><Description>Suture anchor for repair and reattachment of the soft tissue</Description><Size>2.4 – 3.9mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN372</BillingCode><Name>GRYPHON PEEK Instability Anchor</Name><Description>PEEK Anchor with PERMACORD suture</Description><Size>3.0 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>133430</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL061</BillingCode><Name>Speedlock HIP Knotless Fixation Implant</Name><Description>PEEK knotless suture anchor implant for fixation of soft tissue to bone in the hip</Description><Size>3.4mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>271876</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN902</BillingCode><Name>FAST-FIX 360</Name><Description>This is a double anchor, self tying device for all-inside meniscal repair</Description><Size>One size</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>120338</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ095</BillingCode><Name>Mitek Super Quick Anchor Plus </Name><Description>Titanium  Anchor, with various sutures</Description><Size>2.8 x 11.4mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>140796</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BU021</BillingCode><Name>Memofix</Name><Description>Threaded Titanium Suture Anchor</Description><Size>Diameter 3mm</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>288706</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ089</BillingCode><Name>Mitek GII QuickAnchor Plus </Name><Description>Titanium Anchor, with various sutures</Description><Size>2.4 x 8.8mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>133430</ARTG><ARTG>140795</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BW020</BillingCode><Name>Biotek Soft Ligament Anchor</Name><Description>Soft tissue ligament anchor loaded with UHMWPE fiber and needle </Description><Size>Diameter: 2.9mm </Size><SupplierCode>40418</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>314305</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM177</BillingCode><Name>RAPTORMITE 3.0 PK</Name><Description>An non-absorbable polymer (PEEK) suture anchor for use in ligament/tendon reconstruction</Description><Size>3mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW939</BillingCode><PriorBillingCodes><PriorBillingCode>WR426</PriorBillingCode></PriorBillingCodes><Name>Piton 2.8mm</Name><Description>Soft Tissue Fixation Implant</Description><Size>2.8mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>163843</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW555</BillingCode><Name>TwinLoop FLEX Anchor</Name><Description>TwinLoop FLEX Anchor</Description><Size>3.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>229717</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ068</BillingCode><PriorBillingCodes><PriorBillingCode>LM489</PriorBillingCode></PriorBillingCodes><Name>Fully Threaded Suture Anchor </Name><Description>Fully Threaded Suture Anchor </Description><Size>2.4-3.9mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>364759</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BW005</BillingCode><Name>Biotek ligament anchor PEEK</Name><Description>A device designed to be implanted into bone for the attachment of soft tissues either directly or via a suture attached to the device. It is typically used in shoulder and some lower-limb operations, and functions as an alternative to drilling a hole in bone for passing a suture. The device is made of a material that cannot be chemically degraded or absorbed via natural body processes</Description><Size>Diameter: 2.8mm; 3.0mm; 3.5mm</Size><SupplierCode>40418</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>314305</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN854</BillingCode><Name>Fast-Fix Ultra</Name><Description>Meniscal suture anchor</Description><Size>One Size</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>154955</ARTG><ARTG>120338</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI968</BillingCode><Name>ToggleLoc</Name><Description>Femoral Fixation Device</Description><Size>15mm-60mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>116765</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA115</BillingCode><Name>Betta Link Knotless Anchor</Name><Description>Knotless Anchor manufactured from PEEK-OPTIMA polymer pre-assembled to stainless steel inserter. Provided as a single-use sterile device.</Description><Size>3.2mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>387052</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF029</BillingCode><Name>ARC Anchors</Name><Description>All suture soft tissue anchor</Description><Size>Large</Size><SupplierCode>40106</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>308785</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HV004</BillingCode><Name>OzAnchor All Suture</Name><Description>Anchor with suture</Description><Size>2.5mm</Size><SupplierCode>40231</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>351431</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV123</BillingCode><Name>Press FT PEEK Suture Anchor</Name><Description>Press FT PEEK Suture Anchor - preloaded on a single driver</Description><Size>2.6mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>136631</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU250</BillingCode><PriorBillingCodes><PriorBillingCode>DE706</PriorBillingCode></PriorBillingCodes><Name>FiberStitch</Name><Description>Meniscal suture anchor</Description><Size>One size only</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>328289</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ085</BillingCode><Name>PEEK Suture Anchor</Name><Description>PEEK Suture Anchor</Description><Size>2.9mm, 3.5mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>352376</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ285</BillingCode><Name>FOOTPRINT MINI PEEK Suture Anchor</Name><Description>FOOTPRINT MINI PEEK Knotless Suture Anchor is pre-assembled on to an insertion device, supplied with ULTRATAPE Suture.
</Description><Size>3.5mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>428211</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU332</BillingCode><Name>SutureLoc Implant</Name><Description>Meniscal suture anchor</Description><Size>2.6mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>384730</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ037</BillingCode><PriorBillingCodes><PriorBillingCode>PJ029</PriorBillingCode></PriorBillingCodes><Name>Draw tight, </Name><Description>Push in anchors suture based. Recommended for use in both large and small repairs. with two sutures </Description><Size>3.2 mm</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>177866</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN329</BillingCode><Name>GRYPHON PEEK Suture Anchor </Name><Description>Anchor with suture</Description><Size>3.0 x 10.7mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>215753</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ307</BillingCode><Name>Q-Fix All Suture Anchor</Name><Description>Soft suture anchor, with MINITAPE</Description><Size>2.8mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ308</BillingCode><Name>Q-Fix All Suture Anchor</Name><Description>Soft suture anchor with Magnumwire</Description><Size>2.8mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>271876</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ298</BillingCode><Name>Knee FiberTak Anchor Button preloaded with sutures</Name><Description>All suture Anchor preloaded with sutures</Description><Size>2.6</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ299</BillingCode><Name>Knee FiberTak Anchor Double Loaded preloaded with sutures</Name><Description>All Suture Anchor preloaded with sutures</Description><Size>2.6mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ300</BillingCode><Name>Knee FiberTak Anchor Internal Brace preloaded with sutures</Name><Description>All Suture Anchor preloaded with sutures</Description><Size>2.6mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU215</BillingCode><PriorBillingCodes><PriorBillingCode>DE198</PriorBillingCode></PriorBillingCodes><Name>Fastak Suture Anchor (Small Bone)</Name><Description>With Fibrewire Suture</Description><Size>Dia. 2.4mm x Length 7.5mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU336</BillingCode><Name>Knotless FiberTak® Biceps</Name><Description>Non-Absorbable Soft Anchor</Description><Size>2.6mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV027</BillingCode><Name>Pre-Loaded Ultrafix RC Anchor</Name><Description>Surgical Grade Stainless Steel, preloaded with 2 #2 sutures</Description><Size>Dia 2.9mm, length 6.5mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>136631</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JG014</BillingCode><Name>CanFIX Titanium Alloy Suture Anchor</Name><Description>Titanium Anchor with sutures, with or without needles</Description><Size>2.8mm, 3.5mm</Size><SupplierCode>40464</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>411055</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW878</BillingCode><PriorBillingCodes><PriorBillingCode>WR348</PriorBillingCode></PriorBillingCodes><Name>Piton Knotless Fixation Implant System</Name><Description>System includes Piton Knotless anchors (single) NiTi and two Force Fiber sutures size #2 UHMWPE</Description><Size>Anchor: one size. Suture: size 2 in the system, options: blue/white or black/white</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>163843</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW559</BillingCode><Name>ICONiX TT Anchor</Name><Description>ICONiX TT Anchor soft-tissue fixation</Description><Size>1.4mm, 2.3mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>229717</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW667</BillingCode><Name>Omega All-PEEK Knotless Anchor</Name><Description>Knotless Suture Anchor</Description><Size>3.9mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>229717</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK584</BillingCode><Name>Pivot Anatomic Labrum Restoration Anchors</Name><Description>High Strength PEEK anchor pre-laoded with suture and inserter for arthroscopic hip labral reattachment</Description><Size>12mm x 2.4-2.8mm, 1.4-2.0mm, 2.8-3.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>207253</ARTG><ARTG>232914</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA119</BillingCode><Name>JuggerLoc Bone-to-Bone</Name><Description>Ankle Syndesmosis Fixation Device</Description><Size>2.9mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>404670</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU270</BillingCode><Name>Biocomposite Swivelock Anchor</Name><Description>Knotless Suture Anchor</Description><Size>3.5mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>354972</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU307</BillingCode><Name>Dx FiberTak double loaded with 0.9mm SutureTape</Name><Description>Soft Tissue Fixation Device</Description><Size>One size only</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL183</BillingCode><Name>MICRORAPTOR Knotless REGENESORB</Name><Description>Knotless Suture Anchor, absorbable</Description><Size>2.4 – 2.75mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>368071</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN903</BillingCode><Name>Minitac</Name><Description>This is a titanium suture anchor with needles for repair and reattachment of the ligaments in small joint arthroscopy</Description><Size>2.0mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN171</BillingCode><Name>Lupine Anchor System</Name><Description>Suture Anchor</Description><Size>3.9mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>154628</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF146</BillingCode><Name>S-Knot Suture Anchor</Name><Description>The S-Knot Suture Anchor is constructed from High Strength Flat Braided Suture threaded with either 2 or 3 #2 suture strands. The anchor may be inserted either by pre-punching using a 2.8mm bone punch or in the instance of softer bone and driven in using a mallet. Once the anchor is below the level of the cortical  bone the anchor is seated by pulling back on the sutures.</Description><Size>2.8mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>193153</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU274</BillingCode><Name>Nano Swivelock Anchor</Name><Description>Soft Tissue Fixation Anchor</Description><Size>2.5mm x 7mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU226</BillingCode><PriorBillingCodes><PriorBillingCode>DE559</PriorBillingCode></PriorBillingCodes><Name>Dx Swivelock SL</Name><Description>A knotless screw in Anchor used for Soft Tissue Fixation</Description><Size>3.5mm Diameter x 8.5mm length</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU338</BillingCode><Name>Double Loaded Knotless Knee FiberTak  </Name><Description>Self-Punching non-bioabsorbable soft anchor</Description><Size>2.6mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>384730</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IB008</BillingCode><Name>AIM-TEC MINI PK</Name><Description>Peek screw type suture anchor system</Description><Size>3mm</Size><SupplierCode>40009</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>259865</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU362</BillingCode><Name>FiberLock Suspensionplasty</Name><Description>The FiberLock Suspension Implant Kit contains the FiberTak Anchor and devices for insertion for CMC arthritis.</Description><Size>One size only</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ054</BillingCode><Name>Parcus AP knotless</Name><Description>AP knotless push in anchors</Description><Size>2.8, mm Anchors</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>375791</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV139</BillingCode><Name>Y-Knot RC &amp; Y-Knot Pro RC Suture Anchor</Name><Description>The Y-Knot RC All-Suture Anchor is constructed from High Strength Flat Braided Suture.</Description><Size>2.8mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>136631</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA020</BillingCode><PriorBillingCodes><PriorBillingCode>ZA010</PriorBillingCode></PriorBillingCodes><Name>Quattro Anchor</Name><Description>Anchor manufactured from PEEK-OPTIMA polymer pre-assembled to stainless steel inserter.</Description><Size>2.9mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>209509</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH361</BillingCode><Name>JuggerKnot/JuggerLoc Soft Anchor</Name><Description>Suture Anchor, Polyester, PE</Description><Size>2.9mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>208040</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ081</BillingCode><Name>PEEK Suture Anchor</Name><Description>PEEK Suture Anchor</Description><Size>2.9mm, 3.5mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>325207</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ113</BillingCode><PriorBillingCodes><PriorBillingCode>KH064</PriorBillingCode></PriorBillingCodes><Name>Rejoin JoinFix All-Suture Anchor</Name><Description>Suture Anchor System</Description><Size>2.4mm - 3.9mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>320191</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT037</BillingCode><Name>AnchorIT</Name><Description>Soft tissue anchor for reattachment of soft tissue to bone.</Description><Size>3.5 mm</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>405362</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU170</BillingCode><Name>Mectalock PEEK</Name><Description>Suture Anchor</Description><Size>2.4 - 3.4 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>320484</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BU027</BillingCode><PriorBillingCodes><PriorBillingCode>PF029</PriorBillingCode></PriorBillingCodes><Name>ARC Anchors</Name><Description>All suture soft tissue anchor</Description><Size>Large</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>336706</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN907</BillingCode><Name>TWINFIX Ti</Name><Description>This is a titanium suture anchor for repair and reattachment of ligaments to bone in joint arthroscopy</Description><Size>2.8mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU234</BillingCode><Name>Pushlock Suture Anchor</Name><Description>Knotless Suture Anchor</Description><Size>2.5 - 3.5mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT034</BillingCode><PriorBillingCodes><PriorBillingCode>IT016</PriorBillingCode></PriorBillingCodes><Name>Anchor It</Name><Description>Fully threaded Titanium suture anchor with fibrewire suture</Description><Size>2.5mm - 3.5mm</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>271554</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU318</BillingCode><Name>FiberTak </Name><Description>Self-Bunching Soft Anchor</Description><Size>2.6</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BW004</BillingCode><Name>Biotek ligament anchor titanium</Name><Description>A device designed to be implanted into bone for the attachment of soft tissues either directly or via a suture attached to the device. It is typically used in shoulder and some lower-limb operations, and functions as an alternative to drilling a hole in bone for passing a suture. The device is made of a material that cannot be chemically degraded or absorbed via natural body processes</Description><Size>Diameter: 2.8mm; 3.5mm;</Size><SupplierCode>40418</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>314305</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ301</BillingCode><Name>Knee FiberTak Anchor, Hybrid preloaded with sutures</Name><Description>All Suture Anchor preloaded with sutures</Description><Size>2.6mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ117</BillingCode><PriorBillingCodes><PriorBillingCode>KH066</PriorBillingCode></PriorBillingCodes><Name>Rejoin Rapidlink</Name><Description>Suture-Anchor Meniscus Repair Device</Description><Size>One Size</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>320191</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU225</BillingCode><Name>FiberTak DR/ FiberTak RC/FiberTak Knotless</Name><Description>Suture Anchor</Description><Size>2.6mm&gt;</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU231</BillingCode><Name>SutureTak</Name><Description>Suture Anchor</Description><Size>2.4mm - 3.9mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU227</BillingCode><Name>Dx Swivelock</Name><Description>A knotless screw in anchor used for soft tissue fixation to bone</Description><Size>2.4 - 3.9mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU217</BillingCode><PriorBillingCodes><PriorBillingCode>DE428</PriorBillingCode></PriorBillingCodes><Name>Corkscrew Suture Anchor</Name><Description>Titanium alloy with Fibrewire suture</Description><Size>3.5mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU269</BillingCode><Name>BioComposite PushLock</Name><Description>BioComposite Pushlock Knotless Suture Anchor</Description><Size>2.4 - 3.5 mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>354973</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ115</BillingCode><PriorBillingCodes><PriorBillingCode>KH063</PriorBillingCode></PriorBillingCodes><Name>Rejoin Peek Anchor System</Name><Description>Suture Anchor System</Description><Size>2.4mm - 3.9mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>320191</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV010</BillingCode><Name>Mini-Revo Screw</Name><Description>Soft Tissue Re-attachment - Titanium</Description><Size>2.7mm diameter</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>136631</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU368</BillingCode><Name>Knotless FiberTak Biceps Implant</Name><Description>soft tissue fixation anchor </Description><Size>3mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU179</BillingCode><Name>All-Suture Anchor Size 2</Name><Description>Suture Anchor</Description><Size>Ø 2.4 and 2.8 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>330998</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ267</BillingCode><Name>GRYPHON BR PROKNOT</Name><Description>Biocryl Rapide anchor with Permacord suture
</Description><Size>3.00</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>257872</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL155</BillingCode><Name>RAPTOR Anchor - Absorbable</Name><Description>Absorbable suture anchor for repair and reattachment of the soft tissue</Description><Size>2.4 – 3.9mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>164725</ARTG><ARTG>161696</ARTG><ARTG>348730</ARTG><ARTG>164726</ARTG><ARTG>164727</ARTG><ARTG>169170</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF077</BillingCode><Name>Signature Vector™ Anchor</Name><Description>These are an hydroxyapatite incorporated absorbable suture anchor for repair and
reattachment of the labrum in shoulder and hip arthroscopy.</Description><Size>2.9mm, 3.2mm, 3.5mm and 3.7mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>193153</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU248</BillingCode><Name>BioComposite SutureTak</Name><Description>Suture Anchor</Description><Size>2.4 – 3mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>354970</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV126</BillingCode><Name>GENESYS PressFT Suture Anchor 2.6mm</Name><Description>The ConMed Linvatec GENESYS PressFT (biocomposite) Suture Anchors are manufactured from polylactide copolymer (96L/4D PLA co-polymer) and beta-tricalcium phosphate (B-TCp), and are provided sterile, preloaded on a single-use driver and pre-threaded with either one or two Hi-Fi Sutures</Description><Size>2.6mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>208881</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ928</BillingCode><Name>Bioknotless Anchor System</Name><Description>Suture Anchor</Description><Size>3.9mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>154629</ARTG><ARTG>154630</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN340</BillingCode><Name>GRYPHON BR Instability Anchor</Name><Description>Suture Anchor</Description><Size>3.0 x 10.7mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>388083</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ945</BillingCode><Name>GRYPHON BR Instability Anchor</Name><Description>Suture Anchor</Description><Size>2.4-3.0mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>165434</ARTG><ARTG>165465</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF129</BillingCode><Name>FAA Anchor</Name><Description>These are PLA/TCP absorbable anchor with suture for repair and reattachment of the labrum in shoulder and hip arthroscopy.</Description><Size>2.4mm, 3.0mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>193153</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU224</BillingCode><Name>Knotless Hip SutureTak</Name><Description>Knotless suture anchor for hip labral fixation</Description><Size>Diameter: 3mm  Length: 12.7mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU230</BillingCode><Name>SwiveLock Suture Anchor</Name><Description>Suture Anchor</Description><Size>3.5mm - 3.9mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112002</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM454</BillingCode><Name>VIMS large ligament anchor titanium</Name><Description>A device designed to be implanted into bone for the attachment of soft tissues either directly or via a suture attached to the device. It is typically used in shoulder and some lower-limb operations, and functions as an alternative to drilling a hole in bone for passing a suture. The device is made of a material that cannot be chemically degraded or absorbed via natural body processes</Description><Size>Diameter: 5.0mm; 5.5mm; 6.5mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>338393</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA066</BillingCode><Name>Allthread Anchors</Name><Description>suture anchors</Description><Size>4.5-6.8mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>117747</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF103</BillingCode><Name>Galileo Anchor</Name><Description>PEEK Anchor with sutures, with or without needles.</Description><Size>4.0mm, 4.5mm diameters</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>193153</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN331</BillingCode><Name>HEALIX ADVANCE™ Anchor with DYNATAPE™ Suture</Name><Description>PEEK anchor with DYNATAPE suture and DYNACORD suture</Description><Size>4.5-6.5mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>215753</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV152</BillingCode><Name>Argo Knotless PEEK SP Anchor</Name><Description>The CONMED Argo KnotlessTM Anchors are manufactured from PolyEtherEtherKetone (PEEK). Self-punching products include tips manufactured from Titanium. The anchors are provided sterile, preloaded on a single-use driver and pre-threaded with one Hi-Fi® Ribbon. It may be used in either arthroscopic or open surgical procedures. After the suture is anchored to the bone, it may be used to reattach soft tissue, such as ligaments, tendons, or joint capsules to the bone. The suture anchor system thereby stabilizes the damaged soft tissue, in conjunction with appropriate postoperative immobilization throughout the healing period.</Description><Size>4.75mm, 5.5mm PEEK suture anchors with Ti self-punching tip  </Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>376571</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ274</BillingCode><Name>Healix  Anchor System</Name><Description>PEEK anchor with PERMATAPE suture (Blue or While/Blue)</Description><Size>Anchor diameter: 4.5 mm; 5.5 mm; 6.5 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>215753</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ275</BillingCode><Name>Healix  Anchor System</Name><Description>PEEK anchor with ORTHOCORD suture</Description><Size>Anchor diameter: 4.5 mm; 5.5 mm; 6.5 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>205027</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN703</BillingCode><Name>TWINFIX ULTRA - Absorbable Suture Anchor</Name><Description>Preloaded Absorbable HA Suture Anchor (combines PLLA with HA)</Description><Size>4.5 mm to 6.5 mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>181413</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF079</BillingCode><Name>Carbine CF Anchor</Name><Description>These are CF PEEK suture anchor for repair and reattachment of the soft tissue in the
shoulder.</Description><Size>4.5mm, 5.5mm and 6.5mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>193153</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ163</BillingCode><Name>TRUESPAN Meniscal Repair System Absorbable</Name><Description>Preloaded PLGA backstops and ORTHOCORD suture</Description><Size>0, 12, 24 degree Needle</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>425610</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN245</BillingCode><Name>HEALIX Anchor System</Name><Description>Biocryl Rapide anchor with Permatape suture</Description><Size>4.5-6.5mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>311080</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF076</BillingCode><Name>Signature Vortex™ Anchor</Name><Description>These are an hydroxyapatite incorporated PEEK suture anchor for repair and reattachment of
the soft tissue in the shoulder.</Description><Size>4.5mm, 5.5mm and 6.5mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>193153</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BW028</BillingCode><Name>BIO-VIM Bioabsorbable Ligament Anchor</Name><Description>Bioabsorbable Ligament Anchor</Description><Size>Diameter (mm) 4.5 - 5.5</Size><SupplierCode>40418</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>393985</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT022</BillingCode><Name>Loop It</Name><Description>Titanium or stainless steel fixation device with non-absorbable fibrewire suture material</Description><Size>One Size Only</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>297561</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU273</BillingCode><Name>BioComposite Corkscrew Suture Anchor</Name><Description>Suture Anchor</Description><Size>&gt;4mm-6.5mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>354971</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV118</BillingCode><Name>Genesys CrossFT</Name><Description>Micro TCP Soft Tissue Suture Anchor with multiple sutures with or without needles</Description><Size>4.5mm, 5.5mm, 6.5mm diameters</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>194022</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ097</BillingCode><Name>Fastin Anchor System</Name><Description>Suture Anchor</Description><Size>5 - 6.5mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>133430</ARTG><ARTG>152661</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU174</BillingCode><Name>MectaTap Ti</Name><Description>Suture Anchor</Description><Size>Ø 5 - 6.5</Size><SupplierCode>40166</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>324941</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ050</BillingCode><Name>Parcus AP twist</Name><Description>Twist screw in AP anchor</Description><Size>4.5-6.5 mm</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>375791</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL046</BillingCode><Name>Healicoil Regenesorb</Name><Description>HEALICOIL REGENESORB Suture Anchor</Description><Size>4.75mm and 5.5mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>231879</ARTG><ARTG>276921</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN257</BillingCode><Name>HEALIX Anchor System</Name><Description>Biocryl Rapide anchor with Dynacord suture</Description><Size>4.5-6.5mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>330845</ARTG><ARTG>330847</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM179</BillingCode><Name>TWINFIX Ti</Name><Description>This is a titanium suture anchor for repair and reattachment of ligaments to bone in joint arthroscopy</Description><Size>4.5mm, 5.5mm, 6.5mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL055</BillingCode><Name>ArthroCare Anchor System</Name><Description>Anchor fixating soft tissue to bone</Description><Size>4.5,5.5mm &amp; 6.5mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>271876</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN652</BillingCode><Name>OBL Anchor System </Name><Description>Soft Tissue Anchor System Non-preloaded Material:  Titanium Alloy</Description><Size>4.0 and 6.5mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN211</BillingCode><Name>Truespan meniscal repair system</Name><Description>Pre-loaded Peek backstops and ORTHOCORD suture</Description><Size>0 to 24 degree</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>292990</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF148</BillingCode><Name>Dynaloc Shoulder Anchor</Name><Description>PEEK Optima Shoulder Anchor</Description><Size>4.5, 5.5, 6.5mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>193153</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL182</BillingCode><Name>HEALICOIL Knotless REGENESORB</Name><Description>Absorbable Suture Anchors</Description><Size>5.5mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>382150</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF184</BillingCode><Name>Bondi</Name><Description>Twist-in knotless Suture Anchor</Description><Size>4.75mm, 5.5mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>193153</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ049</BillingCode><Name>Parcus AP large</Name><Description>AP knotless push in Anchors Large</Description><Size>4.5, 5,5 mm </Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>375791</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL258</BillingCode><PriorBillingCodes><PriorBillingCode>SL162</PriorBillingCode></PriorBillingCodes><Name>HEALICOIL</Name><Description>HEALICOIL PEEK Suture Anchor with and without needles</Description><Size>4.5mm; 5.0mm and 5.5mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>120338</ARTG><ARTG>428211</ARTG><ARTG>109451</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Description, Size</ChangeExplanation><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN651</BillingCode><Name>OBL Anchor System</Name><Description>Preloaded Soft Tissue Anchor System Material: Titanium Alloy or Polyacetal Polymer. Comes with Insertion device and 2 Braided Polyester Sutures</Description><Size>Anchor sizes - Titanium: 2.8, 3.5, 4.0 5.0, 6.5mm Anchor size - Polymer: 5.0mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA122</BillingCode><Name>GENIE Biocomposite Suture Anchor</Name><Description>absorbable bone fixation anchor</Description><Size>4.5 - 5.5 mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>412790</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA121</BillingCode><Name>ComposiTCP Double Loaded Suture Anchors</Name><Description>Threaded anchor system made of DUOSORB® 30 (β-TCP 30%/ PLDLLA 70%) a composite, absorbable material.</Description><Size>4.5mm, 5.5mm, 6.5mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>424492</ARTG><ARTG>424490</ARTG><ARTG>424491</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU221</BillingCode><PriorBillingCodes><PriorBillingCode>DE707</PriorBillingCode></PriorBillingCodes><Name>TightRope Implant with FiberTag Suture</Name><Description>TightRope implant pre-loaded with FiberTag suture</Description><Size>One size only</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>353493</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IB007</BillingCode><Name>AIM-TEC PRIM PK</Name><Description>Peek screw type suture anchor system</Description><Size>5mm, 6.5mm</Size><SupplierCode>40009</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>259865</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU251</BillingCode><Name>BioComposite SwiveLock</Name><Description>BC SwiveLock</Description><Size>&gt;4mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>354972</ARTG><ARTG>354974</ARTG><ARTG>354975</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU233</BillingCode><PriorBillingCodes><PriorBillingCode>DE434</PriorBillingCode></PriorBillingCodes><Name>Pushlock Suture Anchor</Name><Description>Knotless Suture Anchor</Description><Size>4.5mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ110</BillingCode><PriorBillingCodes><PriorBillingCode>KH071</PriorBillingCode></PriorBillingCodes><Name>Rejoin HealFix Suture Anchor</Name><Description>Suture Anchor System</Description><Size>Greater than 4mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>320191</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV143</BillingCode><Name>TenoLok</Name><Description>Soft tissue anchor with or without suture</Description><Size>5.0mm and 6.0mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>136631</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU252</BillingCode><Name>BioComposite PushLock</Name><Description>Knotless Suture Anchor</Description><Size>4.5mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>354973</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU232</BillingCode><Name>Swivelock</Name><Description>Twist-in knotless suture anchor</Description><Size>≥4mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ116</BillingCode><PriorBillingCodes><PriorBillingCode>KH072</PriorBillingCode></PriorBillingCodes><Name>Rejoin Peek Suture Anchor</Name><Description>Suture Anchor System</Description><Size>Greater than 4.0mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>320191</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV117</BillingCode><Name>CrossFT Suture Anchor Polyester</Name><Description>PEEK Optima Suture Anchor with Multiple Polyester Sutures</Description><Size>4.5mm, 5.5mm and 6.5mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>136631</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU235</BillingCode><Name>Corkscrew FT</Name><Description>Suture Anchor with Fiberwire</Description><Size>4mm - 6.5mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV145</BillingCode><Name>CrossFt Knotless DT</Name><Description>Screw in knotless anchor</Description><Size>4.0mm CrossFT Knotless Anchor  4.0mm CrossFT Knotless Anchor (w/ 1 blue Hi-Fi tape)  4.0mm CrossFT Knotless Anchor (w/ 1 white/black Hi-Fi tape)  4.75mm CrossFT Knotless Anchor   4.75mm CrossFT Knotless Anchor (w/ 1 blue Hi-Fi tape)  4.75mm CrossFT Knotless Anchor (w/ 1 white/black Hi-Fi tape)  5.5mm CrossFT Knotless Anchor   5.5mm CrossFT Knotless Anchor (w/ 1 blue Hi-Fi tape)  5.5mm CrossFT Knotless Anchor (w/ 1 white/black Hi-Fi tape)</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>136631</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ269</BillingCode><Name>HEALIX ADVANCE Anchor System</Name><Description>Biocryl Rapide anchor with ORTHOCORD suture</Description><Size>Anchor diameter: 4.5 mm; 5.5 mm; 6.5 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>205025</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ270</BillingCode><Name>HEALIX ADVANCE Anchor System</Name><Description>Biocryl Rapide anchor with ORTHOCORD suture and needle</Description><Size>Anchor diameter: 5.5 mm; 6.5 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>205024</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ271</BillingCode><Name>HEALIX ADVANCE Knotless Anchor System</Name><Description>Biocryl Rapid anchor with ORTHOCORD suture</Description><Size>Anchor diameter: 4.75 mm; 5.5 mm; 6.5 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>330848</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BW006</BillingCode><Name>Biotek large ligament anchor titanium</Name><Description>A device designed to be implanted into bone for the attachment of soft tissues either directly or via a suture attached to the device. It is typically used in shoulder and some lower-limb operations, and functions as an alternative to drilling a hole in bone for passing a suture. The device is made of a material that cannot be chemically degraded or absorbed via natural body processes</Description><Size>Diameter: 5.0mm; 5.5mm; 6.5mm</Size><SupplierCode>40418</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>314305</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY577</BillingCode><Name>Healix Anchor System</Name><Description>Titanium anchor with suture</Description><Size>4.5 - 6.5mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>133430</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN325</BillingCode><Name>HEALIX Anchor System </Name><Description>Self-Punching Biocomposite Anchor</Description><Size>4.9 mm, 5.5 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>382170</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BW010</BillingCode><Name>Biotek Ligament Anchor</Name><Description>Soft tissue ligament anchor loaded with UHMWPE fiber and needle </Description><Size>4.50mm - 8.00mm</Size><SupplierCode>40418</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>314305</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ678</BillingCode><Name>Versalok Bone Anchor System</Name><Description>Suture anchor</Description><Size>4.9-6.3mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>154329</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BU022</BillingCode><Name>Memofix</Name><Description>Threaded Titanium Suture Anchor</Description><Size>Diameter 4mm to 5mm</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>288706</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BW027</BillingCode><Name>Knotless Bioabsorbable Ligament Anchor</Name><Description>Knotless Bioabsorbable Ligament Anchor</Description><Size>Diameter (mm) 4.75 - 5.5</Size><SupplierCode>40418</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>393986</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BW008</BillingCode><Name>Biotek large suture anchor PEEK</Name><Description>A device designed to be implanted into bone for the attachment of soft tissues either directly or via a suture attached to the device. It is typically used in shoulder and some lower-limb operations, and functions as an alternative to drilling a hole in bone for passing a suture. The device is made of a material that cannot be chemically degraded or absorbed via natural body processes</Description><Size>Diameter: 5.5mm</Size><SupplierCode>40418</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>314305</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN271</BillingCode><Name>HEALIX Anchor System</Name><Description>Self-Punching PEEK Anchor</Description><Size>4.9 mm, 5.5 mm , 6.5 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>215753</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF153</BillingCode><Name>ATOK Anchor</Name><Description>PEEK Shoulder Anchor</Description><Size>4.5, 5.5, 6.5mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>193153</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF003</BillingCode><Name>Signature Turbine™ Anchor</Name><Description>PEEK fully threaded suture anchor</Description><Size>4.5mm, 5.5mm &amp;6.5mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>193153</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF130</BillingCode><Name>PEEKay knotless Anchor</Name><Description>These are PEEK OPTIMA knotless anchors for repair and reattachment of soft tissue in the shoulder.</Description><Size>4.5mm, 5.5mm and 6.5mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>193153</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF078</BillingCode><Name>Christmas Anchor</Name><Description>Titanium Anchor with sutures, with or without needles.</Description><Size>4.5mm, 5.5mm and 6.5mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>193153</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ277</BillingCode><Name>HEALIX ADVANCE Knotless Anchor System</Name><Description>PEEK anchor with ORTHOCORD suture</Description><Size>Anchor diameter: 4.75 mm; 5.5 mm; 6.5 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>330849</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ276</BillingCode><Name>Healix  Anchor System</Name><Description>PEEK anchor with ORTHOCORD suture and needle</Description><Size>Anchor diameter: 5.5 mm; 6.5 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>205026</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA123</BillingCode><Name>GENIE Biocomposite/PEEK Suture Anchor</Name><Description>Biocomposite/PEEK suture anchor</Description><Size>4.5 - 5.5 mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>412791</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ036</BillingCode><PriorBillingCodes><PriorBillingCode>SV040</PriorBillingCode></PriorBillingCodes><Name>V-Lox Titanium Suture Anchors</Name><Description>Titanium Fully Threaded Suture Anchor</Description><Size>4.5mm; 5.0mm; 5.5mm; 6.5mm, double loaded and triple loaded suture anchors</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>177866</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ046</BillingCode><PriorBillingCodes><PriorBillingCode>PJ034</PriorBillingCode></PriorBillingCodes><Name>SLik Fix</Name><Description>Screw in system recomended for teh use in both large and small joint repairs made from PEEK carbon fiber</Description><Size>7mm, 8mm, 9mm </Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>177866</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL257</BillingCode><PriorBillingCodes><PriorBillingCode>SL162</PriorBillingCode></PriorBillingCodes><Name>FOOTPRINT</Name><Description>FOOTPRINT PEEK Suture Anchor</Description><Size>4.5mm to 6.5mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM147</BillingCode><Name>Twinfix PK</Name><Description>PEEK Optima fully threaded suture anchor</Description><Size>4.5mm 5.5mm and 6.5mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV091</BillingCode><Name>ThRevo Suture Anchor</Name><Description>Titanium screw-in suture anchor</Description><Size>5.0mm OD x 14.2mm L</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>136631</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU229</BillingCode><PriorBillingCodes><PriorBillingCode>DE474</PriorBillingCode></PriorBillingCodes><Name>Achilles Speedbridge Convenience Pack</Name><Description>Disposable convenience pack for Achilles Insertional Tendonopathy</Description><Size>one size</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV116</BillingCode><Name>Sequent Meniscal Repair Device</Name><Description>The Sequent Meniscal Repair Device is pre-loaded with polyetheretherketone (PEEK) implants threaded onto one size #0 (3.5 metric) HiFi® suture.  The device sequentially deplos the implants and suture that are tightened down to create multiple stitches to create fixation points along a soft tissue tear</Description><Size>4 (5.1mm  x 1.3mm Implants</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>120427</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV153</BillingCode><Name>Infinity AIM</Name><Description>The Infinity AIM™ is an implantable suture retention device which facilitates percutaneous or endoscopic repair of meniscal tears. The Infinity AIM™ is composed of two (2) polyetheretherketone (PEEK) implants and a strand of #2-0 ultra-high molecular weight polyethylene (UHMWPE) Hi-Fi® suture, blue in color, from solid blue DSM fiber (Cr-Co-Al Oxidecolorant).  </Description><Size>Infinity AIM™, KMR2R - 15° Reverse with two 5mm polyetheretherketone (PEEK) implants and a strand of #2-0 ultra-high molecular weight polyethylene (UHMWPE) Hi-Fi® suture between them        Infinity AIM™ KMR2S 25° Curved with two 5mm polyetheretherketone (PEEK) implants and a strand of #2-0 ultra-high molecular weight polyethylene (UHMWPE) Hi-Fi® suture between them  </Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>136631</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU173</BillingCode><Name>Mectalock Ti</Name><Description> Suture Anchor</Description><Size>Ø 5 - 6.5</Size><SupplierCode>40166</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>324941</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU220</BillingCode><PriorBillingCodes><PriorBillingCode>DE688</PriorBillingCode></PriorBillingCodes><Name>Cinch II</Name><Description>Meniscal anchor</Description><Size>L: 5.3mm   D: 1.1 mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>353493</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV151</BillingCode><Name>Argo Knotless PEEK NSP Anchor</Name><Description>The CONMED Argo KnotlessTM Anchors are manufactured from PolyEtherEtherKetone (PEEK). Non-self-punching products include tips manufactured from PEEK. The anchors are provided sterile, preloaded on a single-use driver and pre-threaded with one Hi-Fi® Ribbon. It may be used in either arthroscopic or open surgical procedures. After the suture is anchored to the bone, it may be used to reattach soft tissue, such as ligaments, tendons, or joint capsules to the bone. The suture anchor system thereby stabilizes the damaged soft tissue, in conjunction with appropriate postoperative immobilization throughout the healing period.</Description><Size>4.75mm, 5.5mm PEEK NSP suture anchors</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>376571</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV113</BillingCode><Name>PopLok Suture Anchor</Name><Description>PEEK Optima Suture Anchor with or without sutures</Description><Size>2.8mm, 3.3mm, 3.5mm &amp; 4.5mm diameters</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>136631</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO408</BillingCode><Name>Acu-Sinch Repair System</Name><Description>This is a suture-and-anchor soft tissue repair system designed to complement the Acumed Clavicle Plating system by treating coracoclavicular ligament repair injuries associated with clavicle fractures and is used in conjuction midshaft or distal clavicle plate. All Acu-Sinch kits come in a sterile procedure pack.</Description><Size>Titanium Anchor: D=5.5mm, L=12mm
Titanium Suture Retainer: L=5.3mm, W=4mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>45062</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB072</BillingCode><Name>Peek Suture Anchor</Name><Description>Peek suture anchor</Description><Size>Great than 4mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>323905</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ031</BillingCode><Name>Knotless PEEK CF Suture Anchors</Name><Description>Suture Anchor, PEEK CF</Description><Size>4.5mm   5.5mm</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>177866</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ055</BillingCode><Name>X-twist Knotless Suture Anchor </Name><Description>Knotless open architecture and fast inserting suture anchor system with multiple sliding suture or tissue sparing tape configurations and is available in PEEK Optima in 4.75mm, 5.5mm and 6.25mm diameters. The Anika X-Twist system is designed to be used in both single row and double row rotator cuff  repairs as well as other knotless or knotted soft tissue repairs.</Description><Size>4.75mm. 5.5mm, 6.25mm </Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>393388</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB067</BillingCode><Name>Full Thread Suture Anchor</Name><Description>Suture Anchor</Description><Size>&gt; 4mm </Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>323905</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ044</BillingCode><Name>Parcus Twist Screw in PEEK suture Anchors</Name><Description>Screw in PEEK CF anchors recommended for small and large joints. Optimal cortical fixation, Non aborbable, radiolucent. PEEK body anchors assembled with 0, 1, 2, 3 sutures or suture tape.  </Description><Size>4.25, 4.75, 5.5, 6.25, 6.5 mm</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>177866</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ045</BillingCode><PriorBillingCodes><PriorBillingCode>PJ034</PriorBillingCode></PriorBillingCodes><Name>SLik Knot-less CF</Name><Description>Knot-less screw in anchor recommended for use in large and small joint repairs</Description><Size>5.5mm- 6.25mm</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>177866</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL242</BillingCode><Name>FAST-FIX FLEX Meniscal Repair System</Name><Description>Soft Tissue Anchor Fixation – PEEK (FLEX Curved or Reverse Curved with or without Bend Tool and Slotted Cannula)</Description><Size>5mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>120338</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT033</BillingCode><PriorBillingCodes><PriorBillingCode>IT016</PriorBillingCode></PriorBillingCodes><Name>Anchor It 5mm</Name><Description>Fully threaded suture anchor with fibrewire suture</Description><Size>5mm</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>271554</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV112</BillingCode><Name>CrossFT Suture Anchor</Name><Description>PEEK Optima Suture Anchor with multiple sutures with or without needles</Description><Size>4.5mm, 5.5mm &amp; 6.5mm diameters</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>136631</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV114</BillingCode><Name>Super Revo-FT,ThRevo-FT</Name><Description>Fully Threaded Suture Anchor pre-threaded with two or three sutures with or without needles</Description><Size>5mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>136631</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV122</BillingCode><Name>Sequent Meniscal Repair Device - 3 Implant</Name><Description>The Sequential Meniscal Repair Device is pre-loaded with polyetheretheketone (PEEK) implants threaded onto one size #0 (3.5 metric) HiFi suture.</Description><Size>5.1mm x 1.3mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>120427</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV090</BillingCode><Name>Super Revo Suture Anchor with Hi-Fi Suture</Name><Description>Titanium Suture Anchor</Description><Size>5.0mm O.D x 14.2mm L</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>136631</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU236</BillingCode><Name>Corkscrew Suture Anchor</Name><Description>Non Absorbable Suture Anchor</Description><Size>&gt;4mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU181</BillingCode><Name>MectaLock PEEK</Name><Description>Suture Anchor</Description><Size>Ø 4.5 - 5.5 - 6.5 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>320484</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU319</BillingCode><Name>ACL Repair TightRope</Name><Description>Knotless tensionable system pre-loaded with FiberTape for ACL Repair. The kit includes the button/ anchor with the construct.</Description><Size>One size only</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>383904</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JG015</BillingCode><Name>CanFIX Titanium Alloy Suture Anchor</Name><Description>Titanium Anchor with sutures, with or without needles.</Description><Size>4.5mm, 5.0mm, 5.5mm and 6.5mm</Size><SupplierCode>40464</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>411055</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV009</BillingCode><Name>Revo Cancellous Screw</Name><Description>Soft Tissue Re-attachment - Titanium</Description><Size>4mm diameter</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>136631</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA021</BillingCode><PriorBillingCodes><PriorBillingCode>ZA010</PriorBillingCode></PriorBillingCodes><Name>Quattro Link Knotless Anchor</Name><Description>Knotless Anchor manufactured from PEEK-OPTIMA polymer pre-assembled to stainless steel inserter. Provided as a single-use sterile device.</Description><Size>4.5mm and 5.5mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>209509</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW556</BillingCode><Name>Titanium Intraline Anchor</Name><Description>Titanium Intraline Anchor</Description><Size>5.5mm, 6.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>229717</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK176</BillingCode><Name>Stryker Cuff Anchor</Name><Description>Bio Zip PLLA anchor for soft tissue ligament/tendon fixation</Description><Size>Dia 3 - 8mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>151656</ARTG><ARTG>152291</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW840</BillingCode><PriorBillingCodes><PriorBillingCode>WR299</PriorBillingCode></PriorBillingCodes><Name>GRAVITY</Name><Description>Titanium Suture Anchor System</Description><Size>5.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>175633</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA072</BillingCode><Name>Ventix Anchor</Name><Description>soft tissue anchor</Description><Size>4.75mm and 5.5mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>349650</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA088</BillingCode><Name>Genie PEEK Anchors/Fix2Lock Anchors PEEK</Name><Description>Knotless anchor manufactured from PEEK. Provided as a single use device</Description><Size>4.5mm &amp; 5.5mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>354952</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA011</BillingCode><Name>Quattro X Suture Anchor</Name><Description>Suture Anchor with sutures, manufactured from PEEK-OPTIMA polymer pre assembled to stainless stell inserter. Provided as a single-use sterile device.</Description><Size>5.5mm and 6.5mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>209509</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HV005</BillingCode><Name>OzAnchor Knotless PEEK</Name><Description>PEEK Suture Anchor</Description><Size>4.5mm</Size><SupplierCode>40231</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>351629</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM456</BillingCode><Name>VIMS large suture anchor PEEK</Name><Description>A device designed to be implanted into bone for the attachment of soft tissues either directly or via a suture attached to the device. It is typically used in shoulder and some lower-limb operations, and functions as an alternative to drilling a hole in bone for passing a suture. The device is made of a material that cannot be chemically degraded or absorbed via natural body processes</Description><Size>Diameter: 5.5mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>338393</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW891</BillingCode><PriorBillingCodes><PriorBillingCode>WR364</PriorBillingCode></PriorBillingCodes><Name>Insite FT anchors</Name><Description>Bone anchors Ti or PEEK, preloaded with suture with or without needle.</Description><Size>4.5mm, 5.5mm or 6.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>163843</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW666</BillingCode><Name>Omega All-PEEK Knotless Anchor</Name><Description>Knotless Suture Anchor</Description><Size>4.75mm to 7mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>229717</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN246</BillingCode><Name>HEALIX Anchor System</Name><Description>PEEK anchor with Dynacord suture</Description><Size>4.5 - 6.5mm anchor diameter</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>215753</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW554</BillingCode><Name>ReelX STT Anchor</Name><Description>ReelX STT Knotless Anchor (PEEK)</Description><Size>5.5mm, 4.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>226667</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM458</BillingCode><Name>VIMS Ligament Anchor</Name><Description>Soft tissue ligament anchor loaded with UHMWPE fiber and needle </Description><Size>4.50mm - 8.00mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>338393</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW552</BillingCode><Name>PEEK Intraline Suture Anchor</Name><Description>PEEK Intraline Suture Anchor</Description><Size>5.5mm, 6.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>229717</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW553</BillingCode><Name>PEEK Zip Anchor</Name><Description>PEEK Zip Anchor</Description><Size>5.5mm, 6.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>229717</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW638</BillingCode><Name>NanoTack TT Anchor</Name><Description>NanoTack TT Anchor with tape</Description><Size>1.4mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>229717</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU280</BillingCode><Name>DX Swivelock Anchor</Name><Description>Soft Tissue Fixation Anchor</Description><Size>4.75mm x 12mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>353482</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VY002</BillingCode><PriorBillingCodes><PriorBillingCode>LM387</PriorBillingCode></PriorBillingCodes><Name>Suture Anchors with Suture</Name><Description>Suture Anchors with Suture</Description><Size>4.0mm or larger</Size><SupplierCode>40467</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>324214</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ041</BillingCode><PriorBillingCodes><PriorBillingCode>SV041</PriorBillingCode></PriorBillingCodes><Name>V-Lox PEEK CF Suture Anchors</Name><Description>PEEK CF Fully Threaded Suture Anchor</Description><Size>4.5m; 5.5mm; 6.5mm,</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>177866</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI114</BillingCode><Name>AClip Femoral</Name><Description>Ligament or tendon anchoring device</Description><Size>One size only</Size><SupplierCode>40041</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>294174</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ069</BillingCode><PriorBillingCodes><PriorBillingCode>LM490</PriorBillingCode></PriorBillingCodes><Name>Fully Threaded Suture Anchor </Name><Description>Fully Threaded Suture Anchor </Description><Size>≥4mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>364759</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV023</BillingCode><Name>AlphaVent</Name><Description>Suture Anchor</Description><Size>4.75mm, 5.50mm, 6.50mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112003</SubGroupID><ARTGs><ARTG>229717</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV147</BillingCode><Name>MicroLink All-Suture Button</Name><Description>The MicroLink™ All-Suture Button (Radiopaque) is an all-suture suspension device with one strand of #2 (5  metric) Hi-Fi® suture, a radiopaque flat braid Hi-Fi® Suture Button and a radiopaque flat braid Hi-Fi® suture  Backstop</Description><Size>N/A</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>136631</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL071</BillingCode><Name>Ultrabutton Adjustable Fixation Device</Name><Description>Ultrabutton construct is pre-assembled titanium button with interlocking threads and flip suture (which controls to the button).</Description><Size>One size only</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>271876</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF154</BillingCode><Name>Signaflip</Name><Description>Fixation for ACL/PCL repair</Description><Size>Fixed/Adjustable loop, 15-60mm length</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>193153</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU223</BillingCode><PriorBillingCodes><PriorBillingCode>DE548</PriorBillingCode></PriorBillingCodes><Name>Tightrope</Name><Description>Titanium or stainless steel fixation device, with non absorbable suture material</Description><Size>2.6mm - 13mm, various shapes, adjustable length suture</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>353493</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU326</BillingCode><Name>Knotless Distal Clavicle Plate Button TightRope® Implant</Name><Description>Knotless Distal Clavicle Plate Button attached to a large Pec Button pre-loaded on an inserter. Titanium or stainless steel button, with nonabsorbable UHMWPE suture material.</Description><Size>One size only</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>350871</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU331</BillingCode><Name>Knotless Mini Tightrope Implant System, 2.7mm, Titanium</Name><Description>Button fixation for ligament repair</Description><Size>One size only</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>350631</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ259</BillingCode><Name>Hercules Syndesmosis Implant Kit</Name><Description>Implant and Instrument Kit containing Two Titanium Alloy buttons tensioned with UHMWPE suture and guidewires and drill bits for stabilisation of the ankle.</Description><Size>1 Size</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>431330</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ108</BillingCode><PriorBillingCodes><PriorBillingCode>KH067</PriorBillingCode></PriorBillingCodes><Name>Rejoin Button</Name><Description>Suture Button</Description><Size>Multiple</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>320191</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU172</BillingCode><Name>Cortical Fixation System</Name><Description>ACL Femoral Cortical Fixation</Description><Size>Length 15mm to 40mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>320480</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV142</BillingCode><Name>Knee Preservation System - GraftMax</Name><Description>Adjustable loop button for soft tissue fixation</Description><Size>KS-ALB and KS BTB (LxWxH):  14mm x 4.5mm x 2mm
KS-BCA (Cradle) (LxWxH): 21mm x 6mm x 2.8mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>136631</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU184</BillingCode><Name>FairFix Adjustable Button System</Name><Description>Button with non absorbable suture material</Description><Size>Adjustable loop length</Size><SupplierCode>40166</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>365812</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU339</BillingCode><Name>Knotless Mini Tightrope Implant System, 1.1mm Titanium</Name><Description>1.1mm Knotless Tightrope Implant System includes the Knotless Mini Tightrope Construct, 2 Buttons, Suture, Passing wires and pins, and Kite Handle.</Description><Size>one size only</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>350631</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU324</BillingCode><Name>TightRope II RT Implant</Name><Description>Suture construct with button for soft tissue to bone fixation for ACL/PCL repair and reconstruction. </Description><Size>One Size Only</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>383904</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV148</BillingCode><Name>Infinity Femoral Adjustable Loop Button</Name><Description>The Infinity Fixation System is a metal buttons and non-absorbable Hi-Fi suture for suspensory fixation of soft tissue grafts to bone used in ligament reconstruction procedures.The cradle is an adaptor for the adjustable loop button, used for wide tunnels.</Description><Size>N/A</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>136631</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ052</BillingCode><PriorBillingCodes><PriorBillingCode>LV154</PriorBillingCode></PriorBillingCodes><Name>Xiros Secure-Loop with Button</Name><Description>The SECURE-LOOP fixation device consists of a sterile and non-absorbable polyester continuous loop captured on a titanium alloy button. The button sits on the exit to a bone tunnel on the cortex, suspending the continuous loop inside the tunnel to provide secure, strong fixation for ligament reconstruction. The SECURE-LOOP fixation device is supplied with sutures that are used  to pull the graft assembly into place andthen flip the button, allowing ligament  reconstruction to be performedarthroscopically. The SECURE-LOOP has been designed to be implantable using generic ACL guidewire systems and a standard technique. Thesuture meets applicable specifications established by the United States Pharmacopeia (USP) for nonabsorbable surgical sutures. The fixation device is made of titanium alloy which meets ISO 5832-3.</Description><Size>10 mm  15 mm  20 mm  25 mm  30 mm  35 mm  40 mm  45 mm  50 mm  55 mm  60 mm</Size><SupplierCode>40138</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>402457</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU334</BillingCode><Name>Knotless BicepsButton</Name><Description>Button suture construct</Description><Size>2.6 mm x 12 mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>385940</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU337</BillingCode><Name>Low-Profile AC Implant</Name><Description>Knotless AC Implant (Button with Non-Absorbable Suture)  </Description><Size>One Size Only</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>353493</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU239</BillingCode><PriorBillingCodes><PriorBillingCode>DE271</PriorBillingCode></PriorBillingCodes><Name>RetroButton</Name><Description>Femoral Fixation Device</Description><Size>12mm Button with 15-60mm loops, 15mm Button with 15-60mm loops</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>353493</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV109</BillingCode><Name>XO Button with Continuous Loop</Name><Description>Titanium suspensor, fixation device for femoral fixation in ACT and PCL repairs</Description><Size>4.5mm x 13.5mm with Continuous Loop lengths 15-60mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>136631</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU329</BillingCode><Name>Knotless AC Open Repair Implant  </Name><Description>Titanium or stainless steel fixation device, with nonabsorbable suture material  </Description><Size>2.6mm – 3.2mm, adjustable length suture</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>385940</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ224</BillingCode><Name>RIGIDLOOP BTB Adjustable Cortical system</Name><Description>Bone-Tendon-Bone Adjustable Cortical System - button and thread</Description><Size>Button: Standard, XL</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>381183</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ225</BillingCode><Name>RIGIDLOOP Cortical fixation system</Name><Description>Cortical Fixation System - Button and thread</Description><Size>Size: 15-60 mm Button: Standard, XL</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>215753</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ239</BillingCode><Name>RIGIDLOOP Adjustable Cortical system</Name><Description>Adjustable Cortical Fixation – adjustable button and thread system</Description><Size>Size: Standard, Large, XL</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>215753</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ240</BillingCode><Name>RIGIDLOOP T Adjustable Cortical system</Name><Description>Adjustable Cortical Fixation – adjustable button and thread system</Description><Size>Button size: Standard, XL</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>381183</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ040</BillingCode><Name>AcTiFlip Infinity loop</Name><Description>Button fixation, recommended for proximal and distal tendon and ligament repair.    Comes with one suture and one needle </Description><Size>12mm  10mm</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>178101</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA086</BillingCode><Name>ToggleLoc Flip</Name><Description>Consists of a metal plate, suture loop and non-absorbable sutures</Description><Size>15mm to 60mm (5mm increments)</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>354952</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI973</BillingCode><Name>Aperfix Femoral Fixation System</Name><Description>Aperfix Femoral Fixation System</Description><Size>9x24mm,10x24mm,9x29mm,10x29mm,11x29mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>152854</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM543</BillingCode><Name>TriMed RipCord® Syndesmosis Button Kit</Name><Description>The system consists of UHMWPE suture, a far button and a near button made from 316L medical grade implant quality stainless steel, and accompanying instrumentation</Description><Size>1 size</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>409845</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW584</BillingCode><Name>ProCinch</Name><Description>ProCinch Adjustable Loop Fixation Device</Description><Size>Length (cm): 35.6, 47.8  Width (cm): 9.7, 19.1  Height (cm): 2.5</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>229717</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI920</BillingCode><Name>EZLoc Femoral fixation Device</Name><Description>Ligament Anchor, Ti, PE</Description><Size>7-8; 9-10mm x Short, std or long.</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>117747</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW540</BillingCode><Name>VersiTomic G-Lok</Name><Description>VersiTomic G-Lok suspension fixation device</Description><Size>15mm, 20mm, 25mm, 30mm, 35mm, 40mm, 45mm, 50mm </Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>229719</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH111</BillingCode><Name>Ziptight Fixation System</Name><Description>Ankle Syndesmosis device, stainless steel or titanium, PE suture with or without disposable instruments.</Description><Size>One Size</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>208040</ARTG><ARTG>116765</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV026</BillingCode><Name>ProCinch (Attachable Button System)</Name><Description>The Stryker ProCinch (Attachable Button System) is comprised of a braided ultra-high molecular weight polyethylene (UHMWPE) and polyester adjustable loop combined with titanium plate (button).  The UHMWPE sutures are looped through the titanium plate to aide in assembly of the device and passing the plate through the intended void.</Description><Size>UHMWPE suture adjustable loop, Attachable Button: Concave Round Button- Diameter: 11mm to 20mm / Standard Flat Button: Length: 12mm to 14mm, Width: 8mm  </Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>229717</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ043</BillingCode><Name>Parcus Sydn-EZ </Name><Description>The Parcus Synd-EZ  is intended to be used as an adjunct in fracture repair involving metaphyseal and periarticular small bone fragments where screws are not indicated, and as adjuncts in external and intramedullary fixation systems involving plates and rods, with fracture braces and casting.</Description><Size>3.9 mm</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>330545</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ052</BillingCode><Name>Parcus Synd-Ez SS</Name><Description>The Parcus Synd-EZ  is intended to be used as an adjunct in fracture repair involving metaphyseal and periarticular small bone fragments where screws are not indicated, and as adjuncts in external and intramedullary fixation systems involving plates and rods, with fracture braces and casting. Includes top hat, suture and button.</Description><Size>3.2 mm</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>375955</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ035</BillingCode><PriorBillingCodes><PriorBillingCode>SV038</PriorBillingCode></PriorBillingCodes><Name>Parcus - GFS II Large and GFS Mini</Name><Description>Parcus - GFS Fixation for knee ligament reconstruction</Description><Size>Button Sizes:   3.9mm-4.4mm in width x 12mm-16.5mm in length.  Loop sizes:  12mm, 15mm, 20mm, 25mm, 30mm, 35mm, 40mm, 45mm, 50mm, 55mm</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>178101</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI110</BillingCode><Name>Comete Anchor</Name><Description>ACL Femoral Cortical Fixation</Description><Size>Length 15mm to 40mm</Size><SupplierCode>40041</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>285471</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NY004</BillingCode><Name>Sekure-Lock</Name><Description>Fixation anchor with suture</Description><Size>One size only</Size><SupplierCode>40138</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>402457</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU335</BillingCode><Name>Knotless Distal Clavicle Plate Button Assembly</Name><Description>Knotless TightRope pre-loaded on Clavicle Button for use with DogBone. Titanium button with nonabsorbable UHMWPE suture material.</Description><Size>One size only</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>350871</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU222</BillingCode><PriorBillingCodes><PriorBillingCode>DE252</PriorBillingCode></PriorBillingCodes><Name>Tightrope Syndesmosis Repair Kit</Name><Description>Titanium or stainless steel, with non absorbable Fiberwire suture material</Description><Size>One size only</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>353493</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU163</BillingCode><Name>Mini Tightrope</Name><Description>CMC Fixation Device</Description><Size>One Size fits all</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>350631</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU162</BillingCode><PriorBillingCodes><PriorBillingCode>DE507</PriorBillingCode></PriorBillingCodes><Name>Mini Tightrope CMC</Name><Description>CMC fixation device</Description><Size>One size only</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>350631</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU171</BillingCode><Name>Adjustable loop</Name><Description>Pullup and Mblock Adjustable fixation system</Description><Size>  4.5 mm    5 -10 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>322721</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU322</BillingCode><Name>TightRope II ABS (Attachable Button System)</Name><Description>Adjustable FiberLoop for Attachable Button System constructs combined with a button</Description><Size>Round Button- Diameter: 11mm to 20mm  Standard Button: Length: 12mm, Width: 8mm; Oblong Button- Length: 13mm, Width: 3.4mm;    Button Shapes: standard, round, oblong; UHMWPE loop without button</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>383904</ARTG><ARTG>353493</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU323</BillingCode><Name>BTB TightRope II</Name><Description>Suture construct with button for soft tissue to bone fixation for ACL/PCL repair and reconstruction</Description><Size>One size only</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>383904</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU205</BillingCode><Name>Orthobutton CL</Name><Description>Braided polyethylene continuous loop combined with a titanium plate </Description><Size>12 - 60 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>411650</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL251</BillingCode><Name>ULTRABUTTON TIB</Name><Description>Adjustable Fixation Device consists of a graft suspension loop and a titanium cortical button</Description><Size>Small, Medium, Large</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF019</BillingCode><Name>EZ Flip ACL/PCL Fixation system</Name><Description>Fixation for ACL/PCL fixation</Description><Size>15-60mm length</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>193153</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN853</BillingCode><Name>Endobutton</Name><Description>Fixation for ACL/PCL reconstruction</Description><Size>5-60mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL252</BillingCode><Name>ULTRABUTTON BB</Name><Description>Adjustable Fixation Device consists of a graft suspension loop and a titanium cortical button</Description><Size>one size only</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL016</BillingCode><Name>Endobutton Twinbridge</Name><Description>A button/thread/button device for ligament reconstruction</Description><Size>6mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>172519</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BW016</BillingCode><Name>Biotek Button System</Name><Description>Adjustable Fiber Loop for attachable Button System and tibial base plate for button system  UHMWPE loop without button</Description><Size>Round Button- Dia: 6 mm to 20 mm    Rectangular button- Length: 4 mm to 30 mm                                    Width: 2 mm to 10 mm    Button Shapes: Standard, round, oblong etc.  UHMWPE loop without button </Size><SupplierCode>40418</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>314305</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL253</BillingCode><Name>ULTRABUTTON QUAD</Name><Description>Adjustable Fixation Device consists of a graft suspension loop and a titanium cortical button</Description><Size>one size only</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL082</BillingCode><Name>INVISIKNOT</Name><Description>Ankle Syndesmosis Repair Device</Description><Size>Fracture or non fracture</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>287770</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA117</BillingCode><Name>OrthoButton AL</Name><Description>Consists of a metal plate, suture loop and non-absorbable sutures and a braided ultra-high molecular weight polyethylene   </Description><Size>Self-adjusting loop covering 15 to 60mm ACL loop repair diameters</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>397951</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ039</BillingCode><Name>AcTiFlip Cinch loop</Name><Description>Button fixation recommended for biceps repair both proximal and distal repairs.   With one size two suture</Description><Size>12mm  10mm</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>178101</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB068</BillingCode><Name>G Loop</Name><Description>Titanium or Stainless Steel fixation device with non-absorbable suture material</Description><Size>Adjustable Length</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>323905</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW784</BillingCode><Name>GRAVITY SYNCHFIX</Name><Description>Titanium syndesmosis fixation device, with non absorbable suture material and including medial button.</Description><Size>one size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>175633</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM469</BillingCode><Name>Button Loop System</Name><Description>Fixed length or adjustable button loop system</Description><Size>Multiple fixed and adjustable options to suit patient anatomy</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112004</SubGroupID><ARTGs><ARTG>338954</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN258</BillingCode><Name>RIGIDLOOP Clip Cortical Button</Name><Description>Clip Cortical Button</Description><Size>Standard; XL</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112005</SubGroupID><ARTGs><ARTG>381183</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Description, Size</ChangeExplanation><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU180</BillingCode><Name>MectaFix Continuous Loop</Name><Description>ACL reconstructions</Description><Size>15 - 60 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112005</SubGroupID><ARTGs><ARTG>332525</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW971</BillingCode><PriorBillingCodes><PriorBillingCode>WR368</PriorBillingCode></PriorBillingCodes><Name>ArthroTunneler TunnelPro System</Name><Description>Lateral button, PEEK</Description><Size>10mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112005</SubGroupID><ARTGs><ARTG>214982</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW539</BillingCode><Name>VersiTomic G-Lok</Name><Description>VersiTomic G-Lok suspension fixation device - No Loop</Description><Size>No Loop</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112005</SubGroupID><ARTGs><ARTG>229719</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HV002</BillingCode><Name>OzLoop</Name><Description>Fixation Button</Description><Size>15mm to 60mm</Size><SupplierCode>40231</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112005</SubGroupID><ARTGs><ARTG>351392</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA087</BillingCode><Name>ToggleLoc Flipwasher</Name><Description>Titanium Button</Description><Size>15mm-20mm,  20mm (Extender)</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112005</SubGroupID><ARTGs><ARTG>354952</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV018</BillingCode><Name>Suture Button</Name><Description>The Slotted Button device is a single-use, titanium implant used for  fixation of soft tissue to bone.</Description><Size>11–20mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112005</SubGroupID><ARTGs><ARTG>381237</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ042</BillingCode><PriorBillingCodes><PriorBillingCode>SV076</PriorBillingCode></PriorBillingCodes><Name>PARCUS GFS Naked</Name><Description>Graft Fixation System  for use in the fixation of ligament or tendon repairs.</Description><Size>Button widths: 1.4mm -4.4mm   Button lengths: 5.9mm - 21mm</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112005</SubGroupID><ARTGs><ARTG>178101</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO111</BillingCode><Name>APTUS</Name><Description>Insert for Suture or Screw Fixation</Description><Size>Various</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112005</SubGroupID><ARTGs><ARTG>206157</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BW011</BillingCode><Name>ONButton CL Fixation Button</Name><Description>Titanium fixation button and UHMWPE braid (Ultra High Molecular Weight Poly  Ethylene braid) suture</Description><Size>Loop Size 12mm - 40mm</Size><SupplierCode>40418</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112005</SubGroupID><ARTGs><ARTG>314305</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL078</BillingCode><Name>Double ENDOBUTTON Fixation Device</Name><Description>Titanium or stainless steel screwbutton, titanium and stainless steel round ENDOBUTTON device and UHMW polyethylene suture</Description><Size>Various sizes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112005</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF185</BillingCode><Name>SignaFlip Extender Button</Name><Description>Titanium Extender button</Description><Size>10-20mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112005</SubGroupID><ARTGs><ARTG>193153</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU228</BillingCode><PriorBillingCodes><PriorBillingCode>DE500</PriorBillingCode></PriorBillingCodes><Name>TightRope Button</Name><Description>Titanium or stainless steel button</Description><Size>5mm-20mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112005</SubGroupID><ARTGs><ARTG>353493</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN426</BillingCode><Name>ACL/PCL Reconstructions</Name><Description>EndoButton</Description><Size>4 x 12mm, 4mm x 18mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112005</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU150</BillingCode><Name>Tibial Pull Suture Plate (PSP)</Name><Description>Tibial Pull Suture Plate</Description><Size>Single size</Size><SupplierCode>40166</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112005</SubGroupID><ARTGs><ARTG>290767</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU237</BillingCode><Name>Suture Button</Name><Description>Multiple hole button for fixation of bone to bone or soft tissue to bone, and are intended as fixation posts, a distribution bridge, or for distributing suture tension over areas of ligament or tendon repair. A button implant system is supplied with suture.</Description><Size>2.6mm - 7.5mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112005</SubGroupID><ARTGs><ARTG>385940</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV149</BillingCode><Name>Infinity  Tibial Button</Name><Description>The tibial buttons are available in two (2) sizes to accommodate various tunnel sizes and is meant to be used with the adjustable free loop for suspensory fixation of soft tissue grafts to bone in ligament reconstruction procedures.</Description><Size>Standard and Large</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112005</SubGroupID><ARTGs><ARTG>136631</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU189</BillingCode><Name>FairFix Adjustable Button Extender</Name><Description>Button Extender</Description><Size>Various sizes</Size><SupplierCode>40166</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112005</SubGroupID><ARTGs><ARTG>365812</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU327</BillingCode><Name>Knotless Tension Tight Button</Name><Description>Biceps Suture Button</Description><Size>2.6mm - 7.5mm  </Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112005</SubGroupID><ARTGs><ARTG>353493</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU151</BillingCode><Name>Extracortical Femoral Button</Name><Description>Extracortical Femoral Button</Description><Size>Single size</Size><SupplierCode>40166</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112005</SubGroupID><ARTGs><ARTG>290768</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN428</BillingCode><Name>ACL/PCL Reconstructions</Name><Description>EndoButton CL and Xtendobutton</Description><Size>10-60 mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112005</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ303</BillingCode><Name>Tightrope ABS Button Round Concave</Name><Description>Tibial buttons to accommodate various tunnel sizes</Description><Size>11-17mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112005</SubGroupID><ARTGs><ARTG>353493</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ024</BillingCode><PriorBillingCodes><PriorBillingCode>SV039</PriorBillingCode></PriorBillingCodes><Name>Parcus PEEK CF Interface Screw</Name><Description>PEEK CF Interface Screw</Description><Size>7,8,9mm x 20-35mm 10,11,12mm x 25-35mm</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>177865</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VY003</BillingCode><Name>Titan Interference Screws </Name><Description>Interference Screws </Description><Size>All sizes</Size><SupplierCode>40467</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>370602</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW794</BillingCode><PriorBillingCodes><PriorBillingCode>WR080</PriorBillingCode></PriorBillingCodes><Name>G-Force Tenodesis System</Name><Description>Cannulated Interference Screw - PEEK Optima</Description><Size>4-8mm diameter, 10-25mm width</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>175633</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST830</BillingCode><Name>Stryker Wedge Interference Screw</Name><Description>Small threaded titanium screw for ligament/tendon fixation</Description><Size>Diameter 7 - 9mm, Length 20 - 25mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>139736</ARTG><ARTG>140466</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF015</BillingCode><Name>TLS - Tendon Anchoring System - Titanium</Name><Description>Titanium screw for suspensory fixation of tendon</Description><Size>10 x 20mm, 10 x 25mm, 12 x 20mm</Size><SupplierCode>40106</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>181401</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI239</BillingCode><Name>Arthrotek Ligament Fixation System</Name><Description>Interference Screw, Titanium</Description><Size>15-30mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>208040</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR031</BillingCode><Name>LARS Interference Screw</Name><Description>Titanium Interference screw</Description><Size>5.2 - 10mm diameter, 
15 - 30mm</Size><SupplierCode>39996</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>138574</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ051</BillingCode><Name>Parcus Interference Ti screws</Name><Description>Interference screws for soft tissue fixation (Titanium)</Description><Size>7-12 mm (20-35mm in length</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>177866</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF017</BillingCode><Name>TLS, TLS Tendon Anchoring Screw</Name><Description>Screw for graft fixation</Description><Size>10 x 20mm, 10 x 25mm</Size><SupplierCode>40106</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>181401</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL017</BillingCode><Name>Biosure Healicoil</Name><Description>interference screw</Description><Size>6-10mm diameter</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA089</BillingCode><Name>Neo Advance PEEK Interference Screws</Name><Description>PEEK Interference Screws</Description><Size>7 × 25mm, 7 × 30mm, 8 × 25mm, 8 × 30mm, 9 × 25mm, 9× 30mm, 10× 25mm, 10× 30mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>354952</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN420</BillingCode><Name>ACL/PCL Reconstruction</Name><Description>RCI Screws Titanium</Description><Size>7-11mm diameter, 25-40mm length</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN981</BillingCode><Name>BIOSURE SYNC</Name><Description>Soft tissue intra-tunnel tibial fixation device which includes Interference screw and sheath</Description><Size>6-12mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM164</BillingCode><Name>BIOSURE</Name><Description>A non-absorbable polymer (PEEK) interference screw for use in ligament/tendon reconstruction</Description><Size>6-12mm in diameter</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BW017</BillingCode><Name>Biotek SOFTFIX PK Interference screw</Name><Description>Interference screw for use in ligament/tendon reconstruction</Description><Size>Diameter: 4.0mm - 11.0mm    Length:  10mm - 35mm</Size><SupplierCode>40418</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>314305</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF035</BillingCode><Name>Signature ST Shoulder Anchor</Name><Description>PEEK fully threaded suture anchor</Description><Size>2.3mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF016</BillingCode><Name>TLS - Tendon Anchoring Screw - PEEK</Name><Description>PEEK screw for suspensory fixation of tendon</Description><Size>10 x 20mm 10 x 25mm</Size><SupplierCode>40106</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>181401</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ912</BillingCode><Name>Intrafix Interference System</Name><Description>Non absorbable screw/sheath</Description><Size>7-12 mm x 23-30 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>215753</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HV001</BillingCode><Name>OzScrew</Name><Description>PEEK Screw</Description><Size>Diameter 8mm to 12mm  Lengths 25mm and 30mm</Size><SupplierCode>40231</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>351410</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI990</BillingCode><Name>Quattro Bolt</Name><Description>Tenodesis Screw</Description><Size>10-16 mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>209509</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU120</BillingCode><Name>Tenodesis Screw</Name><Description>Non Absorbable Tenodesis Screw</Description><Size>2.5mm-9mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>350870</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL103</BillingCode><PriorBillingCodes><PriorBillingCode>SF097</PriorBillingCode></PriorBillingCodes><Name>Bi-On™ Inteference Screw</Name><Description>HA infused Polymer Interference Screws</Description><Size>5-12mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><Suffix>AB, HA</Suffix><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>457</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF096</BillingCode><Name>Bio-Composite Interference Screw</Name><Description>HA infused Polymer Interference Screws</Description><Size>5-12mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><Suffix>AB, HA</Suffix><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>457</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW541</BillingCode><Name>Biosteon (HA/PLLA) Screws</Name><Description>Biosteon HA/PLLA reabsorbable bone screw</Description><Size>6, 7, 8, 9, 10 x 23mm; 6, 7, 8, 9, 10, 11, 12 x 28mm; 9, 10, 11, 12 x 35mm </Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><Suffix>AB, HA</Suffix><ARTGs><ARTG>143167</ARTG></ARTGs><MinimumBenefit>457</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM176</BillingCode><Name>Bioabsorbable HA Screw</Name><Description>Absorbable HA Interference Screw</Description><Size>Various</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><Suffix>AB, HA</Suffix><ARTGs><ARTG>124506</ARTG><ARTG>162821</ARTG></ARTGs><MinimumBenefit>457</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF151</BillingCode><Name>SignaLoc Screw</Name><Description>HA infused polymer Interference Screw</Description><Size>5-12mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><Suffix>AB, HA</Suffix><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>457</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU255</BillingCode><Name>BioComposite Interference Screw</Name><Description>Soft Tissue Fixation Device</Description><Size>6-12mm x 23-35mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>360376</ARTG></ARTGs><MinimumBenefit>457</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU349</BillingCode><Name>BioComposite Tenodesis Screw 4mm x 10mm, with Disposable Driver</Name><Description>Interference Screw for Soft tissue fixation</Description><Size>Diameter: 4mm  Length - 10mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>398150</ARTG></ARTGs><MinimumBenefit>457</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU264</BillingCode><PriorBillingCodes><PriorBillingCode>DE068</PriorBillingCode></PriorBillingCodes><Name>Interference Screws</Name><Description>ARTHREX Non-sheathed</Description><Size>7 x 28mm - 12 x 28mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>350870</ARTG></ARTGs><MinimumBenefit>457</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI109</BillingCode><Name>Eclipse BCP Screw</Name><Description>Absorbable, osteoconducting interference screw</Description><Size>Diameter 7mm to 12mm  Length 20mm to 35mm</Size><SupplierCode>40041</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>284239</ARTG></ARTGs><MinimumBenefit>457</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL159</BillingCode><PriorBillingCodes><PriorBillingCode>SN004</PriorBillingCode><PriorBillingCode>SN421</PriorBillingCode></PriorBillingCodes><Name>Bioabsorbable Screw</Name><Description>Absorbable Interference Screw</Description><Size>Various</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>121752</ARTG><ARTG>126191</ARTG><ARTG>322284</ARTG></ARTGs><MinimumBenefit>457</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN373</BillingCode><Name>INTRAFIX™ Advance BR™</Name><Description>Tibial Sheath and Screw System</Description><Size>7-10mm X 23-30 mm; Small and Large</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>421230</ARTG></ARTGs><MinimumBenefit>457</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW549</BillingCode><Name>Bioabsorbable (PLLA) Wedge Interference Screws</Name><Description>Bioabsorbable (PLLA) ACL Wedge Interference Screw </Description><Size>9, 10, 11, 12 x35mm; 7, 8, 9, 10 x 28mm; 7,8,9 x 23mm </Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>143167</ARTG></ARTGs><MinimumBenefit>457</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA025</BillingCode><Name>ComposiTCP Interference Screw</Name><Description>Interference Screw for ACL Reconstruction</Description><Size>Diameters: 6 to 11 mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>308241</ARTG><ARTG>308240</ARTG></ARTGs><MinimumBenefit>457</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA120</BillingCode><Name>Neo Advance Biocomposite Interference Screws  </Name><Description>Biocomposite Interference Screws  </Description><Size>Ø7.0 x (25,30) mm  Ø8.0 x (23,25,28,30) mm  Ø9.0 x (23,25,28,30) mm  Ø10.0 x (23,25,28,30) mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>409050</ARTG></ARTGs><MinimumBenefit>457</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN369</BillingCode><Name>MILAGRO® Small Bioabsorbable Interference Screw</Name><Description>Biocryl Rapide Interference screw system</Description><Size>Diameter 5-8 mm; Length 12-30 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>122579</ARTG><ARTG>217763</ARTG></ARTGs><MinimumBenefit>457</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ961</BillingCode><Name>BioIntrafix</Name><Description>Tibial soft tissue fastner screw/sheath</Description><Size>6-8mm-7-10mm x 30mm; Small and Large</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>136254</ARTG><ARTG>136255</ARTG></ARTGs><MinimumBenefit>457</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN371</BillingCode><Name>MILAGRO® Advance BR interference screw</Name><Description>Biocryl Rapide Interference screw system</Description><Size>Diameter 7-12 mm; Length 23-35 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>218737</ARTG></ARTGs><MinimumBenefit>457</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV120</BillingCode><Name>GENESYS Matryx Interference Screw, diameter 7 - 11mm</Name><Description>GENESYS Matryx Interference Screw  - cannulated bioabsorbable</Description><Size>7.0x20mm,7.0x25mm,7.0x30mm,8.0x20mm,8.0x25mm,8.0x30mm,8.0x35mm,9.0x20mm,9.025mm,9.0x30mm,9.0x35mm,10x20mm,10x25mm,10x30mm,10x35mm,11x20mm,11x25mm,11x25mm,11x25mm,11x25mm,11x30mm,11x35mm,11x40mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>194179</ARTG></ARTGs><MinimumBenefit>457</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK047</BillingCode><Name>Stryker Wedge Interference Screw</Name><Description>Threaded biosteon screw for ligment/tendon fixation</Description><Size>Dia 7 - 12mm, length 20 - 40mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>143167</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV016</BillingCode><Name>Propel Interference Screws</Name><Description>ACL Fixation - Titanium</Description><Size>Diameter 7.0 - 9.0mm, Length 20 - 30mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>129072</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ111</BillingCode><PriorBillingCodes><PriorBillingCode>KH068</PriorBillingCode></PriorBillingCodes><Name>Rejoin Interference Screw</Name><Description>Interference Screw</Description><Size>6mm - 12mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>320191</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU121</BillingCode><PriorBillingCodes><PriorBillingCode>DE710</PriorBillingCode></PriorBillingCodes><Name>PEEK Tenodesis Screw</Name><Description>Interference Screw (2.5mm x 6mm)</Description><Size>2.5mm x 6mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>350870</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV017</BillingCode><Name>Guardsman Femoral Interference Screws</Name><Description>ACL Fixation - Titanium</Description><Size>Diameter 7.0 - 9.0mm, Length 20 - 30mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>129072</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV146</BillingCode><Name>EZStart Screw</Name><Description>The EZStart™ Interference Screw is a dual threaded titanium interference screw with a tapered tip for easy insertion into  bone</Description><Size>6-10mm width x 15 - 30mm long</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>129072</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU118</BillingCode><PriorBillingCodes><PriorBillingCode>DE439</PriorBillingCode></PriorBillingCodes><Name>Peek Delta Screws</Name><Description>Interference screw for soft tissue Fixation</Description><Size>6-12mm Diameter x (23mm-35m) Length</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>350870</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV018</BillingCode><Name>Cannulated Interference Screws</Name><Description>ACL Fixation - Titanium</Description><Size>Diameter 7.0 - 9.0mm, Length 20 - 40mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>129072</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU117</BillingCode><PriorBillingCodes><PriorBillingCode>DE374</PriorBillingCode></PriorBillingCodes><Name>GraftBolt</Name><Description>Interference Screw and Sheath</Description><Size>7mm, 8mm, 9mm and 10mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>350870</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN425</BillingCode><Name>ACL/PCL Reconstructions</Name><Description>Cannuflex Silk &amp; Soft Silk Interference Screw</Description><Size>5.5 x 20mm - 9x30mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU169</BillingCode><Name>Mectascrew PEEK</Name><Description>Interference Screw</Description><Size>6-12 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>320872</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF001</BillingCode><Name>Tissue Loc Tenodesis Screw</Name><Description>Cannulated Interference Screw - PEEK</Description><Size>4x10mm, 5x10mm, 4x15mm, 5x15mm, 6x15mm, 6x20mm, 7x25mm, 8x25mm, 8x30mm, 9x25mm, 9x30mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU333</BillingCode><Name>FastThread PEEK Interference Screw</Name><Description>PEEK Interference Screw</Description><Size>Diameters: 6 - 12mm   Length: 20 - 30mm  </Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>350870</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BW018</BillingCode><Name>Biotek SOFTFIX Interference screw</Name><Description>Interference screw for use in ligament/tendon reconstruction</Description><Size>Diameter 5.0mm - 11.0mm    Length 15mm - 35mm</Size><SupplierCode>40418</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>314305</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK023</BillingCode><Name>ACL Wedge Interference Screw</Name><Description> Interference Screw</Description><Size>Dia 7 - 12mm, length 20 - 40mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>140466</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WU002</BillingCode><PriorBillingCodes><PriorBillingCode>VK020</PriorBillingCode></PriorBillingCodes><Name>CPS Screw Hexalon Biodegradable ACL/PCL Reconstruction</Name><Description>Biodegradable ACL/PCL Recon Screw PLLA/PGA/TMC</Description><Size>6 x 20, 6 x 25, 6 x 30, 7 x 20, 7 x 25, 7 x 30, 8 x 20, 8 x 25, 8 x 30, 9 x 20, 9 x 25, 9 x 30, 10 x 30</Size><SupplierCode>40389</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>154551</ARTG></ARTGs><MinimumBenefit>457</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU265</BillingCode><Name>BioComposite Tenodesis Screw</Name><Description>Soft Tissue Fixation</Description><Size>3mm-9mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>360374</ARTG><ARTG>360373</ARTG></ARTGs><MinimumBenefit>457</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU330</BillingCode><Name>FastThread</Name><Description>BioComposite Interference Screw</Description><Size>Length: 20mm-30mm  Diameter: 6mm- 12mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>398151</ARTG></ARTGs><MinimumBenefit>457</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV103</BillingCode><Name>Matryx Interference Screw</Name><Description>Matryx (SR-96L/4D PLA with ß-TCP) Inteference Screw</Description><Size>7.3 x 20mm; 7.3 x 25mm; 7.3 x 30mm; 8 x 20mm; 8 x 25mm; 8 x 30mm; 9 x 20mm; 9 x 25mm; 9 x 30mm; 9 x 38mm; 10 x 25mm; 10 x 33mm; 10 x 38mm; 11 x 25mm; 11 x 33mm; 11 x 38mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>139664</ARTG></ARTGs><MinimumBenefit>457</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV121</BillingCode><Name>GENESYS Matrix Interference Screw, diameter 5-6.5mm.</Name><Description>GENESYS Matrix Interference Screw - Cannulated,bioabsorbable</Description><Size>5.0mm diameter x15,20,25,30mm lengths
5.5mm diameter x15,20,25,30mm lengths
6.0mm diameter x15,20,25,30mm lengths
6.5mm diameter x15,20,25,30mm lengths</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>101275</ARTG></ARTGs><MinimumBenefit>457</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU119</BillingCode><PriorBillingCodes><PriorBillingCode>DE440</PriorBillingCode></PriorBillingCodes><Name>Interference Screws</Name><Description>Interference screw for Soft Tissue Fixation</Description><Size>7-10mm x (15-35mm)</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>350870</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI241</BillingCode><Name>Gentle Threads Ligament Fixation Screws</Name><Description>Screw, Graft Interference, PGA/PLA</Description><Size>7mm, 8mm, 9mm, 10mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112006</SubGroupID><ARTGs><ARTG>154007</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ063</BillingCode><PriorBillingCodes><PriorBillingCode>WF001</PriorBillingCode></PriorBillingCodes><Name>Quick Start Screw</Name><Description>Titanium Interference Screw</Description><Size>Diameter 6 to 12mm  Length 20 to 40mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112007</SubGroupID><ARTGs><ARTG>339465</ARTG></ARTGs><MinimumBenefit>451</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK024</BillingCode><Name>Stryker Cross-screw</Name><Description>Cross screw</Description><Size> 40-60mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112007</SubGroupID><ARTGs><ARTG>139735</ARTG></ARTGs><MinimumBenefit>451</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA546</BillingCode><Name>Ligamys Monoblock</Name><Description>Dynamic spring system with clamping cone</Description><Size>One size</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112007</SubGroupID><ARTGs><ARTG>230046</ARTG></ARTGs><MinimumBenefit>451</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ078</BillingCode><Name>Rigidfix ACL Cross Pin</Name><Description>Polylactic acid pin</Description><Size>2.7 &amp; 3.3mm x 42mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112007</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>140561</ARTG></ARTGs><MinimumBenefit>462</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU256</BillingCode><Name>Bio-Transfix</Name><Description>Composition Poly (L-lactide)</Description><Size>Diameter 5mm, length 50mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108790</GroupID><SubGroupID>112007</SubGroupID><Suffix>AB</Suffix><ARTGs><ARTG>360377</ARTG></ARTGs><MinimumBenefit>462</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ310</BillingCode><Name>Pitch-Patch</Name><Description>Rotator Cuff Reinforcement Patch</Description><Size>30mm x 20mm and 35mm x 25mm</Size><SupplierCode>40138</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108791</GroupID><SubGroupID>112009</SubGroupID><ARTGs><ARTG>384984</ARTG></ARTGs><MinimumBenefit>4217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NY001</BillingCode><Name>LK2 Poly-Tape</Name><Description>Polyester tape</Description><Size>Width 8mm-40mm  Length 500 and 800mm</Size><SupplierCode>40138</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108791</GroupID><SubGroupID>112009</SubGroupID><ARTGs><ARTG>380417</ARTG></ARTGs><MinimumBenefit>4217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NY003</BillingCode><Name>Infinity-Lock Button System</Name><Description>Tube Tape with Infinity-Lock Button</Description><Size>One size only</Size><SupplierCode>40138</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108791</GroupID><SubGroupID>112009</SubGroupID><ARTGs><ARTG>379210</ARTG></ARTGs><MinimumBenefit>4217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR202</BillingCode><Name>Ligament Advanced Reinforcement System (LARS) Artificial Ligament – LAC 20</Name><Description>Woven polyester prosthetic ligament</Description><Size>20 fibres</Size><SupplierCode>39996</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108791</GroupID><SubGroupID>112009</SubGroupID><ARTGs><ARTG>138573</ARTG></ARTGs><Note>That an Artificial Ligament should only be funded for intra-articular cases where no non-synthetic graft sources (allografts and autografts) are available.</Note><MinimumBenefit>4217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR203</BillingCode><Name>Ligament Advanced Reinforcement System (LARS) Artificial Ligament - LAC 30</Name><Description>Woven polyester prosthetic ligament</Description><Size>30 fibres</Size><SupplierCode>39996</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108791</GroupID><SubGroupID>112009</SubGroupID><ARTGs><ARTG>138573</ARTG></ARTGs><Note>That an Artificial Ligament should only be funded for intra-articular cases where no non-synthetic graft sources (allografts and autografts) are available.</Note><MinimumBenefit>4217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM070</BillingCode><Name>Lockdown LSSS Shoulder Stabilisation System - Ligament Prosthesis, non-absorbable</Name><Description>Woven Polyester Prosthetic Ligament</Description><Size>Various</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108791</GroupID><SubGroupID>112009</SubGroupID><ARTGs><ARTG>135600</ARTG></ARTGs><MinimumBenefit>4217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA545</BillingCode><Name>Ligamys DIS Suture with button</Name><Description>UHMWPE braid with Ti alloy button</Description><Size>One size</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108791</GroupID><SubGroupID>112009</SubGroupID><ARTGs><ARTG>232098</ARTG></ARTGs><Note>That an Artificial Ligament should only be funded for intra-articular cases where no non-synthetic graft sources (allografts and autografts) are available.</Note><MinimumBenefit>4217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR204</BillingCode><Name>Ligament Advanced Reinforcement System (LARS) Artificial Ligament - MCL 32</Name><Description>Woven polyester prosthetic ligament</Description><Size>32 fibres</Size><SupplierCode>39996</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108791</GroupID><SubGroupID>112009</SubGroupID><ARTGs><ARTG>138573</ARTG></ARTGs><Note>That an Artificial Ligament should only be funded for intra-articular cases where no non-synthetic graft sources (allografts and autografts) are available.</Note><MinimumBenefit>4217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR201</BillingCode><Name>Ligament Advanced Reinforcement System (LARS) Artificial Ligament -  AC30RA </Name><Description>Woven polyester prosthesic ligament</Description><Size>30 fibres</Size><SupplierCode>39996</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108791</GroupID><SubGroupID>112009</SubGroupID><ARTGs><ARTG>138573</ARTG></ARTGs><Note>That an Artificial Ligament should only be funded for intra-articular cases where no non-synthetic graft sources (allografts and autografts) are available.</Note><MinimumBenefit>4217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR214</BillingCode><Name>Ligament Advanced Reinforcement System (LARS) Artificial Ligament</Name><Description>Woven polyester prosthetic ligaments</Description><Size>8 fibres</Size><SupplierCode>39996</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108791</GroupID><SubGroupID>112009</SubGroupID><ARTGs><ARTG>138573</ARTG></ARTGs><Note>That an Artificial Ligament should only be funded for intra-articular cases where no non-synthetic graft sources (allografts and autografts) are available.</Note><MinimumBenefit>4217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR205</BillingCode><Name>Ligament Advanced Reinforcement System (LARS) Artificial Ligament  - Rotator Cuff CR 25</Name><Description>Woven polyester prosthetic ligament</Description><Size>40 fibres</Size><SupplierCode>39996</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108791</GroupID><SubGroupID>112009</SubGroupID><ARTGs><ARTG>138573</ARTG></ARTGs><Note>That an Artificial Ligament should only be funded for intra-articular cases where no non-synthetic graft sources (allografts and autografts) are available.</Note><MinimumBenefit>4217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR206</BillingCode><Name>Ligament Advanced Reinforcement System (LARS) Artificial Ligament  - Rotator Cuff CR 30</Name><Description>Woven polyester prosthetic ligament</Description><Size>48 fibres</Size><SupplierCode>39996</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108791</GroupID><SubGroupID>112009</SubGroupID><ARTGs><ARTG>138573</ARTG></ARTGs><Note>That an Artificial Ligament should only be funded for intra-articular cases where no non-synthetic graft sources (allografts and autografts) are available.</Note><MinimumBenefit>4217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR032</BillingCode><Name>Ligament Advanced Reinforcement System (LARS) Artificial Ligament</Name><Description>Woven polyester prosthetic ligaments</Description><Size>60,80,100,120,160 &amp; Y shaped fibres</Size><SupplierCode>39996</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108791</GroupID><SubGroupID>112009</SubGroupID><ARTGs><ARTG>138573</ARTG></ARTGs><Note>That an Artificial Ligament should only be funded for intra-articular cases where no non-synthetic graft sources (allografts and autografts) are available.</Note><MinimumBenefit>4217</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW987</BillingCode><PriorBillingCodes><PriorBillingCode>WR455</PriorBillingCode></PriorBillingCodes><Name>Cartiva® Synthetic Cartilage Implant</Name><Description>Polymer Cartilage Implant</Description><Size>Diameter: 6mm, 8mm, 10mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108791</GroupID><SubGroupID>112010</SubGroupID><Suffix>≤ 10mm</Suffix><ARTGs><ARTG>278815</ARTG></ARTGs><MinimumBenefit>1420</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO107</BillingCode><Name>APTUS Wedge</Name><Description>Titanium Wedges</Description><Size>Wedges 4mm-12mm</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108792</GroupID><SubGroupID>112011</SubGroupID><Suffix>3D anatomical</Suffix><ARTGs><ARTG>206157</ARTG></ARTGs><MinimumBenefit>1219</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW718</BillingCode><PriorBillingCodes><PriorBillingCode>WR071</PriorBillingCode></PriorBillingCodes><Name>BioFoam Bone Wedge</Name><Description>Titanium metal scaffold for angular correction in ankle and foot</Description><Size>Depth 14 - 44mm  Width 10 - 44mm  Thickness 4.5 - 12mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108792</GroupID><SubGroupID>112011</SubGroupID><Suffix>3D anatomical</Suffix><ARTGs><ARTG>198485</ARTG></ARTGs><MinimumBenefit>1219</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU241</BillingCode><PriorBillingCodes><PriorBillingCode>DE577</PriorBillingCode></PriorBillingCodes><Name>BioSync Anatomic Reconstruction Wedge</Name><Description>Titanium metal scaffold for angular correction in ankle and foot</Description><Size>Cotton Wedges 16mm-20mm Depth x 4.5mm-7.5mm Thickness  Evans Wedges  18mm-22mm Width &amp; Depth x 6.5mm-12mm Thickness</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108792</GroupID><SubGroupID>112011</SubGroupID><Suffix>3D anatomical</Suffix><ARTGs><ARTG>355042</ARTG></ARTGs><MinimumBenefit>1219</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW525</BillingCode><Name>Exeter Hip X-Change Revision System</Name><Description>X-Change Stainless steel Revision Mesh - Medial Wall,Rim, Femoral. Flat</Description><Size>Small, medium and large</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108792</GroupID><SubGroupID>112011</SubGroupID><ARTGs><ARTG>205495</ARTG></ARTGs><MinimumBenefit>902</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH661</BillingCode><PriorBillingCodes><PriorBillingCode>OO121</PriorBillingCode></PriorBillingCodes><Name>MUTARS - Arthrodesis body</Name><Description>Arthrodesis Body</Description><Size>120mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112014</SubGroupID><ARTGs><ARTG>284220</ARTG><ARTG>242292</ARTG></ARTGs><MinimumBenefit>6242</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BW013</BillingCode><Name>Keep Walking Spacer</Name><Description>Polyethylene spacer</Description><Size>Size: Small, Medium, Large.  Diameter: 54mm, 58mm, 62mm.</Size><SupplierCode>40418</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112014</SubGroupID><ARTGs><ARTG>307660</ARTG></ARTGs><MinimumBenefit>6242</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH670</BillingCode><PriorBillingCodes><PriorBillingCode>OO131</PriorBillingCode></PriorBillingCodes><Name>MUTARS humerus screw</Name><Description>MUTARS humerus screw</Description><Size>15mm,35mm,55mm,75mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112016</SubGroupID><ARTGs><ARTG>246973</ARTG><ARTG>250513</ARTG></ARTGs><MinimumBenefit>1767</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BR001</BillingCode><Name>OPRA System</Name><Description>Central screw - titanium</Description><Size>One size only</Size><SupplierCode>40322</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112016</SubGroupID><ARTGs><ARTG>145488</ARTG></ARTGs><MinimumBenefit>1767</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BR002</BillingCode><Name>OPRA System</Name><Description>Healing cylinder - titanium</Description><Size>One size only</Size><SupplierCode>40322</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112017</SubGroupID><ARTGs><ARTG>145488</ARTG></ARTGs><MinimumBenefit>2993</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OY011</BillingCode><Name>Healing Plug Unidirectional Locking</Name><Description>Unidirectional locking
Highly polished to minimise soft tissue irritation
Fixation of offset Antirotational bushing, Taper sleeve into the stem &amp; cone
An elongated deep groove to prevent rotation
Composed of a forged CoCrMo alloy accordingto ISO 5832-12, the M14 male thread of the
screw locks with the M 14 female thread of the abutment.</Description><Size>3 size</Size><SupplierCode>40112</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112018</SubGroupID><ARTGs><ARTG>229716</ARTG></ARTGs><MinimumBenefit>2337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BR003</BillingCode><Name>OPRA System</Name><Description>Healing screw - titanium</Description><Size>One size only</Size><SupplierCode>40322</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112018</SubGroupID><ARTGs><ARTG>145488</ARTG></ARTGs><MinimumBenefit>2337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BR004</BillingCode><Name>OPRA System</Name><Description>Fixture  Biohelix</Description><Size>15 - 80mm</Size><SupplierCode>40322</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112019</SubGroupID><ARTGs><ARTG>145488</ARTG></ARTGs><MinimumBenefit>35055</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BW012</BillingCode><Name>Keep Walking Femoral stem</Name><Description>Titanium alloy femoral stem component</Description><Size>Length: 120mm - 180mm Diameter: 12mm - 17mm</Size><SupplierCode>40418</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112019</SubGroupID><ARTGs><ARTG>307660</ARTG></ARTGs><MinimumBenefit>35055</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OY008</BillingCode><Name>Fem Stem Cem'Less lntraMed</Name><Description>Stem Cem'Less lntraMed</Description><Size>83 items with sizes ranging in stem length from 140mm to 180mm</Size><SupplierCode>40112</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112019</SubGroupID><ARTGs><ARTG>195009</ARTG><ARTG>195008</ARTG></ARTGs><MinimumBenefit>35055</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OY003</BillingCode><Name>Intramedullary Femoral Stem Type A</Name><Description>Modular Intramedullary stem</Description><Size>14mm - 21mm, 1mm increments</Size><SupplierCode>40112</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112019</SubGroupID><ARTGs><ARTG>228038</ARTG></ARTGs><MinimumBenefit>35055</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OY001</BillingCode><Name>Intramedullary Femoral Stem Type B</Name><Description>Modular Stem w/proximal fixation/THR option</Description><Size>14mm-22mm, 1mm increaments</Size><SupplierCode>40112</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112019</SubGroupID><ARTGs><ARTG>228038</ARTG></ARTGs><MinimumBenefit>35055</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HR004</BillingCode><Name>OTNI Osseointegration Femur Prosthesis</Name><Description>The medical device acts as an abutment and provides a fixed support for the connection of an artificial limb prosthesis to the residual femoral bone after transfemoral amputation.</Description><Size>OTNi Femur Stem Ø15x140 + OTNi Proximal Screw + OTNi Healing Plug  OTNi Femur Stem Ø16x140 + OTNi Proximal Screw + OTNi Healing Plug  OTNi Femur Stem Ø17x140 + OTNi Proximal Screw + OTNi Healing Plug  OTNi Femur Stem Ø18x140 + OTNi Proximal Screw + OTNi Healing Plug  OTNi Femur Stem Ø19x140 + OTNi Proximal Screw + OTNi Healing Plug  OTNi Femur Stem Ø20x140 + OTNi Proximal Screw + OTNi Healing Plug  OTNi Femur Stem Ø21x140 + OTNi Proximal Screw + OTNi Healing Plug  OTNi Femur Stem Ø22x140 + OTNi Proximal Screw + OTNi Healing Plug  </Size><SupplierCode>40235</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112019</SubGroupID><ARTGs><ARTG>354881</ARTG></ARTGs><MinimumBenefit>35055</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OY002</BillingCode><Name>Intramedullary Femoral Stem Type C</Name><Description>Modular anatomic stem w/screw options</Description><Size>Left &amp; Right 17mm - 24mm</Size><SupplierCode>40112</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112019</SubGroupID><ARTGs><ARTG>228038</ARTG></ARTGs><MinimumBenefit>35055</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BR005</BillingCode><Name>OPRA System</Name><Description>Abutment - titanium</Description><Size>Length 20mm - 78mm</Size><SupplierCode>40322</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112020</SubGroupID><ARTGs><ARTG>145495</ARTG></ARTGs><MinimumBenefit>18288</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OY009</BillingCode><Name>Orthodynamics The Integral Leg Prostheses-Dual Cone Extension (as a component of the Orthodynamics The Integral Leg Prosthesis</Name><Description>Orthodynamics The Integral Leg Prosthesis-Dual Cone Extension</Description><Size>6 sizes</Size><SupplierCode>40112</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112020</SubGroupID><ARTGs><ARTG>195009</ARTG><ARTG>109214</ARTG><ARTG>195008</ARTG></ARTGs><MinimumBenefit>18288</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OY004</BillingCode><Name>Dual Cone Extension Niobium aluminum oxide coated Abutment</Name><Description>Dual Cone Extension Niobium aluminum oxide coated Abutment</Description><Size>5 sizes</Size><SupplierCode>40112</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112020</SubGroupID><ARTGs><ARTG>228038</ARTG><ARTG>229734</ARTG><ARTG>229715</ARTG></ARTGs><MinimumBenefit>18288</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HR006</BillingCode><Name>OTNi DC Adapter</Name><Description>The modular dual cone transcutaneous adapter, interconnects the femur at the stoma region to an external esoprosthesis by means of the OTN click safety adapter and OTN cannulated self-locking screw.</Description><Size>available in lengths of 60mm , 70mm, 80mm, 90mm, 100mm and 110mm of unique diameter of 18mm</Size><SupplierCode>40235</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112020</SubGroupID><ARTGs><ARTG>354839</ARTG></ARTGs><MinimumBenefit>18288</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OY005</BillingCode><Name>Modular Cylinder Extension abutment full Niobium aluminium oxide coated</Name><Description>Modular Cylinder Extension abutment full Niobium aluminium oxide coated</Description><Size>10 sizes</Size><SupplierCode>40112</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112020</SubGroupID><ARTGs><ARTG>228038</ARTG><ARTG>229734</ARTG><ARTG>229715</ARTG></ARTGs><MinimumBenefit>18288</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BW015</BillingCode><Name>Keep Walking Washer-Screw Assembly</Name><Description>Washer and screw assembly</Description><Size>one size only</Size><SupplierCode>40418</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112021</SubGroupID><ARTGs><ARTG>307660</ARTG></ARTGs><MinimumBenefit>5486</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BR006</BillingCode><Name>OPRA System</Name><Description>Abutment screw - titanium</Description><Size>Size Range in Length from 23 mm to 87 mm</Size><SupplierCode>40322</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112021</SubGroupID><ARTGs><ARTG>145495</ARTG></ARTGs><MinimumBenefit>5486</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HR005</BillingCode><Name>OTNI locking screw</Name><Description>Titanium screw for structural reinforcement of internal cone extension of proximal</Description><Size>One size M6x1 </Size><SupplierCode>40235</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112021</SubGroupID><ARTGs><ARTG>354839</ARTG></ARTGs><MinimumBenefit>5486</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OY010</BillingCode><Name>Abutment Screw</Name><Description>Titanium screw for structural reinforcement of the internal Cone Extension</Description><Size>5 sizes</Size><SupplierCode>40112</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112021</SubGroupID><ARTGs><ARTG>229716</ARTG></ARTGs><MinimumBenefit>5486</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW256</BillingCode><Name>HMRS Oncology Humeral Stem</Name><Description>Cobalt Chromium</Description><Size>7x75mm, 7x115mm, 9x75mm, 9x115mm, 11x115mm, 25mmx75mm, 25mmx100mm, 50mmx75mm, 50mmx100mm,75mmx100mm, 100mmx50mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112022</SubGroupID><ARTGs><ARTG>16234</ARTG><ARTG>128450</ARTG></ARTGs><MinimumBenefit>5486</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH672</BillingCode><PriorBillingCodes><PriorBillingCode>OO133</PriorBillingCode></PriorBillingCodes><Name>MUTARS humeral stem</Name><Description>MUTARS humeral stems</Description><Size>7-16mm diameter  75mm length</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112022</SubGroupID><ARTGs><ARTG>238835</ARTG><ARTG>244655</ARTG><ARTG>250512</ARTG></ARTGs><MinimumBenefit>5486</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW222</BillingCode><Name>Howmedica Modular Resection System</Name><Description>Humeral Anchorage Piece -  Vitallium</Description><Size>9, 10, 11, 12mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112023</SubGroupID><ARTGs><ARTG>242296</ARTG></ARTGs><MinimumBenefit>4539</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW221</BillingCode><Name>Howmedica Modular Resection System</Name><Description>Humerus Extension Piece -  Vitallium</Description><Size>5, 15, 30, 45, 60, 75, 90, 105, 120, 135, 150, 165mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112024</SubGroupID><ARTGs><ARTG>128026</ARTG></ARTGs><MinimumBenefit>4173</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH668</BillingCode><PriorBillingCodes><PriorBillingCode>OO129</PriorBillingCode></PriorBillingCodes><Name>MUTARS extension piece</Name><Description>MUTARS humerus extension piece</Description><Size>20mm/40mm/60mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112024</SubGroupID><ARTGs><ARTG>284403</ARTG><ARTG>244561</ARTG></ARTGs><MinimumBenefit>4173</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH664</BillingCode><Name>MUTARS Humerus diaphyseal implant</Name><Description>MUTARS Humerus diaphyseal implant</Description><Size>8-9 mm diameter, 80mm resection length</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112024</SubGroupID><ARTGs><ARTG>284242</ARTG><ARTG>221739</ARTG></ARTGs><MinimumBenefit>4173</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW218</BillingCode><Name>Howmedica Modular Resection System</Name><Description>Humerus Connection Piece -  Vitallium</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112026</SubGroupID><ARTGs><ARTG>242296</ARTG></ARTGs><MinimumBenefit>4351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH669</BillingCode><PriorBillingCodes><PriorBillingCode>OO130</PriorBillingCode></PriorBillingCodes><Name>MUTARS humerus reducer</Name><Description>MUTARS humerus reducer</Description><Size>10/100mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112026</SubGroupID><ARTGs><ARTG>244561</ARTG><ARTG>284590</ARTG></ARTGs><MinimumBenefit>4351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH667</BillingCode><PriorBillingCodes><PriorBillingCode>OO128</PriorBillingCode></PriorBillingCodes><Name>MUTARS Humerus connecting part</Name><Description>MUTARS Humerus connecting part</Description><Size>80mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112026</SubGroupID><ARTGs><ARTG>244561</ARTG><ARTG>284241</ARTG></ARTGs><MinimumBenefit>4351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW255</BillingCode><Name>Howmedica Modular Resection System</Name><Description>Oncology Humeral Body -  Titanium</Description><Size>40 - 140mm in 20mm increments</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112027</SubGroupID><ARTGs><ARTG>128450</ARTG><ARTG>166620</ARTG></ARTGs><MinimumBenefit>3916</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW202</BillingCode><Name>Howmedica Modular Resection System</Name><Description>Wedge -  Vitallium</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112028</SubGroupID><ARTGs><ARTG>242296</ARTG></ARTGs><MinimumBenefit>200</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW219</BillingCode><Name>Howmedica Modular Resection System</Name><Description>Humerus Connecting Screw -  Vitallium</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112029</SubGroupID><ARTGs><ARTG>242316</ARTG></ARTGs><MinimumBenefit>620</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW220</BillingCode><Name>Howmedica Modular Resection System</Name><Description>Humerus Hex Socket Bolt -  Vitallium</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112030</SubGroupID><ARTGs><ARTG>242316</ARTG></ARTGs><MinimumBenefit>537</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW200</BillingCode><Name>Howmedica Modular Resection System</Name><Description>Plug Screw Axis -  Vitallium</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112031</SubGroupID><ARTGs><ARTG>248353</ARTG><ARTG>242296</ARTG></ARTGs><MinimumBenefit>206</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW213</BillingCode><Name>Howmedica Modular Resection System</Name><Description>Humeral Bearing -  Vitallium</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112033</SubGroupID><ARTGs><ARTG>242296</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW254</BillingCode><Name>HMRS Oncology Humeral Head/Cap</Name><Description>Cobalt Chromium</Description><Size>40, 44mm, Cap</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112034</SubGroupID><ARTGs><ARTG>128450</ARTG></ARTGs><MinimumBenefit>4047</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH703</BillingCode><PriorBillingCodes><PriorBillingCode>OO127</PriorBillingCode></PriorBillingCodes><Name>MUTARS Humerus cap</Name><Description>MUTARS Humerus cap</Description><Size>Small, medium and large. +5 and +10mm offset
Standard / Inverse</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112034</SubGroupID><ARTGs><ARTG>227772</ARTG><ARTG>234173</ARTG></ARTGs><MinimumBenefit>4047</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH666</BillingCode><PriorBillingCodes><PriorBillingCode>OO126</PriorBillingCode></PriorBillingCodes><Name>MUTARS Humerus Head</Name><Description>MUTARS Humerus Head</Description><Size>50mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112034</SubGroupID><ARTGs><ARTG>223513</ARTG><ARTG>284244</ARTG></ARTGs><MinimumBenefit>4047</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW216</BillingCode><Name>Howmedica Modular Resection System</Name><Description>Distal Humerus Cone -  Vitallium</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112035</SubGroupID><ARTGs><ARTG>242296</ARTG></ARTGs><MinimumBenefit>4130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW217</BillingCode><Name>Howmedica Modular Resection System</Name><Description>Distal Humerus Flange -  Vitallium</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112035</SubGroupID><ARTGs><ARTG>242296</ARTG></ARTGs><MinimumBenefit>4130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH346</BillingCode><Name>Comprehesive Segmental Revision System (SRS)</Name><Description>Comprehensive SRS Flange</Description><Size>Small, large</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112035</SubGroupID><ARTGs><ARTG>104347</ARTG></ARTGs><MinimumBenefit>4130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW643</BillingCode><Name>METS Humeral Collar Round Smooth</Name><Description>Titanium, smooth uncoated collar for a secure fit in the humeral canal</Description><Size>20mm, 22mm, 24mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112036</SubGroupID><ARTGs><ARTG>246505</ARTG></ARTGs><MinimumBenefit>2200</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA036</BillingCode><Name>Equinoxe HRP Distal Stem Collar</Name><Description>Distal stem collar is used with the distal stems to provide external fixation and rotational stability within the intramedullary canal.</Description><Size>17.5 - 33.5</Size><SupplierCode>40074</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112036</SubGroupID><ARTGs><ARTG>396475</ARTG></ARTGs><MinimumBenefit>2200</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW619</BillingCode><Name>METS Humeral Component for use with Hemi Head</Name><Description>Titanium humeral component</Description><Size>Small and standard</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112037</SubGroupID><ARTGs><ARTG>276014</ARTG></ARTGs><MinimumBenefit>6690</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW620</BillingCode><Name>METS Humeral Head Fixation Screw</Name><Description>Titanium screw which fixes the humeral component and the humeral head together</Description><Size>Small and standard</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112038</SubGroupID><ARTGs><ARTG>246503</ARTG></ARTGs><MinimumBenefit>537</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW621</BillingCode><Name>METS Humeral Component with Liner and re-attachment</Name><Description>Titanium component with HA coated rails for tissue reattachment, HYMWPE liner with encased metal ring for use with contrained glenoid</Description><Size>Mono-size, left and right</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112039</SubGroupID><ARTGs><ARTG>277425</ARTG></ARTGs><MinimumBenefit>8541</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW622</BillingCode><Name>METS Humeral Collar Round Coated</Name><Description>Titanium colar with HAP coated stipples</Description><Size>20mm, 22mm, 24mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112040</SubGroupID><ARTGs><ARTG>246505</ARTG></ARTGs><MinimumBenefit>3916</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW623</BillingCode><Name>METS Humeal Stem</Name><Description>Straight titanium stems, 7-11mm diameters</Description><Size>Diameters 7-11mm,  Lengths 70-90mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112041</SubGroupID><ARTGs><ARTG>276068</ARTG></ARTGs><MinimumBenefit>2587</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW624</BillingCode><Name>METS Humeral Shaft</Name><Description>Titanium shafts in 15mm increments, reconstructs the humeral shaft where there is diseased or deficient bone</Description><Size>Lengths 38-143mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112042</SubGroupID><ARTGs><ARTG>246504</ARTG></ARTGs><MinimumBenefit>3081</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW625</BillingCode><Name>METS Humeral Integral Shaft &amp; Stem Coated</Name><Description>Titanium, combined shaft, stem &amp; collar with HA coated stipples</Description><Size>20mm shaft plateau with 8mm diameter stem, 24mm shaft plateau with 10mm diameter stem
7945</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112043</SubGroupID><ARTGs><ARTG>276913</ARTG></ARTGs><MinimumBenefit>7548</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW626</BillingCode><Name>METS Humeral Component with Liner</Name><Description>Titanium component, UHMWPE liner with encased metal ring for use with constrained glenoid</Description><Size>Mono-size, left and right</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112045</SubGroupID><ARTGs><ARTG>277395</ARTG></ARTGs><MinimumBenefit>6729</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW627</BillingCode><Name>METS Humeral Component with Reattachment for use with Hemi Head</Name><Description>Titanium humeral component with HA coated rails for tissue reattachment</Description><Size>Small and standard</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112046</SubGroupID><ARTGs><ARTG>276015</ARTG></ARTGs><MinimumBenefit>8875</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH674</BillingCode><PriorBillingCodes><PriorBillingCode>OO135</PriorBillingCode></PriorBillingCodes><Name>MUTARS Glenoid</Name><Description>MUTARS Glenoid</Description><Size>1 size</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112047</SubGroupID><ARTGs><ARTG>227161</ARTG></ARTGs><MinimumBenefit>7111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH665</BillingCode><PriorBillingCodes><PriorBillingCode>OO125</PriorBillingCode></PriorBillingCodes><Name>MUTARS Glenosphere</Name><Description>MUTARS glenosphere</Description><Size>40mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112047</SubGroupID><ARTGs><ARTG>227771</ARTG></ARTGs><MinimumBenefit>7111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW628</BillingCode><Name>METS Bayley Walker Glenoid Component</Name><Description>Titanium HAP coated tapered screw with 22.2mm CoCr-Molybdenum head, for Glenoid fixation</Description><Size>Extra small, small and standard</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112047</SubGroupID><ARTGs><ARTG>276250</ARTG></ARTGs><MinimumBenefit>7111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW644</BillingCode><Name>METS Humeral Hemi-head</Name><Description>Titanium humeral hemi-head forming part of a modular system to replace diseased or damaged bone</Description><Size>Diameters 43mm, 46mm, 52mm, 55mm, 58mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112048</SubGroupID><ARTGs><ARTG>276014</ARTG></ARTGs><MinimumBenefit>3218</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH634</BillingCode><PriorBillingCodes><PriorBillingCode>OO082</PriorBillingCode></PriorBillingCodes><Name>MUTARS - Arthrodesis stems</Name><Description>Arthrodesis tibial and femoral stems, cvd, straight, cemented/cementless</Description><Size>11-20mm x 100 - 250mm length</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112049</SubGroupID><ARTGs><ARTG>236019</ARTG></ARTGs><MinimumBenefit>3724</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH659</BillingCode><PriorBillingCodes><PriorBillingCode>OO119</PriorBillingCode></PriorBillingCodes><Name>MUTARS - Arthrodesis Tibial component</Name><Description>MUTARS - Arthrodesis Tibial component</Description><Size>45mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112051</SubGroupID><ARTGs><ARTG>242292</ARTG><ARTG>284589</ARTG></ARTGs><MinimumBenefit>6242</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH660</BillingCode><PriorBillingCodes><PriorBillingCode>OO120</PriorBillingCode></PriorBillingCodes><Name>MUTARS - Arthrodesis femoral component</Name><Description>MUTARS - Arthrodesis femoral component</Description><Size>45mm left and right</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108793</GroupID><SubGroupID>112053</SubGroupID><ARTGs><ARTG>242292</ARTG><ARTG>284584</ARTG></ARTGs><MinimumBenefit>6242</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ058</BillingCode><Name>F1 Proximal Femoral Nail</Name><Description>F1 Femoral Nail, Titanium</Description><Size>170mm, 200mm
120deg, 125deg, 130deg</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112057</SubGroupID><ARTGs><ARTG>111818</ARTG></ARTGs><MinimumBenefit>910</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW051</BillingCode><Name>WEGO Nailing Systems</Name><Description>Femoral Nail</Description><Size>≤ 200mm</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112057</SubGroupID><ARTGs><ARTG>324374</ARTG></ARTGs><MinimumBenefit>910</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ158</BillingCode><Name>PediNail Platform</Name><Description>Pediatric Nailing Platform Femur</Description><Size>7mm x 200mm  Child  Left, Right</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112057</SubGroupID><ARTGs><ARTG>191587</ARTG></ARTGs><MinimumBenefit>910</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI723</BillingCode><Name>Zimmer Natural Nail System</Name><Description>Cephalomedullary, Short Nails, Titanium</Description><Size>10mm to 14.5mm (in 1.5mm increments) x 21.5cm 125 to 135 CCD (in 5 CCD increments) Left and Right.</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112057</SubGroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>910</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH313</BillingCode><Name>Affixus Hip Fracture Nail System</Name><Description>Short Hip fracture nails</Description><Size>9-13mm diameter, 180mm length</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112057</SubGroupID><ARTGs><ARTG>212235</ARTG></ARTGs><MinimumBenefit>910</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN763</BillingCode><Name>IMHS CP</Name><Description>Intramedullary Hip Nail, stainless steel</Description><Size>10 - 16mm x 19.5cm left and right</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112057</SubGroupID><ARTGs><ARTG>104370</ARTG></ARTGs><MinimumBenefit>910</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN838</BillingCode><Name>Trigen InterTAN Nail</Name><Description>Nail, Titanium</Description><Size>diameter 10-13mm
length 18-46cm
Angle 125°-135°</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112057</SubGroupID><ARTGs><ARTG>104370</ARTG></ARTGs><MinimumBenefit>910</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX049</BillingCode><Name>CLAVO™ Proximal Femoral Rotational-Stability Nail, Extra-Small/Small, 130° </Name><Description>Femoral Nail </Description><Size>9-12 mm D &lt;220mm length</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112057</SubGroupID><ARTGs><ARTG>378490</ARTG></ARTGs><MinimumBenefit>910</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK246</BillingCode><Name>Gamma LN</Name><Description>Standard - Titanium</Description><Size>120, 125, 130 Deg; Diameter 9-13mm; Length 170mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112057</SubGroupID><ARTGs><ARTG>95185</ARTG></ARTGs><MinimumBenefit>910</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JD015</BillingCode><Name>Proximal Femur Nails</Name><Description>Nails</Description><Size>Diameter 11mm
Proximal Diameter 17mm
&lt;220mm length</Size><SupplierCode>40214</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112057</SubGroupID><ARTGs><ARTG>222647</ARTG></ARTGs><MinimumBenefit>910</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY790</BillingCode><Name>AO/ASIF Intramedullary Nails</Name><Description>Femoral Nail</Description><Size>9-15mm D &lt;220mm length</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112057</SubGroupID><ARTGs><ARTG>161140</ARTG></ARTGs><MinimumBenefit>910</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK214</BillingCode><Name>Stryker Trauma Locking Nail System</Name><Description>Reconstruction Nail</Description><Size>Recon Nail Left/RightDiameter 9-15mm, Length 240-480mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112058</SubGroupID><ARTGs><ARTG>95185</ARTG></ARTGs><MinimumBenefit>1188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK244</BillingCode><Name>Stryker Intramedullary Nailing System</Name><Description>Gamma Long</Description><Size>120, 125, 130 Deg; Diameter 9-15mm; Length 240-480mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112058</SubGroupID><ARTGs><ARTG>95185</ARTG></ARTGs><MinimumBenefit>1188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH314</BillingCode><Name>Affixus Hip Fracture Nail System</Name><Description>Long Hip fracture nails</Description><Size>9-15mm diameter, 260-460mm length</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112058</SubGroupID><ARTGs><ARTG>212235</ARTG></ARTGs><MinimumBenefit>1188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX055</BillingCode><Name>CLAVO™ Proximal Femoral Rotational-Stability Nail, Standard/ Long, Left/ Right, 130°.</Name><Description>Femoral Nail</Description><Size>9-12mm D ≥ 220mm length</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112058</SubGroupID><ARTGs><ARTG>378490</ARTG></ARTGs><MinimumBenefit>1188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ183</BillingCode><Name>Stryker Intramedullary Nailing System</Name><Description>Gamma Intermediate</Description><Size>120, 125, 130 Deg; Diameter 9-13mm; Length 240mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112058</SubGroupID><ARTGs><ARTG>382682</ARTG></ARTGs><MinimumBenefit>1188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY791</BillingCode><Name>AO/ASIF Intramedullary Nails</Name><Description>Femoral Nail</Description><Size>9-15mm D ≥ 220mm length</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112058</SubGroupID><ARTGs><ARTG>161140</ARTG></ARTGs><MinimumBenefit>1188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL065</BillingCode><Name>Trigen</Name><Description>Femoral Nail, Titanium</Description><Size>9, 10, 11.5 &amp; 13mm diameter</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112058</SubGroupID><ARTGs><ARTG>104370</ARTG></ARTGs><MinimumBenefit>1188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI715</BillingCode><Name>Zimmer Natural Nail System</Name><Description>Cephalomedullary, Femoral Long Nails, Titanium</Description><Size>10mm to 14.5mm (in 1.5mm increments) x 30 to 48cm (in 2cm increments) x 125 &amp; 130 CCD Left and Right.</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112058</SubGroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>1188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI722</BillingCode><Name>Zimmer Natural Nail System</Name><Description>Antegrade Femoral Nails, Greater Trochanter, Titanium</Description><Size>8 to 14mm x 24 to 48cm (in 2cm increments) Left and Right</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112058</SubGroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>1188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW052</BillingCode><Name>WEGO Nailing Systems</Name><Description>Femoral Nail</Description><Size>≥220mm</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112058</SubGroupID><ARTGs><ARTG>324374</ARTG></ARTGs><MinimumBenefit>1188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ086</BillingCode><Name>PediNail System</Name><Description>Intramedullary Femoral Nail</Description><Size>7-10mm x 12-42cm
Left, Right</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112058</SubGroupID><ARTGs><ARTG>191587</ARTG></ARTGs><MinimumBenefit>1188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ007</BillingCode><Name>F3 Femoral Nail</Name><Description>F3 Femoral Nail Titanium</Description><Size>Length 320mm to 440mm, left and right</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112058</SubGroupID><ARTGs><ARTG>111818</ARTG></ARTGs><MinimumBenefit>1188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ067</BillingCode><Name>F1 Proximal Femoral Nail</Name><Description>F1 Femoral Nail - Long</Description><Size>340mm - 460mm
120deg, 125deg, 130deg</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112058</SubGroupID><ARTGs><ARTG>111818</ARTG></ARTGs><MinimumBenefit>1188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ157</BillingCode><Name>PediNail Platform</Name><Description>Pediatric Nailing Platform Femur</Description><Size>7-12mm x 220-420mm  Left, Right  Child, Adolescent</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112058</SubGroupID><ARTGs><ARTG>191587</ARTG></ARTGs><MinimumBenefit>1188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JD016</BillingCode><Name>Proximal Femur Nail</Name><Description>Femoral Nail</Description><Size>Diameter 11mm
Proximal Diameter 17mm
Length ≥220mm</Size><SupplierCode>40214</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112058</SubGroupID><ARTGs><ARTG>222647</ARTG></ARTGs><MinimumBenefit>1188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN521</BillingCode><Name>TriGen</Name><Description>Femoral Nail</Description><Size>8-18mm D ≥ 220mm length</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112058</SubGroupID><ARTGs><ARTG>104370</ARTG></ARTGs><MinimumBenefit>1188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN764</BillingCode><Name>IMHS CP</Name><Description>Intramedullary Hip Nail, stainless steel</Description><Size>10 - 14mm x 32 - 44cm left and right</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112058</SubGroupID><ARTGs><ARTG>104370</ARTG></ARTGs><MinimumBenefit>1188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI721</BillingCode><Name>Zimmer Natural Nail System</Name><Description>Retrograde Femoral Nail - Titanium</Description><Size>10mm to 13mm x 16, 20, 24, 28, 30, 32, 34, 36, 38, 40, 42, 44cm Universal.  </Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112059</SubGroupID><ARTGs><ARTG>169891</ARTG></ARTGs><MinimumBenefit>995</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AX020</BillingCode><Name>S2 Nail System</Name><Description>Cannulated supracondylar nail, stainless steel</Description><Size>11/13mm x 160-380mm</Size><SupplierCode>40029</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112059</SubGroupID><ARTGs><ARTG>119002</ARTG></ARTGs><MinimumBenefit>995</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JD019</BillingCode><Name>Femoral Nail</Name><Description>Femoral Nail</Description><Size>Diameter 10 - 12mm</Size><SupplierCode>40214</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112059</SubGroupID><ARTGs><ARTG>222647</ARTG></ARTGs><MinimumBenefit>995</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN522</BillingCode><Name>TriGen</Name><Description>Femoral nail</Description><Size>8.5-13mm x 15-50cm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112059</SubGroupID><ARTGs><ARTG>104370</ARTG></ARTGs><MinimumBenefit>995</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN299</BillingCode><Name>AO/ASIF Intramedullary Nails</Name><Description>Retrograde Femoral Nail</Description><Size>9-15mm / 160-420mm Length</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112059</SubGroupID><ARTGs><ARTG>161140</ARTG></ARTGs><MinimumBenefit>995</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK202</BillingCode><Name>Stryker Trauma Locking Nail System</Name><Description>SCN</Description><Size>Diameter 8mm - 15mm,   Length 170mm - 480mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112059</SubGroupID><ARTGs><ARTG>95185</ARTG></ARTGs><MinimumBenefit>995</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ064</BillingCode><Name>S2 Nail System</Name><Description>Cannulated supracondylar nail, stainless steel</Description><Size>11/13mm x 160-380mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112059</SubGroupID><ARTGs><ARTG>111818</ARTG></ARTGs><MinimumBenefit>995</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB078</BillingCode><Name>Mini Nailing System</Name><Description>Mini Nailing System</Description><Size>Diameter 3mm - 4mm, Length 130mm - 230mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112060</SubGroupID><ARTGs><ARTG>229660</ARTG></ARTGs><MinimumBenefit>963</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW537</BillingCode><Name>Stryker Intramedullary Nailing System</Name><Description>Tibial nails</Description><Size>8-15mm Diameter, 240- 420mm lengths</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112060</SubGroupID><ARTGs><ARTG>139722</ARTG></ARTGs><MinimumBenefit>963</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU149</BillingCode><PriorBillingCodes><PriorBillingCode>DE684</PriorBillingCode></PriorBillingCodes><Name>Fibulock, Fibular Nail System</Name><Description>Fibular Nail for Fibular Fracture Fixation</Description><Size>4 Sizes (Left &amp; Right Side Specific)</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112060</SubGroupID><ARTGs><ARTG>350831</ARTG></ARTGs><MinimumBenefit>963</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW536</BillingCode><Name>Stryker Intermedullary Nailing System</Name><Description>Femoral Nails</Description><Size>7-15mm Diameter , 140 to 480 lengths</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112060</SubGroupID><ARTGs><ARTG>95185</ARTG></ARTGs><MinimumBenefit>963</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY788</BillingCode><Name>AO/ASIF Intramedullary Nails</Name><Description>Tibial Nail</Description><Size>7-19; 200-600mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112060</SubGroupID><ARTGs><ARTG>161138</ARTG></ARTGs><MinimumBenefit>963</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI719</BillingCode><Name>Zimmer Natural Nail System</Name><Description>Tibial Nails - Titanium</Description><Size>8.3mm; 9.3mm; 10mm; 11mm; 12mm; 14mm x 24 to 44cm in 2cm increments</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112060</SubGroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>963</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ012</BillingCode><Name>Austofix Femoral and Tibial Nailing System</Name><Description>Universal Tibial Nail (UTN) 4.0/4.8, stainless steel or titanium</Description><Size>Diameter 8 – 11mm, Lengths 260mm – 420mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112060</SubGroupID><ARTGs><ARTG>111818</ARTG></ARTGs><MinimumBenefit>963</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN841</BillingCode><Name>Trigen META</Name><Description>Metaphyseal Nail, Titanium</Description><Size>8.5-13mm
15x50cm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112060</SubGroupID><ARTGs><ARTG>117591</ARTG></ARTGs><MinimumBenefit>963</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JD020</BillingCode><Name>Tibial Nail</Name><Description>Tibial Nail</Description><Size>10 - 11mm diameter</Size><SupplierCode>40214</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112060</SubGroupID><ARTGs><ARTG>222647</ARTG></ARTGs><MinimumBenefit>963</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO280</BillingCode><Name>Acumed Fibula Rod System</Name><Description>Intramedullary Nail, fibula lower limb specific</Description><Size>3.00mm &amp; 3.6mm diameter left and right specific rods with lengths of 110mm, 145mm, 180mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112060</SubGroupID><ARTGs><ARTG>99822</ARTG></ARTGs><MinimumBenefit>963</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW002</BillingCode><Name>WEGO Nailing Systems</Name><Description>Tibial Nail</Description><Size>&gt; 220mm</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112060</SubGroupID><ARTGs><ARTG>324375</ARTG></ARTGs><MinimumBenefit>963</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH367</BillingCode><Name>Fassier-Duval Telescopic IM System Component: Male</Name><Description>The Fassier-Dual Telescopic IM System is an endomedular nail designed for patients suffering from Osteogenesis Impecfecta (OI), Skeletal Displasia, Congenital Tibial Pseudoarthrosis, Limb lengthening over nail, Segmental Tumour removal and other bone deformities</Description><Size>The system is composed of a total of 108 rods in 9 different diameters per type.  The nail is manufactured in both Ti alloy (Ti6A14V ASTM-136) and medical grade Stainless Steel (315L, ASTM 138).  It is available in five diameters: 3.2, 4,4.8,5.6 and 6.4 mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112061</SubGroupID><Suffix>Gth</Suffix><ARTGs><ARTG>141020</ARTG></ARTGs><MinimumBenefit>3348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW876</BillingCode><PriorBillingCodes><PriorBillingCode>WR346</PriorBillingCode></PriorBillingCodes><Name>Aequalis Humeral Nail</Name><Description>Humeral Nail, straight, cannulated, Ti</Description><Size>Right/Left, dia 7mm and 8mm, Lg 130mm, 210mm, 230mm, 250mm and 270mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112061</SubGroupID><ARTGs><ARTG>164794</ARTG></ARTGs><MinimumBenefit>878</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY689</BillingCode><Name>MultiLoc Humeral Nail</Name><Description>Humeral Nail</Description><Size>7.0mm-9.5mm D, 160mm-315mm L</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112061</SubGroupID><ARTGs><ARTG>161139</ARTG></ARTGs><MinimumBenefit>878</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN740</BillingCode><Name>Trigen</Name><Description>Humeral Nail</Description><Size>7-11cm x 16-30cm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112061</SubGroupID><ARTGs><ARTG>117600</ARTG></ARTGs><MinimumBenefit>878</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA071</BillingCode><Name>Affixus Humeral Nail System</Name><Description>Humeral Nails, Universal and Proximal, Titanium, Locking, cannulated</Description><Size>7-11mm x 160-280mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112061</SubGroupID><ARTGs><ARTG>124766</ARTG></ARTGs><MinimumBenefit>878</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK199</BillingCode><Name>Stryker Trauma Locking Nail System</Name><Description>Proximal Humeral Nail</Description><Size>Nail Left/Right</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112061</SubGroupID><ARTGs><ARTG>139723</ARTG><ARTG>76714</ARTG></ARTGs><MinimumBenefit>878</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK006</BillingCode><Name>Stryker Trauma Locking Nail System</Name><Description>Titanium - Humeral Nail</Description><Size>Dia 7,8,9mm length 140 - 320mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112061</SubGroupID><ARTGs><ARTG>139723</ARTG></ARTGs><MinimumBenefit>878</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO424</BillingCode><Name>ACUMED POLARUS® 3 Solution Nails</Name><Description>ACUMED POLARUS 3 SOLUTION HUMERAL NAILS</Description><Size>A range of proximal and distal nails, 150mm, 200mm, 220mm, 240mm, 260mm, 280mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112061</SubGroupID><ARTGs><ARTG>99822</ARTG></ARTGs><MinimumBenefit>878</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ075</BillingCode><Name>Cannulated Humeral Nail</Name><Description>Humeral Nail</Description><Size>Diameter: 7mm to 9mm  Length: 170mm to 280mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112061</SubGroupID><ARTGs><ARTG>111818</ARTG></ARTGs><MinimumBenefit>878</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY416</BillingCode><Name>AO/ASIF Intramedullary Nails ASLS</Name><Description>Intramedullary Angular Stable Locking System</Description><Size>4-6mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112061</SubGroupID><ARTGs><ARTG>168395</ARTG></ARTGs><MinimumBenefit>878</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH368</BillingCode><Name>Fassier-Duval Telescopic IM System Component: Female</Name><Description>The Fassier-Duval Telescopic IM System is an endomedular nail designed for patients suffering from Osteogenesis Imperfecta (OI), Skeletal Displasia, Congenital Tibial Pseudoarthrosis, Limb lengthening over nail, Segmental Tumor removal and other bone defo</Description><Size>The system is composed of a total of 108 rods in 9 different diameters per type.  The nail is manufactured in both Ti alloy (Ti6A14V ASTM-136) and medical grade stainless steel (316L, ASTM 138).  It is available in five diameters: 3.2,4.4,8,5.6 and 6.4mm;</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112061</SubGroupID><Suffix>Gth</Suffix><ARTGs><ARTG>141020</ARTG></ARTGs><MinimumBenefit>3348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK035</BillingCode><Name>Telescopic Nail</Name><Description>The Telescopic Nail consists of two parts, D profile bar (male nail) and suitable D profile tube (female nail) with threaded end. It is made of high grade medical stainless steel. The male and female nails have five different diameter choices. The male nail comes in one length for each diameter. The female nails have five different length choices for each diameter. The Telescopic Nail includes a special designed corkscrew end on the distal part of the male nail that holds the nail firmly in the bone and prevents damage to the growth plate. The Telescopic Nail is indicated for children with long bone deformity corrections, fracture stabilisation, patients with osteoporotic bone and for children older than 18 months who are diagnosed with osteogenesis imperfecta.</Description><Size>Female Nail 3.5mm diameter 110, 120, 130, 140, 150mm lengths.  Angled Female Nail 3.5mm diameter 110, 130, 150mm lengths.  Male Nail 2.0mm diameter 180mm length.    Female Nail 4.0mm diameter 150, 170, 180, 190, 200mm lengths.  Angled Female Nail 4.0mm diameter 150, 180, 200mm lengths.  Male Nail 2.5mm diameter 250mm length.    Female Nail 5.0mm diameter 150, 200, 210, 230, 250mm lengths.  Angled Female Nail 5.0mm diameter 150, 210, 250mm lengths.  Male Nail 3.5mm diameter 300mm length.    Female Nail 6.0mm diameter 250, 270, 280, 290, 300mm lengths.  Angled Female Nail 6.0mm diameter 150, 210, 250mm lengths.  Male Nail 4.0mm diameter 350mm length.    Female Nail 6.5mm diameter 190, 200, 250, 280, 300mm lengths.  Angled Female Nail 6.5mm diameter 150, 210, 250mm lengths.  Male Nail 5.0mm diameter 350mm length.</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112061</SubGroupID><Suffix>Gth</Suffix><ARTGs><ARTG>305115</ARTG><ARTG>307686</ARTG><ARTG>310263</ARTG><ARTG>307748</ARTG><ARTG>308017</ARTG></ARTGs><MinimumBenefit>3348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN497</BillingCode><Name>Intramedullary Nailing System</Name><Description>Knee Fusion Nail</Description><Size>Diameter 11- 13 mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112062</SubGroupID><ARTGs><ARTG>104370</ARTG></ARTGs><MinimumBenefit>4464</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO100</BillingCode><Name>LINK Knee Fusion Nail</Name><Description>Cobalt Chromium</Description><Size>180mm, 220mm, 260mm</Size><SupplierCode>40190</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112062</SubGroupID><ARTGs><ARTG>140661</ARTG><ARTG>140663</ARTG></ARTGs><MinimumBenefit>4464</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK337</BillingCode><Name>Stryker Trauma Locking Nail System</Name><Description>Arthrodesis Nail - Knee</Description><Size>Arthrodesis Nail Left/Right; 11.5mm and 13mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112062</SubGroupID><ARTGs><ARTG>139633</ARTG></ARTGs><MinimumBenefit>4464</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK051</BillingCode><Name>Orthofix AHN</Name><Description>Hindfoot Fusion Nailing System, titanium.</Description><Size>10, 11, 12mm diameter.  150 - 300mm length.</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112063</SubGroupID><ARTGs><ARTG>377916</ARTG></ARTGs><MinimumBenefit>3300</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB074</BillingCode><Name>Ankle Arthrodesis Nail</Name><Description>Ankle Arthrodesis Nail</Description><Size>10mm - 12mm diameter</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112063</SubGroupID><ARTGs><ARTG>229660</ARTG></ARTGs><MinimumBenefit>3300</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL205</BillingCode><PriorBillingCodes><PriorBillingCode>IG100</PriorBillingCode></PriorBillingCodes><Name>Panta Arthrodesis Nail</Name><Description>Ankle Nail, Titanium</Description><Size>Diameter 10 -13 mm  Length - 150-240 mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112063</SubGroupID><ARTGs><ARTG>173962</ARTG></ARTGs><MinimumBenefit>3300</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW929</BillingCode><PriorBillingCodes><PriorBillingCode>WR411</PriorBillingCode></PriorBillingCodes><Name>611 Ankle Fusion Nail</Name><Description>The 611 ankle arthrodesis nail is made out of titanium alloy (Ti6AI4V) and is associated with self locking screws, a plug and an internal screw. The nail is delivered sterile. The self locking screws, plug and internal locking screw are delivered non-sterile with the instrumentation</Description><Size>10mm x 180mm, 6 deg left, 10mm x 180mm, 6 deg right  12mm x 180mm, 6 deg left, 12mm x 180mm, 6 deg right  10mm x 180mm, 11 deg left, 10mm x 180mm, 11 deg right  12mm x 180mm, 11 deg left, 12mmx180mm, 11 right</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112063</SubGroupID><ARTGs><ARTG>198776</ARTG></ARTGs><MinimumBenefit>3300</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW798</BillingCode><PriorBillingCodes><PriorBillingCode>WR208</PriorBillingCode></PriorBillingCodes><Name>Valor Hindfoot Fusion System</Name><Description>Valor Hindfoot Fusion Nail, Titanium Alloy</Description><Size>10 &amp; 11.5mm diameter, 150, 200 &amp; 250mm length, left and right</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112063</SubGroupID><ARTGs><ARTG>198549</ARTG></ARTGs><MinimumBenefit>3300</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY130</BillingCode><Name>AO/ASIF Arthrodesis system</Name><Description>Arthrodesis</Description><Size>26 - 240mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112063</SubGroupID><ARTGs><ARTG>141931</ARTG></ARTGs><MinimumBenefit>3300</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JD010</BillingCode><Name>Ankle Arthrodesis Nail</Name><Description>Arthrodesis Nail</Description><Size>10 &amp; 12mm diameter</Size><SupplierCode>40214</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112063</SubGroupID><ARTGs><ARTG>222647</ARTG></ARTGs><MinimumBenefit>3300</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ016</BillingCode><PriorBillingCodes><PriorBillingCode>LM369</PriorBillingCode></PriorBillingCodes><Name>Ankle Arthrodesis Nail</Name><Description>Ankle Arthrodesis Nail</Description><Size>Multiple sizes to suit patient anatomy</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112063</SubGroupID><ARTGs><ARTG>308941</ARTG></ARTGs><MinimumBenefit>3300</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU356</BillingCode><Name>DualCompression Hindfoot Nail</Name><Description>Hindfoot Nail for Arthrodesis</Description><Size>Diameters: 10.5mm, 11.5mm, 12.5mm      Lengths: 180mm, 210mm, 240mm, 300mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112063</SubGroupID><ARTGs><ARTG>409312</ARTG></ARTGs><MinimumBenefit>3300</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK450</BillingCode><Name>T2 Ankle Arthrodesis Nail</Name><Description>T2 Ankle Arthrodesis Type II Anodized Titanium Alloy (Ti6A14V)</Description><Size>10, 11, 12mm Diameters &amp; 150,200 &amp; 300mm Lengths</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112063</SubGroupID><ARTGs><ARTG>139633</ARTG><ARTG>16221</ARTG></ARTGs><MinimumBenefit>3300</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH044</BillingCode><Name>Biomet Phoenix Nail Arthrodesis Nailing System - Nail</Name><Description>Ankle Arthrodesis Locking Nail, Titanium Alloy</Description><Size>10 - 12mm diameter x 150 - 300mm length</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112063</SubGroupID><ARTGs><ARTG>212594</ARTG></ARTGs><MinimumBenefit>3300</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN772</BillingCode><Name>Trigen</Name><Description>Hindfoot Fusion Nail, Titanium</Description><Size>10 - 11.5mm Diameter</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112063</SubGroupID><ARTGs><ARTG>116509</ARTG></ARTGs><MinimumBenefit>3300</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF019</BillingCode><Name>Tylos</Name><Description>Ankle arthrodesis nail for Tibial Talo Calcaneal fusion</Description><Size>10 - 12mm diameter</Size><SupplierCode>40106</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112063</SubGroupID><ARTGs><ARTG>274577</ARTG></ARTGs><MinimumBenefit>3300</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN061</BillingCode><Name>Interphalangeal implants</Name><Description>Interphalangeal implants</Description><Size>XS, S, M, L</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112069</SubGroupID><ARTGs><ARTG>299344</ARTG></ARTGs><MinimumBenefit>548</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN045</BillingCode><Name>Newclip Hammertoe</Name><Description>Proximal Interphalangeal Implant</Description><Size>XS, S, M, L</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112069</SubGroupID><ARTGs><ARTG>299344</ARTG></ARTGs><MinimumBenefit>548</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW839</BillingCode><PriorBillingCodes><PriorBillingCode>WR298</PriorBillingCode></PriorBillingCodes><Name>Phalinx / Pro-toe VO*</Name><Description>Hammertoe Fixation System Implants</Description><Size>Extra Small - Large, Straight &amp; Angled</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112069</SubGroupID><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>548</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW981</BillingCode><Name>SALVATION Limb Salvage System Intramedullary Fusion Bolts</Name><Description>Intramedullary Fusion Bolts</Description><Size>5 - 7mm x 50 - 170mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112069</SubGroupID><ARTGs><ARTG>198549</ARTG></ARTGs><MinimumBenefit>548</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW821</BillingCode><PriorBillingCodes><PriorBillingCode>WR252</PriorBillingCode></PriorBillingCodes><Name>Pro-toe VO</Name><Description>Hammertoe Fixation System</Description><Size>Small, Large, Straight &amp; Angled</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112069</SubGroupID><ARTGs><ARTG>198485</ARTG></ARTGs><MinimumBenefit>548</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ025</BillingCode><PriorBillingCodes><PriorBillingCode>LM246</PriorBillingCode><PriorBillingCode>LM246</PriorBillingCode></PriorBillingCodes><Name>Duafit</Name><Description>Interphalangeal implant</Description><Size>11 - 20 mm implant length, zero, 10.0 or 17.0 degrees of plantarflexion</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112069</SubGroupID><ARTGs><ARTG>236773</ARTG></ARTGs><MinimumBenefit>548</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER387</BillingCode><Name>Paragon 28 Hammer Tube System</Name><Description>Paragon 28 Hammer tube, proximal interphalangeal joint arthrodesis; solid or cannulated, Peek, sterile</Description><Size>dia (2.50-3.75 mm); angle 0-10°; length (14-16mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112069</SubGroupID><ARTGs><ARTG>290441</ARTG></ARTGs><MinimumBenefit>548</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI980</BillingCode><Name>Nextra hammertoe Correction Prosthesis</Name><Description>Interdigital Fusion Implant</Description><Size>3.5mm MPI / 3.2mm PI  4.5mm MPI / 3.2mm PI  5.5mm MPI / 3.2mm PI  4.5mm MPI / 4.5mm PI  5.5mm MPI / 4.5mm PI</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112069</SubGroupID><ARTGs><ARTG>293060</ARTG></ARTGs><MinimumBenefit>548</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM300</BillingCode><Name>Intramedullary Arthrodesis Implant</Name><Description>Implant for small joint Arthrodesis</Description><Size>Small, Medium, Large</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112069</SubGroupID><ARTGs><ARTG>164980</ARTG></ARTGs><MinimumBenefit>548</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB051</BillingCode><Name>HN Intramedullary Nail</Name><Description>The HN Intramedullary Nail</Description><Size>Length 10mm - 26mm, Diameter 5.5mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112069</SubGroupID><ARTGs><ARTG>229660</ARTG></ARTGs><MinimumBenefit>548</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER380</BillingCode><Name>Paragon 28 Phantom Lapidus Nail System-Intramedullary nail, foot</Name><Description>Phantom Lapidus intramedullary nail, foot, left or right</Description><Size>dia 5.5 mmx length (38-60 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112069</SubGroupID><ARTGs><ARTG>290443</ARTG></ARTGs><MinimumBenefit>548</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW787</BillingCode><Name>SALVATION 2 Midfoot Nail</Name><Description>Intramedullary Nail</Description><Size>60-160mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112069</SubGroupID><ARTGs><ARTG>328561</ARTG></ARTGs><MinimumBenefit>548</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK038</BillingCode><Name>Fusion Beaming System</Name><Description>The Fusion Beaming System has been designed to address the specific demands of advanced deformity and trauma reconstructions of foot and ankle applications. The system was developed for the treatment of neuropathic deformities, such as Charcot, requiring fusion of the medial and/or lateral columns, with or without corrective osteotomies as well as for joint fusions within the mid and hindfoot. The Fusion Beaming System consists of two different diameter implant ranges, designed for optimal implant selection for wide ranging patient anatomies, and an instrumentation including the dedicated Sterilization Tray. The Fusion Beaming System is designed with an instrumentation and technique that have been developed to simplify the surgery.</Description><Size>5.4mm diameter implants: Lengths - 50mm, 55mm, 60mm, 65mm, 70mm, 75mm, 80mm, 85mm, 90mm, 95mm, 100mm, 105mm, 110mm, 115mm, 120mm, 125mm, 130mm, 135mm, 140mm, 145mm, 150mm, 155mm, 160mm, 165mm, 170mm.  7.4mm diameter implants: Lengths - 50mm, 55mm, 60mm, 65mm, 70mm, 75mm, 80mm, 85mm, 90mm, 95mm, 100mm, 105mm, 110mm, 115mm, 120mm, 125mm, 130mm, 135mm, 140mm, 145mm, 150mm, 155mm, 160mm, 165mm, 170mm, 175mm, 180mm, 185mm, 190mm, 195mm, 200mm.</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112069</SubGroupID><ARTGs><ARTG>295285</ARTG><ARTG>307583</ARTG><ARTG>307749</ARTG></ARTGs><MinimumBenefit>548</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU157</BillingCode><PriorBillingCodes><PriorBillingCode>DE550</PriorBillingCode></PriorBillingCodes><Name>RetroFusion</Name><Description>Implant for PIP Arthrodesis for Hammertoe and Clawtoe Deformity</Description><Size>20mm Length  24mm Length</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112069</SubGroupID><ARTGs><ARTG>350672</ARTG></ARTGs><MinimumBenefit>548</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BU013</BillingCode><Name>Lync Intramedullary Implant</Name><Description>Lync is a titanium intramedullary implant</Description><Size>12mm to 20mm Length, Angled 0 degrees and 10 degrees</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112069</SubGroupID><ARTGs><ARTG>235763</ARTG></ARTGs><MinimumBenefit>548</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK039</BillingCode><Name>C-Nail</Name><Description>C-Nail is an intramedullary nail for minimal-invasive fixation of intraarticular calcaneal fractures. The principle is to stabilise with the nail the four to five main fragments of the fractured calcaneus in conjunction with up to seven interlocking screws and thus creating angular stable fixation. The maximum stability is achieved by fixing the sustentacular fragment towards the nail with two interlocking screws guided by a very precise aiming devise. The design of the nail is clearly marked "L" for left foot and "R" for right foot. The nail length is 65mm with a diameter of 8mm. The nail can be extended and closed with an end cap that comes in 0mm, 5mm, 10mm, 15mm and 20mm sizes.</Description><Size>C-Nail: 65mm length x 8mm diameter (Left and Right option).</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112070</SubGroupID><ARTGs><ARTG>301836</ARTG><ARTG>308208</ARTG><ARTG>308209</ARTG><ARTG>308210</ARTG><ARTG>308207</ARTG><ARTG>305133</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB064</BillingCode><Name>C Nail</Name><Description>Intramedullary Nail</Description><Size>60mm - 100mm </Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112070</SubGroupID><ARTGs><ARTG>229660</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF022</BillingCode><Name>Calcanail</Name><Description>Subtalar fusion and fracture nail</Description><Size>10-12mm Diameter, 45-85mm length</Size><SupplierCode>40106</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112070</SubGroupID><ARTGs><ARTG>274577</ARTG></ARTGs><ChangeExplanation>Change to Group benefit</ChangeExplanation><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ094</BillingCode><Name>PediFlex System</Name><Description>Intramedullary Flexible Nail, Titanium, Stainless Steel, Standard, Tapered Tip, Round Tip</Description><Size>1.5-4.5mm x 300-450mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112071</SubGroupID><ARTGs><ARTG>191587</ARTG></ARTGs><MinimumBenefit>223</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY064</BillingCode><Name>Elastic Nail</Name><Description>Elastic bone nail</Description><Size>1.5mm - 4.0mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112071</SubGroupID><ARTGs><ARTG>303674</ARTG><ARTG>303666</ARTG></ARTGs><MinimumBenefit>223</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK506</BillingCode><Name>T2 Kids Paediatric Nail</Name><Description>Paediatric Flexible Nail</Description><Size>1.5-4mm, 300-450mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112071</SubGroupID><ARTGs><ARTG>169585</ARTG></ARTGs><MinimumBenefit>223</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO161</BillingCode><Name>Polarus Humeral Rod System</Name><Description>Polarus Radius Rod Titanium</Description><Size>190 to 230mm length</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112072</SubGroupID><ARTGs><ARTG>99822</ARTG></ARTGs><MinimumBenefit>1381</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO159</BillingCode><Name>Polarus Humeral Rod System</Name><Description>Polarus Ulna Rod Titanium</Description><Size>210 to 270mm length</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112072</SubGroupID><ARTGs><ARTG>99822</ARTG></ARTGs><MinimumBenefit>1381</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK015</BillingCode><Name>ISKD Internal Limb Lengthening System</Name><Description>Titanium Alloy</Description><Size>Diameter 12.5 - 14.5mm</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112073</SubGroupID><ARTGs><ARTG>118320</ARTG><ARTG>189940</ARTG><ARTG>189941</ARTG></ARTGs><MinimumBenefit>16741</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH542</BillingCode><Name>Precice Intramedullary Limb Lengthening System , Nail</Name><Description>Precice Intramedullary Nail</Description><Size>(8.5-14)mm diameter x (130-375)mm length</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112073</SubGroupID><ARTGs><ARTG>244568</ARTG><ARTG>290819</ARTG><ARTG>244569</ARTG></ARTGs><MinimumBenefit>16741</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN205</BillingCode><Name>Hammerlock</Name><Description>Intramedulary Nitinol Implant</Description><Size>Small to large</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112079</SubGroupID><Suffix>Interphalangeal</Suffix><ARTGs><ARTG>95685</ARTG></ARTGs><MinimumBenefit>548</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU219</BillingCode><PriorBillingCodes><PriorBillingCode>DE715</PriorBillingCode></PriorBillingCodes><Name>Dynanite PIP Hammertoe Implant</Name><Description>PIP Arthrodesis Implant</Description><Size>12mm, 14mm, 16mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112079</SubGroupID><Suffix>Interphalangeal</Suffix><ARTGs><ARTG>354292</ARTG></ARTGs><MinimumBenefit>548</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ079</BillingCode><Name>Austofix Orthofuse</Name><Description>Titanium Intramedullary Fusion Devices</Description><Size>3.3mm Prox, 4.3mm Mid  2.8mm Prox, 3.8mm Mid  </Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112079</SubGroupID><Suffix>Interphalangeal</Suffix><ARTGs><ARTG>284755</ARTG></ARTGs><MinimumBenefit>548</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO451</BillingCode><Name>ToeGrip</Name><Description>toe interphalangeal joint arthrodesis implant</Description><Size>Extra-small, small, medium, large, extra large</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112079</SubGroupID><Suffix>Interphalangeal</Suffix><ARTGs><ARTG>369250</ARTG></ARTGs><MinimumBenefit>548</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF025</BillingCode><Name>TicTac</Name><Description>Interphalangeal implant</Description><Size>Straight and angled</Size><SupplierCode>40106</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112079</SubGroupID><Suffix>Interphalangeal</Suffix><ARTGs><ARTG>290541</ARTG></ARTGs><MinimumBenefit>548</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM545</BillingCode><Name>Reduct Arthrodesis Screw System</Name><Description>The REDUCT® Arthrodesis Screw System is intended for fixation of osseous fragments or fractures, arthrodesis of small joints, and osteotomies, with the appropriately sized screw.</Description><Size>• 2.0mm non-cannulated screws: 20mm - 44mm in 2mm increments.  • 2.5mm cannulated screws: 26mm - 40mm in 2mm increments.  • 3.5mm cannulated screws: 32mm - 46mm in 2mm increments.</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112079</SubGroupID><Suffix>Interphalangeal</Suffix><ARTGs><ARTG>279795</ARTG></ARTGs><MinimumBenefit>548</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB073</BillingCode><Name>Hammer Fusion System</Name><Description>Interphalangeal Arthrodesis Implant</Description><Size>2.0mm - 4.0mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108794</GroupID><SubGroupID>112079</SubGroupID><Suffix>Interphalangeal</Suffix><ARTGs><ARTG>229660</ARTG></ARTGs><MinimumBenefit>548</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI717</BillingCode><Name>Zimmer Natural Nail System</Name><Description>Cancellous Screws Titanium - Partially Threaded &amp; Fixed Angle</Description><Size>6.0mm x 50 to 145mm at 5mm increments</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112080</SubGroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK036</BillingCode><Name>C-Nail Bone Screws</Name><Description>C-Nail is an intramedullary nail for minimally invasive fixation of intraarticular calcaneal fractures. The principle is to stabilise with the nail the four to five main fragments of the fractured calcaneus in conjunction with up to seven interlocking screws and thus creating angular stable fixation. The maximum stability is achieved by fixing the sustentacular fragment towards the nail with two interlocking screws guided by a very precise aiming device. The design of the nail is clearly marked "L" for left foot and "R" for right foot. The nail length is 65mm with a diameter of 8mm. The nail can be extended and closed with an end cap that comes in 0mm, 5mm, 10mm, 15mm and 20mm sizes.</Description><Size>Self-tapping cortical bone screws 3.5mm in diameter with 2.5mm hexagonal head. Lengths 22mm, 24mm, 26mm, 28mm, 30mm, 32mm, 34mm, 36mm, 38mm, 40mm, 42mm, 44mm 46mm, 48mm, 50mm, 52mm, 54mm, 56mm, 58mm, 60mm, 62mm, 64mm, 66mm, 68mm, 70mm.</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112080</SubGroupID><ARTGs><ARTG>308210</ARTG></ARTGs><MinimumBenefit>222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB079</BillingCode><Name>Mini Nailing System Reconstruction Screw</Name><Description>Mini Nailing System Reconstruction Screw</Description><Size>10mm - 40mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112080</SubGroupID><ARTGs><ARTG>223188</ARTG></ARTGs><MinimumBenefit>222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA069</BillingCode><Name>Affixus Humeral Nail System</Name><Description>Cancellous Screws Titanium - Partially Threaded &amp; Fixed Angle</Description><Size>4x34mm - 4x80mm (in 2mm increments)</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112080</SubGroupID><ARTGs><ARTG>274566</ARTG></ARTGs><MinimumBenefit>222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF021</BillingCode><Name>Tylos</Name><Description>Tylos trans-calcaneal reconstruction pin</Description><Size>0-35, 0-45, 0-55, 10-35, 10-45, 10-55, 20-35, 20-45, 20-55, 30-35, 30-45, 30-55, 40-35, 40-45, 40-55</Size><SupplierCode>40106</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112080</SubGroupID><ARTGs><ARTG>274577</ARTG></ARTGs><MinimumBenefit>222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK203</BillingCode><Name>Stryker Trauma Locking Nail System</Name><Description>SCN</Description><Size>Condyle Screws 5mm x (40mm-120mm)</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112080</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>139625</ARTG><ARTG>76714</ARTG></ARTGs><MinimumBenefit>253</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK215</BillingCode><Name>Stryker Trauma Locking Nail System</Name><Description>Reconstruction Nail</Description><Size>Recon Lag Screw</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112080</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>139625</ARTG><ARTG>76714</ARTG></ARTGs><MinimumBenefit>253</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF023</BillingCode><Name>Calcanail Screw</Name><Description>Cannulated Screw</Description><Size>5mm diameter, 28 - 40mm length</Size><SupplierCode>40106</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112080</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>274577</ARTG></ARTGs><MinimumBenefit>253</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN519</BillingCode><Name>TriGen</Name><Description>Capture Reconstruction Screws Titanium</Description><Size>6.4mm diameter 65-125mm length</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112080</SubGroupID><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY263</BillingCode><Name>AO/ASIF Intramedullary Nails</Name><Description>Reconstruction Screw, Titanium Alloy</Description><Size>26-200mm Length</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112080</SubGroupID><ARTGs><ARTG>157068</ARTG><ARTG>227971</ARTG></ARTGs><MinimumBenefit>222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL229</BillingCode><PriorBillingCodes><PriorBillingCode>IG138</PriorBillingCode></PriorBillingCodes><Name>Panta Arthrodesis Nail</Name><Description>Fully threaded lag Screw, Titanium</Description><Size>Diameter 5 mm Length - 20 - 110 mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112080</SubGroupID><ARTGs><ARTG>173963</ARTG></ARTGs><MinimumBenefit>222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ065</BillingCode><Name>S2 Nail System</Name><Description>6.2mm condylar screws</Description><Size>6.5mm x 60-85mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112080</SubGroupID><ARTGs><ARTG>111818</ARTG></ARTGs><MinimumBenefit>222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AX021</BillingCode><Name>S2 Nail System</Name><Description>6.2mm condylar screws</Description><Size>6.5mm x 60-85mm</Size><SupplierCode>40029</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112080</SubGroupID><ARTGs><ARTG>119002</ARTG></ARTGs><MinimumBenefit>222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN775</BillingCode><Name>IMHS CP</Name><Description>Set Screw, Stainless Steel</Description><Size>Standard</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC187</BillingCode><Name>SMR Revision Modular Locking Ring</Name><Description>Modular Locking Collar (Ring) Ti6AI4V</Description><Size>One Size</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>168582</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU363</BillingCode><Name>Dual Compression Hindfoot Nail - Headless Screws</Name><Description>Titanium Headless Cortical Screws</Description><Size>Diameter: 5mm   Length: 50mm-120mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>350672</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN467</BillingCode><Name>Compressing Screw</Name><Description>For Intramedullary and compression Hip Screw Systems</Description><Size>19mm &amp; 28.5mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB075</BillingCode><Name>Intramedullary Nailing System Locking Screw </Name><Description>Intramedullary Nailing System Locking Screw </Description><Size>5.0mm - 6.0mm </Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>223188</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH732</BillingCode><Name>Precice Intramedullary Limb Lengthening System</Name><Description>Precice Fully Threaded Locking Screw</Description><Size>4-5mm (Diameter) x 20-100mm (Length)</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>290819</ARTG><ARTG>244569</ARTG><ARTG>244568</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER687</BillingCode><Name>Paragon 28 Phantom Hindfoot TTC Nail System-Threaded Peg</Name><Description>Tibial, calcaneal or subtalar threaded peg/crossing screw</Description><Size>Diameter: 5.0mm; Length: 20mm – 70mm in 2mm increments.   Diameter: 7.2mm; Length: 45mm – 120mm in 5mm increments.</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>402229</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK247</BillingCode><Name>Gamma LN</Name><Description>Set Screw - Titanium</Description><Size>8x17.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>139625</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST043</BillingCode><Name>Stryker Intramedullary Nailing System</Name><Description>Locking Screw - Titanium</Description><Size>20-120mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>139625</ARTG><ARTG>313420</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN739</BillingCode><Name>Trigen</Name><Description>Self Tapping Cortical Screw</Description><Size>20mm - 110mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JD018</BillingCode><Name>Nail Set Screw</Name><Description>Nail Set Screw</Description><Size>Static &amp; Dynamic</Size><SupplierCode>40214</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>222647</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JD011</BillingCode><Name>Screws - Reconstruction</Name><Description>Screws</Description><Size>3.5 - 5 mm diameter</Size><SupplierCode>40214</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>222647</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF020</BillingCode><Name>Tylos Screw</Name><Description>Cortical Screw for Tibio Talo Calcaneal fusion</Description><Size>5mm x 25mm, 30mm, 35mm, 40mm, 45mm, 50mm, 55mm</Size><SupplierCode>40106</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>274577</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK245</BillingCode><Name>Stryker Intramedullary Nailing System</Name><Description>Locking Screw - Titanium</Description><Size>25mm - 120mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>313420</ARTG><ARTG>139625</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER686</BillingCode><Name>Paragon 28 Phantom Hindfoot TTC Nail System-Internal Compression Screw</Name><Description>Compression screw</Description><Size>one size</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>402229</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK216</BillingCode><Name>Stryker Trauma Locking Nail System</Name><Description>Reconstruction Nail</Description><Size>Blocking Screw</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>139625</ARTG><ARTG>313420</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER382</BillingCode><Name>Paragon 28 Phantom Lapidus Nail-Screw, small (2.71mm – 4.49mm)</Name><Description>Paragon 28 Phantom Lapidus Nail-Screw, small</Description><Size>dia 3.5 mm x length (10-46 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>290443</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI718</BillingCode><Name>Zimmer Natural Nail System</Name><Description>Cortical Screws - Fixed Angle (Fully Threaded) Titanium</Description><Size>4.0mm &amp; 5.0mm x 20 to 60mm (2.5mm increments); 4.0mm &amp; 5.0mm x 65 to 100mm (5mm increments)</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN762</BillingCode><Name>IMHS CP</Name><Description>Captured locking screw</Description><Size>4.5mm x 22mm to 4.5mm x 64mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OY006</BillingCode><Name>Dual Cone Locking Extension (as a component of the Orthodynamics The Integral Leg Prosthesis</Name><Description>Orthodynamics The Integral Leg Prosthesis-Dual Cone Locking Extension</Description><Size>6 sizes</Size><SupplierCode>40112</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>109214</ARTG><ARTG>195008</ARTG><ARTG>195009</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY690</BillingCode><Name>MultiLoc Screw</Name><Description>Conical, Locking "Screw-in-Screw"</Description><Size>4.5mm; 20mm - 60mm Length</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>157068</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ024</BillingCode><Name>Austofix Femoral and Tibial Nailing System</Name><Description>4.0/4.8 Screws, Locking, stainless steel or titanium</Description><Size>Diameter 4.0-4.8mm, Lengths 20-90mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>111818</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ063</BillingCode><Name>F1 Proximal Femoral Nail</Name><Description>Set Screw</Description><Size>Single Size</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>111818</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU357</BillingCode><Name>Dual Compression Hindfoot Nail - Low Profile Screws</Name><Description>Low Profile Cortical Screws </Description><Size>5mm Diamater  20mm-32mm  35mm-60mm  </Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>350672</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW003</BillingCode><Name>WEGO Nailing Systems</Name><Description>Locking Screw for IM Nails</Description><Size>4.0-6.5mm x 18-130mm</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>324375</ARTG><ARTG>324374</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH541</BillingCode><Name>Precice Intramedullary Limb Lengthening System</Name><Description>Precice Partially Threaded Locking Screw</Description><Size>Diameter (3.5 -5.0)mm diameter x (20- 80)mm length</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>244569</ARTG><ARTG>290819</ARTG><ARTG>244568</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY789</BillingCode><Name>AO/ASIF intramedullary Nails</Name><Description>Locking Screws/Bolts/Nuts, Titanium Alloy</Description><Size>4 mm (18-80 mm length), 5 mm (26-120 mm length)</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112081</SubGroupID><ARTGs><ARTG>133919</ARTG><ARTG>157068</ARTG><ARTG>297881</ARTG></ARTGs><MinimumBenefit>139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER685</BillingCode><Name>Paragon 28 Phantom Hindfoot TTC Nail System-End Cap</Name><Description>Shouldered or compression end cap</Description><Size>short or long</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>402215</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW012</BillingCode><Name>WEGO Nailing Systems</Name><Description>End Cap for Nails</Description><Size>0-20mm</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>324374</ARTG><ARTG>324375</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ062</BillingCode><Name>F1 Proximal Femoral Nail</Name><Description>Screw End Cap</Description><Size>5mm, 10mm, 15mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>111818</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OY007</BillingCode><Name>Orthodynamics The Integral Leg Prostheses-Central Screw (as a component of the Orthodynamics The Integral Leg Prosthesis</Name><Description>Orthodynamics The Integral Leg Prosthesis-Central Screw</Description><Size>1 size</Size><SupplierCode>40112</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>195009</ARTG><ARTG>109214</ARTG><ARTG>195008</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU367</BillingCode><Name>Dual Compression Hindfoot Nail - End Cap</Name><Description>End Cap for DualCompression Hindfoot Nail</Description><Size>Standard, 2.5mm, 5mm, 10mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>409311</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO200</BillingCode><Name>Polarus Humeral Fixation System</Name><Description>End cap screw, titanium</Description><Size>0-6mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>99822</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ087</BillingCode><Name>Intramedullary Nail End Caps</Name><Description>PediNail End Caps
PediFlex End Caps</Description><Size>0-20mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>191587</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ021</BillingCode><Name>Austofix Femoral and Tibial Nailing System</Name><Description>M8 End Cap, Intramedullary Nails, stainless steel or titanium</Description><Size>1mm-20mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>111818</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ061</BillingCode><Name>F1 Proximal Femoral Nail</Name><Description>F1 Helical End Cap</Description><Size>5mm, 10mm, 15mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>111818</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL206</BillingCode><PriorBillingCodes><PriorBillingCode>IG102</PriorBillingCode></PriorBillingCodes><Name>Panta Arthrodesis Nail</Name><Description>End Cap, Titanium</Description><Size>One Size</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>173962</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JD012</BillingCode><Name>Nail Caps</Name><Description>Nail Cap</Description><Size>0, 5, 10 &amp; 11mm diameter</Size><SupplierCode>40214</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>222647</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK037</BillingCode><Name>C-Nail End Caps</Name><Description>C-Nail is an intramedullary nail for minimally invasive fixation of intraarticular calcaneal fractures. The principle is to stabilise with the nail the four to five main fragments of the fractured calcaneus in conjunction with up to seven interlocking screws and thus creating angular stable fixation. The maximum stability is achieved by fixing the sustentacular fragment towards the nail with two interlocking screws guided by a very precise aiming device. The design of the nail is clearly marked "L" for left foot and "R" for right foot. The nail length is 65mm with a diameter of 8mm. The nail can be extended and closed with an end cap that comes in 0mm, 5mm, 10mm, 15mm and 20mm sizes.</Description><Size>End Cap: 0mm, 5mm, 10mm, 15mm, 20mm.</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>308209</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH540</BillingCode><Name>Precice Intramedullary Limb Lengthening System</Name><Description>Precice End Cap</Description><Size>0-20mm length</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>244569</ARTG><ARTG>290819</ARTG><ARTG>244568</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BR007</BillingCode><Name>OPRA System - Graft Screw</Name><Description>Graft Screw</Description><Size>One size only</Size><SupplierCode>40322</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>145488</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB065</BillingCode><Name>End Cap</Name><Description>Nail End Cap</Description><Size>One size</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>229660</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN498</BillingCode><Name>Intramedullary Nailing System</Name><Description>Nail Cap</Description><Size>0 - 30 mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>137602</ARTG><ARTG>104369</ARTG><ARTG>104370</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN713</BillingCode><Name>Trigen</Name><Description>Stable-Lok Nut</Description><Size>One Size Only</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>141019</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY125</BillingCode><Name>AO/ASIF Intramedullary Nails</Name><Description>End caps - Femoral, Tibial, Nailing Systems - TFNA, TNA, FRNA, RFNA, ETN, PFNA</Description><Size>0 - 40mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>182344</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX053</BillingCode><Name>CLAVO™ Nail Cap for PFRN, Extension 0, 5, 10, 15 mm</Name><Description>Extension Nail Cap For Proximal Femoral Rotational Nail.</Description><Size>0 - 15 mm</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>378490</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK491</BillingCode><Name>U-Blade End Cap</Name><Description>U-Blade Lag Screw End Cap</Description><Size>One size 9mm x 10.5mm (diameter)</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>139625</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA070</BillingCode><Name>Affixus Humeral Nail System</Name><Description>End caps for Affixus Humeral Nail System</Description><Size>0mm, 8.5x0mm - 8.5x20mm, 9.5x5mm - 9.5x20mm, 10.5x2.5mm - 10.5x7.5mm, 11x2.5mm - 11x7.5mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>170659</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW797</BillingCode><PriorBillingCodes><PriorBillingCode>WR207</PriorBillingCode></PriorBillingCodes><Name>Valor Hindfoot Fusion System - Endcap</Name><Description>Valor Endcap</Description><Size>n/a</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>198549</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH045</BillingCode><Name>Biomet Phoenix Arthrodesis Nailing System - End Cap</Name><Description>Offset end cap, Titanium</Description><Size>0mm - 5mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>213856</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW931</BillingCode><PriorBillingCodes><PriorBillingCode>WR413</PriorBillingCode></PriorBillingCodes><Name>611 Ankle Fusion Nail - Component: PLUGS</Name><Description>The 611 ankle arthrodesis nail, 2mm &amp; 7mm plugs are made out of titanium alloy (Ti6AI4V). They are delivered non-sterile</Description><Size>0mm - 7.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>198776</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST045</BillingCode><Name>Stryker Intramedullary Nailing System</Name><Description>End Caps - Titanium</Description><Size>Standard to +35mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>144000</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH316</BillingCode><Name>Affixus Hip Fracture Nail System</Name><Description>End Caps</Description><Size>5mm, flush or impinging</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>177871</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK248</BillingCode><Name>Gamma LN</Name><Description>Proximal/Extension Plug - Titanium</Description><Size>0mm, 5mm, 10mm, 15mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>144000</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA064</BillingCode><PriorBillingCodes><PriorBillingCode>ZI710</PriorBillingCode><PriorBillingCode>ZI711</PriorBillingCode><PriorBillingCode>ZI720</PriorBillingCode></PriorBillingCodes><Name>Zimmer Natural Nail System</Name><Description>Nail caps - titanium</Description><Size>0-15mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112087</SubGroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK490</BillingCode><Name>Gamma</Name><Description>U-Blade Lag Screw Set</Description><Size>Dia. 10.5mm, 70-130mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112089</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>139625</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ059</BillingCode><Name>F1 Proximal Femoral Nail</Name><Description>F1 10.4mm Helical Blade</Description><Size>10.4mm width, 60-120mm length</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112089</SubGroupID><ARTGs><ARTG>111818</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ011</BillingCode><Name>Austofix Femoral and Tibial Nailing System</Name><Description>6.2/6.5 Hip Screw, stainless steel or titanium</Description><Size>Diameter 6.2-6.5mm, Lengths 70-120mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112089</SubGroupID><ARTGs><ARTG>111818</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI713</BillingCode><Name>Zimmer Natural Nail System</Name><Description>Lag Screws, Titanium</Description><Size>10.5mm x 70 to 130mm in 5mm increments</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112089</SubGroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK243</BillingCode><Name>Gamma LN</Name><Description>Lag Screw - Titanium</Description><Size>10.5mmx70mm - 10.5mmx130mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112089</SubGroupID><ARTGs><ARTG>139625</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN761</BillingCode><Name>IMHS CP</Name><Description>Subtrochanteric lag screw</Description><Size>12.7mm x 70mm to 12.7mm x 140mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112089</SubGroupID><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL026</BillingCode><Name>Compresion Hip Screw</Name><Description>Lag Screws</Description><Size>55-140mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112089</SubGroupID><ARTGs><ARTG>104369</ARTG><ARTG>104370</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY126</BillingCode><Name>AO/ASIF Intramedullary Nails</Name><Description>Spiral blade</Description><Size>Length 34 - 100mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112089</SubGroupID><ARTGs><ARTG>227971</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY803</BillingCode><Name>AO/ASIF Intramedullary Nails</Name><Description>Femoral Neck Screw Perforated</Description><Size>70mm - 130mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112089</SubGroupID><ARTGs><ARTG>227971</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JD017</BillingCode><Name>Proximal Femur Lag Screws</Name><Description>Lag Screws</Description><Size>80-110mm Length</Size><SupplierCode>40214</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112089</SubGroupID><ARTGs><ARTG>222647</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL228</BillingCode><PriorBillingCodes><PriorBillingCode>IG137</PriorBillingCode></PriorBillingCodes><Name>Panta Arthrodesis Nail</Name><Description>Partially threaded lag Screw, Titanium</Description><Size>Diameter 5 mm Length - 20 - 110 mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112089</SubGroupID><ARTGs><ARTG>173963</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ060</BillingCode><Name>F1 Proximal Femoral Nail</Name><Description>10.4mm Hip Screw</Description><Size>10.4mm width, 60-120mm length</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112089</SubGroupID><ARTGs><ARTG>111818</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW046</BillingCode><Name>WEGO Nailing Systems</Name><Description>Femoral Neck Lag Screw</Description><Size>75 - 120mm</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112089</SubGroupID><ARTGs><ARTG>324374</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL066</BillingCode><Name>TriGen</Name><Description>Integrated Lag / Compression Screw Kit</Description><Size>65 mm - 120 mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112089</SubGroupID><Suffix>Comp</Suffix><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>243</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL067</BillingCode><Name>TriGen</Name><Description>Compression Screw</Description><Size>35 mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112089</SubGroupID><Suffix>Comp</Suffix><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>243</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN774</BillingCode><Name>IMHS CP</Name><Description>Captured Compression Screw, Stainless Steel</Description><Size>19mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112089</SubGroupID><Suffix>Comp</Suffix><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>243</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST035</BillingCode><Name>Stryker Intramedullary Nailing System</Name><Description>Compression Screw -Titanium</Description><Size>0 – 35mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112089</SubGroupID><Suffix>Comp</Suffix><ARTGs><ARTG>139625</ARTG><ARTG>313420</ARTG></ARTGs><MinimumBenefit>243</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ030</BillingCode><PriorBillingCodes><PriorBillingCode>LM370</PriorBillingCode></PriorBillingCodes><Name>Intramedullary Nail Screw</Name><Description>Intramedullary Nail Screw</Description><Size>Multiple sizes to suit patient anatomy</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112089</SubGroupID><ARTGs><ARTG>266217</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX051</BillingCode><Name>CLAVO™ Anti-Rotation Screw for PFRN</Name><Description>Anti-rotation screw</Description><Size>Length 75-120mm</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112089</SubGroupID><ARTGs><ARTG>378490</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH315</BillingCode><Name>Affixus Hip Fracture Nail System</Name><Description>Lag Screw</Description><Size>70-130mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112089</SubGroupID><ARTGs><ARTG>210296</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY285</BillingCode><Name>AO/ASIF Intramedullary nails</Name><Description>Helical blade</Description><Size>65-135mm length</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108795</GroupID><SubGroupID>112089</SubGroupID><Suffix>Com</Suffix><ARTGs><ARTG>227971</ARTG></ARTGs><MinimumBenefit>442</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW335</BillingCode><Name>Omega Plus Compression Hip Screw System</Name><Description>Compression Screw -  Stainless Steel</Description><Size>25mm length</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112120</SubGroupID><ARTGs><ARTG>76592</ARTG><ARTG>119660</ARTG></ARTGs><MinimumBenefit>92</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN945</BillingCode><Name>Peri-Loc</Name><Description>Screw Accessories, Hole Filler</Description><Size>4.5mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112120</SubGroupID><ARTGs><ARTG>140705</ARTG></ARTGs><MinimumBenefit>92</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA554</BillingCode><Name>Affinis Inverse cap</Name><Description>Titanium screw locking cap</Description><Size>one size</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112120</SubGroupID><ARTGs><ARTG>241996</ARTG></ARTGs><MinimumBenefit>92</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL241</BillingCode><Name>EVOS</Name><Description>Screw Accessories, Hole Filler</Description><Size>3.5mm and 4.5mm  </Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112120</SubGroupID><ARTGs><ARTG>368491</ARTG><ARTG>230143</ARTG></ARTGs><MinimumBenefit>92</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ071</BillingCode><PriorBillingCodes><PriorBillingCode>LM378</PriorBillingCode></PriorBillingCodes><Name>Orthopaedic screw cap</Name><Description>Orthopaedic screw cap</Description><Size>All sizes</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112120</SubGroupID><ARTGs><ARTG>266216</ARTG></ARTGs><MinimumBenefit>92</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI597</BillingCode><Name>NCB Plating System</Name><Description>NCB Spacers &amp; Screw Caps</Description><Size>1, 2 and 3</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112120</SubGroupID><ARTGs><ARTG>100337</ARTG></ARTGs><MinimumBenefit>92</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK048</BillingCode><Name>AHN Locking End Caps</Name><Description>AHN end cap.</Description><Size>0mm, 5mm, 10mm.</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112120</SubGroupID><ARTGs><ARTG>377915</ARTG></ARTGs><MinimumBenefit>92</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU204</BillingCode><PriorBillingCodes><PriorBillingCode>DE371</PriorBillingCode></PriorBillingCodes><Name>Cannulated Titanium Low Profile Screws, Large</Name><Description>Cannulated titanium Low Profile Screws, Large</Description><Size>4.5-6.7mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU115</BillingCode><PriorBillingCodes><PriorBillingCode>DE343</PriorBillingCode></PriorBillingCodes><Name>PEEKPower HTO Plate</Name><Description>Medial High Tibial Osteotomy Implant Device System</Description><Size>5.0mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU208</BillingCode><Name>Titanium Locking Cortical and Cancellous Screws, Large</Name><Description>Titanium Locking Cortical and Cancellous Screws, Large</Description><Size>4.5-6.5mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>350871</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU116</BillingCode><PriorBillingCodes><PriorBillingCode>DE344</PriorBillingCode></PriorBillingCodes><Name>iBalance HTO System</Name><Description>PEEK Screws for iBalance HTO Implant</Description><Size>4.5mm Cortical and 6.5mm Cancellous</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>350871</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO414</BillingCode><Name>Acumed Screws</Name><Description>Locking Screws</Description><Size>&gt;4.5mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ091</BillingCode><Name>Bone Screws</Name><Description>Cortical, Locking, Self-tapping, Standard, T20, Fully Threaded</Description><Size>4.5 - 5.0mm Diameter  10-90mm Length</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>191602</ARTG><ARTG>191587</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ048</BillingCode><Name>Valetis Screws</Name><Description>Titanium Locking Screws</Description><Size>5.0mm width, 10-100mm length</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>284755</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RV009</BillingCode><Name>PS Locking Dual Thread Screw</Name><Description>Locking Screw ø4.5mm, self-tapping, VAL, Dual Thread</Description><Size>4.5mm, 29-90mm Length</Size><SupplierCode>39940</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>DT,LK</Suffix><ARTGs><ARTG>330190</ARTG></ARTGs><MinimumBenefit>289</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER522</BillingCode><Name>Paragon 28 Monster Screw System-Screws, standard ( ≥4.5mm), dual thread, locking</Name><Description>Paragon 28 Monster Screw System-Joust Beaming Screws, ( ≥4.5mm), headless, dual thread, locking, Ti</Description><Size>dia (5.0-7.2mm) x length (50-185mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>DT</Suffix><ARTGs><ARTG>289308</ARTG></ARTGs><MinimumBenefit>229</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ557</BillingCode><Name>DELTA Xtend</Name><Description>Non Locking Canulated Metaglene Screw </Description><Size>4.5mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>150913</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT031</BillingCode><Name>Integrant 6.5mm Screws</Name><Description>6.5mm diameter screws with variable pitch/dynamic thread</Description><Size>6.5mm diameter, 45mm-120mm length</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>230954</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO357</BillingCode><Name>Acutrak 2</Name><Description>Headless compression screw</Description><Size>&gt;4.5mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI180</BillingCode><Name>Zimmer Large Herbert Bone Screw</Name><Description>4.5mm Cannulated Double Threaded Compression Bone Screw - Ti Alloy</Description><Size>30 - 70mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF024</BillingCode><Name>FH Screw Systems</Name><Description>Large Compression Screw</Description><Size>45mm - 110mm</Size><SupplierCode>40106</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>141164</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ026</BillingCode><PriorBillingCodes><PriorBillingCode>LM287</PriorBillingCode><PriorBillingCode>LM287</PriorBillingCode></PriorBillingCodes><Name>IBS Screw</Name><Description>Compression Screw</Description><Size>4.5, 6.5 &amp; 8.0mm diameter</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>266217</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW855</BillingCode><PriorBillingCodes><PriorBillingCode>WR319</PriorBillingCode></PriorBillingCodes><Name>Unima Screw</Name><Description>Foot Screw</Description><Size>4.5 x 26 - 70mm  7.3 x 40 - 120mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>295072</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW697</BillingCode><PriorBillingCodes><PriorBillingCode>WR033</PriorBillingCode></PriorBillingCodes><Name>Cannulated Screw</Name><Description>Multi use compression screw, cannulated, stainless steel or titanium</Description><Size>6.5mm&amp; 7.0mm dia, 40-110mm lengths in 5mm increments</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW982</BillingCode><Name>SALVATION Limb Salvage System Intramedullary Fusion Beams</Name><Description>Intramedullary Fusion Beams</Description><Size>5 - 7mm x 50 - 170mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>198549</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW561</BillingCode><Name>Stryker Fixos Screws</Name><Description>Stryker Fixos Screws &gt;4.5mm</Description><Size>5mm &amp; 7mm diameter</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>269713</ARTG><ARTG>295226</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF087</BillingCode><Name>Speyside Double Threaded Cannulated Screw</Name><Description>Speyside - Double threaded – Self tapping or self drilling cannulated screw</Description><Size>Diameter 4.5 and 6.5mm x Length 30 to 100mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV011</BillingCode><Name>Perform Reverse Central Locking Screw</Name><Description>Titanium Locking Screw</Description><Size>6.5mm, 9.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>386960</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RV008</BillingCode><Name>PS Non-locking Dual Thread Screw</Name><Description>Non Locking Screw ø4.5mm, self-tapping, Dual Thread</Description><Size>4.5mm, 29-50mm Length</Size><SupplierCode>39940</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>DT</Suffix><ARTGs><ARTG>330190</ARTG></ARTGs><MinimumBenefit>229</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL080</BillingCode><Name>Conquest FN</Name><Description>Cannulated Screws</Description><Size>≥4.50mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT,LK</Suffix><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>412</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW799</BillingCode><PriorBillingCodes><PriorBillingCode>WR209</PriorBillingCode></PriorBillingCodes><Name>Non-Locking Screws</Name><Description>Titanium or Stailess Steel Alloy Non-Locking Screws</Description><Size>20-100mm, 4.5-5.5mm Diameter</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>198549</ARTG><ARTG>326629</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA553</BillingCode><Name>Affinis Inverse Screw with Locking Cap</Name><Description>Titanium Screw with Locking Cap</Description><Size>Length 15mm to 51mm  Diameter 4.5mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>241996</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM554</BillingCode><Name>Skeletal Dynamics Bone Screw Non-Locking</Name><Description>Bone Screw Non-Locking</Description><Size>4.5mm diameter, 14 to 40mm length</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH283</BillingCode><Name>ALPS Plating System</Name><Description>Non-locking bone screws</Description><Size>4.5 - 6.5mm diameter</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>153087</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI534</BillingCode><Name>Zimmer Trabecular Metal Reverse Shoulder System</Name><Description>Inverse/Reverse Screw 4.5mm</Description><Size>18mm, 24mm, 27mm, 30mm, 33mm, 36mm, 42mm, 48mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>260178</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI891</BillingCode><Name>NCB System</Name><Description>NCB Screws</Description><Size>14- 100mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>100337</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD054</BillingCode><Name>Replacement retaining screw for glenoid head</Name><Description>Replacement retaining screw for glenoid head</Description><Size>6.5mm x 30mm</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>212521</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ143</BillingCode><Name>Bone Screws</Name><Description>Self-tapping, Cortical, Solid, Cancellous Thread, T20, Partially Threaded, Recon</Description><Size>4.5-5.0mm Diameter  10-100mm Length</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>191602</ARTG><ARTG>191587</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU190</BillingCode><Name>MSS - Medacta Shoulder System Polyaxial Locking Screws</Name><Description>Glenoid Polyaxial Locking Screws</Description><Size>from 14 to 50 mm in 4mm steps</Size><SupplierCode>40166</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>400831</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI831</BillingCode><Name>NCB Polyaxial Locking System</Name><Description>Variable Angle Locking Screw Cap - Ti Alloy</Description><Size>8mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>100337</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW699</BillingCode><PriorBillingCodes><PriorBillingCode>WR036</PriorBillingCode></PriorBillingCodes><Name>Charlotte Carolina Jones Fracture System</Name><Description>Low profile, solid-core, surgical grade stainless steel screw, partially threatded with thread length varying anthropometrically relative to overall screw length, utilising specialised instruments for IM placement in the 5th metatarsal</Description><Size>4.5mm, 4.5mm, 6.5mm, 40mm-70mm overall screw lengths</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI205</BillingCode><Name>Zimmer Screws</Name><Description>4.5mm Cortical Screws</Description><Size>14 - 120mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH317</BillingCode><Name>Affixus Hip Fracture Nail System</Name><Description>Distal screw</Description><Size>30-80mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>210296</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK052</BillingCode><Name>AHN Screw</Name><Description>Compression screw.</Description><Size>20 - 120mm length.  5mm diameter.</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>377916</ARTG><ARTG>377918</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY596</BillingCode><Name>AO/ASIF Screws</Name><Description>Cortex,Cancellous, Compression Screws</Description><Size>≥ 4.5mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>157068</ARTG><ARTG>297881</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU210</BillingCode><Name>Low Profile Screw</Name><Description>Low Profile Screw</Description><Size>4.5mm - 5.5mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU156</BillingCode><Name>PEEKPower HTO Plate</Name><Description>Medial High Tibial Osteotomy Implant Device System</Description><Size>4.5mm Titanium compression Screws</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>351000</ARTG><ARTG>350871</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU268</BillingCode><PriorBillingCodes><PriorBillingCode>DE367</PriorBillingCode></PriorBillingCodes><Name>Cancellous Bone Screws</Name><Description>Cancellous Bone Screws</Description><Size>25-50mm x 6.5mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>350871</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU186</BillingCode><Name>PAO Cortical Screw Ø4.5</Name><Description>Peri-Acetabular Osteotomy Cortical Screw</Description><Size>Ø4.5 L 50-140 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>219907</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT009</BillingCode><Name>Hawk Anterior Ankle Fusion Set</Name><Description>6.5mm screw set with lengths ranging from 35mm to 110 mm.</Description><Size>6.5mm length 35mm to 110mm</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>191738</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ052</BillingCode><Name>Valetis Screws</Name><Description>Titanium Cancellous Screws</Description><Size>4.5mm width, 10-80mm length</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>284755</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ121</BillingCode><Name>Verso Shoulder System - Baseplate Fixation Screw</Name><Description>Verso Shoulder Base Plate Fixation Screw</Description><Size>5mm diameter, 15mm-50mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>262473</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ051</BillingCode><Name>Valetis Screws</Name><Description>Titanium Cortical Screws</Description><Size>4.5mm width, 10-80mm length</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>284755</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO413</BillingCode><Name>Acumed Screws</Name><Description>Screws</Description><Size>&gt;4.5mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU155</BillingCode><PriorBillingCodes><PriorBillingCode>DE537</PriorBillingCode></PriorBillingCodes><Name>Arthrex Jones Fracture Screw</Name><Description>Partially Threaded Screw to fixate fractures of the 5th Metatarsal</Description><Size>4.5mm (40-65mm Lengths)  5.5mm (40-65mm Lengths)  6.0mm (40-65mm Lengths)</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>350672</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ098</BillingCode><Name>Austofix L&amp;C Large Fragment Plate and Screw System</Name><Description>Cortex, Cancellous Screws</Description><Size>4.5mm, 6.5mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>284755</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ072</BillingCode><PriorBillingCodes><PriorBillingCode>LM381</PriorBillingCode><PriorBillingCode>LM381</PriorBillingCode></PriorBillingCodes><Name>Screw and Locking Cap</Name><Description>Screw and Locking Cap</Description><Size>4.5 mm and larger diameter</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>266216</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX019</BillingCode><Name>ARMAR Meril Locking Plate System Cancellous Screw</Name><Description>TiCP and Stainless Steel Cancellous Bone Screws</Description><Size>6.5mm Diameter
20-150mm Length</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>286843</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA539</BillingCode><Name>Affinis Inverse Lag Screw</Name><Description>Metaglene Lag screw</Description><Size>18x4.5mm to 38 x 4.5 mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>241996</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA037</BillingCode><Name>Equinoxe HRP Taper Locking Screw</Name><Description>A range of sizes of locking screws to secure the proximal body to the distal stem after all taper segments have been individually impacted and engaged.</Description><Size>0mm - 162.5mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>396477</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX017</BillingCode><Name>ARMAR Meril Locking Plate System Self Tapping Cortex Screws</Name><Description>TiCP and Stainless Steel Self Tapping Cortex Screws</Description><Size>4.5mm Diameter
14-145mm Length</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>286843</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ044</BillingCode><PriorBillingCodes><PriorBillingCode>LM374</PriorBillingCode></PriorBillingCodes><Name>Plate Screw</Name><Description>Plate Screw</Description><Size>4.5mm diameter and greater</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>266216</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ003</BillingCode><Name>FlexiSystem, Flexit Cortical and Cancellous locking screws and duel threaded screws</Name><Description>Cortical and Cancellous locking Duel threaded screws</Description><Size>30,35,40,45,50,55,60,6,70,75mm</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>206423</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN007</BillingCode><Name>Newclip Locking Bone Screws</Name><Description>Locking Bone Screws</Description><Size>Diam ≥4.5mm, length 15 - 110mm</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>260233</ARTG><ARTG>260234</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA530</BillingCode><Name>Affinis Inverse locking screw</Name><Description>Locking Metaglene screw</Description><Size>24x4.0mm to 48x4.0mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>241996</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW872</BillingCode><PriorBillingCodes><PriorBillingCode>WR342</PriorBillingCode></PriorBillingCodes><Name>Aequalis Reversed Shoulder - Fixation Screw for Articular Implant</Name><Description>Titanium, sterile and non-sterile</Description><Size>D4.5mm, L20 to 50mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>214803</ARTG><ARTG>291613</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX041</BillingCode><Name>ARMAR Meril Locking Plate System Self Drilling Cannulated Screw</Name><Description>TAN Cannulated Bone Screws</Description><Size>4.5-6.5mm Diameter
20-150mm Length</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>286843</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH184</BillingCode><Name>Small / Large  Fragment Set</Name><Description>Cannulated Bone Screw Titanium</Description><Size>4.5 - 8mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>153087</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH284</BillingCode><Name>ALPS Plating System</Name><Description>Locking screws</Description><Size>4.5 to 6.5mm diameter</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>153087</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM550</BillingCode><Name>Skeletal Dynamics Bone Screw Locking  </Name><Description>Bone Screw Locking  </Description><Size>4.5mm diameter, 16 to 34mm length</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX018</BillingCode><Name>ARMAR Meril Locking Plate System Self tapping Locking Screws</Name><Description>TiCP Self Tapping Locking Screws</Description><Size>5mm Diameter
14-90mm Length</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286843</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EX047</BillingCode><Name>Equinoxe Glenosphere Locking Screw</Name><Description>The Locking Screw locks compression screws to the glenoid plate at a variable angle</Description><Size>one size</Size><SupplierCode>40074</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>159797</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW836</BillingCode><PriorBillingCodes><PriorBillingCode>WR294</PriorBillingCode></PriorBillingCodes><Name>SALVATION 3Di Plating System - OP Locking Screws</Name><Description>Osteopenic locking screws</Description><Size>Diameter: 5.5mm  Length: 16, 18, 20, 22, 25, 30, 35, 40, 45, 50, 55, 60mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER393</BillingCode><Name>Paragon 28 Monster Screw System-Screws, standard ( ≥4.5mm), cannulated, dual thread, locking</Name><Description>Paragon 28 Monster Screw System-screws, cannulated, dual thread, locking, headless, partial thread, Titanium</Description><Size>dia (4.5-7.2 mm) x length (50-200mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>289308</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM134</BillingCode><Name>TriMed Compression Screws</Name><Description>Compression Screws</Description><Size>4.5-7.5mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>229704</ARTG></ARTGs><ChangeExplanation>Change to Group benefit</ChangeExplanation><MinimumBenefit>412</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW531</BillingCode><Name>Stryker Plating System</Name><Description>Locking Screw</Description><Size>5.0mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>352530</ARTG><ARTG>139635</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW791</BillingCode><PriorBillingCodes><PriorBillingCode>WR074</PriorBillingCode></PriorBillingCodes><Name>Locking Screws</Name><Description>Stainless Steel or Titanium Locking Screws</Description><Size>4.5-5.5mm diameter, 8 - 100m length</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL151</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Standard screws - Locking</Description><Size>≥4.5mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>104369</ARTG><ARTG>230143</ARTG><ARTG>368491</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB062</BillingCode><Name>MCS</Name><Description>MCS System</Description><Size>&gt; 4.5mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>223188</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW917</BillingCode><PriorBillingCodes><PriorBillingCode>WR397</PriorBillingCode></PriorBillingCodes><Name>NexFix 6.5mm Compression Screw</Name><Description>The NexFix Compression Screw is a stainless steel, cannulated, self tapping, and self drilling fixation device for osteotomies, fusions and fracture fixation of small bones</Description><Size>6.5mm diameter x 40-120mm in 5mm increments with short and long thread options</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>148960</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW914</BillingCode><PriorBillingCodes><PriorBillingCode>WR394</PriorBillingCode></PriorBillingCodes><Name>NexFix 4.5MM Compression Screw</Name><Description>The NexFix Compression Screw is a stainless steel, cannulated, self tapping, and self drilling fixation device for osteotomies, fusions and fracture fixation of small bones</Description><Size>4.5mm diameter x 14-40mm in 2mm increments, 40-65mm in 5mm increments, with short and long thread options</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>148960</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ037</BillingCode><PriorBillingCodes><PriorBillingCode>LM350</PriorBillingCode><PriorBillingCode>LM350</PriorBillingCode></PriorBillingCodes><Name>Orthopaedic Fixation Screw</Name><Description>Fixation Screw</Description><Size>4.5mm and larger diameter, all lengths</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>266217</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM142</BillingCode><Name>Extremity Medical Compression Screw System</Name><Description>Compression Screws</Description><Size>≥ 4.5mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>164980</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KO002</BillingCode><PriorBillingCodes><PriorBillingCode>LM397</PriorBillingCode></PriorBillingCodes><Name>Headless Compression Screws</Name><Description>Headless Compression Screws</Description><Size>4.50mm or larger diameter</Size><SupplierCode>40387</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>329613</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI836</BillingCode><Name>NCB Polyaxial Locking System</Name><Description>4.5mm Cannulated Variable Angle Locking Screws - Ti Alloy</Description><Size>14 - 100mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>100337</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF116</BillingCode><Name>Speyside Superscrew - Standard</Name><Description>Cannulated Cortical / Cancellous Lag Screw Partial or Full Thread</Description><Size>Dia. 4.5 / 5.0 / 6.5 / 7.2 mm x 25-140mm Length</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL170</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS  </Name><Description>Standard Screws - Cannulated</Description><Size>≥4.5mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>230143</ARTG><ARTG>368491</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL009</BillingCode><Name>Cannulated screws</Name><Description>Partially &amp; Fully Threaded Stainless Steel</Description><Size>≥4.5mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>99767</ARTG><ARTG>104369</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY630</BillingCode><Name>AO/ASIF Screws</Name><Description>Cannulated Full, Partial Thread screw</Description><Size>≥4.50mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>157068</ARTG><ARTG>297881</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL008</BillingCode><Name>Cannulated Screw</Name><Description>Partially &amp; Fully Threaded Titanium</Description><Size>≥4.5mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB044</BillingCode><Name>Cannulated Screws 6.5 &amp; 7.3mm</Name><Description>Cannulated Screws</Description><Size>6.5mm &amp; 7.3mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>223188</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER392</BillingCode><Name>Paragon 28 Monster Screw System-Screws, Standard ( ≥4.5mm), cannulated</Name><Description>Paragon 28 Monster Screw System-Screws, standard ( ≥4.5mm), cannulated, headed, with and without blunt tip</Description><Size>diameter (4.5-7.0 mm) x length (18-200 mm) x length of thread (6-200 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>289308</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM507</BillingCode><Name>Partially threaded cannulated screw</Name><Description>Partially threaded cannulated screw</Description><Size>≥4.5mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>306780</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK529</BillingCode><Name>Stryker Cannulated Screw System</Name><Description>Asnis III Cannulated screws  Asnis JFX Cannulated Compression Screw</Description><Size>5.0-8.0mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>340042</ARTG><ARTG>119660</ARTG><ARTG>352531</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM368</BillingCode><Name>Intramedullary Beam</Name><Description>Intramedullary Beam</Description><Size>All sizes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>164980</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RV005</BillingCode><Name>PS  Locking Screw</Name><Description> Locking screw</Description><Size>4.5mm Diameter, 24-90mm Length</Size><SupplierCode>39940</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>330190</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN768</BillingCode><Name>Peri-Loc</Name><Description>Fixation Device, Internal, Locking, Stainless Steel, Cortical &amp; Cancellous Screw</Description><Size>4.5mm -5.0mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM506</BillingCode><Name>Locking Screw (Standard)</Name><Description>Locking Screw (Standard)</Description><Size>≥4.5mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>306780</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER504</BillingCode><Name>Paragon 28 Gorilla Plating System-Screws, standard ( ≥ 4.5mm), locking</Name><Description>Paragon 28 Gorilla Plating System-Screws, standard ( ≥ 4.5mm), locking, recon/Tuffneck</Description><Size>dia (4.5-5.2 mm) x length (14-60 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>289308</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH166</BillingCode><Name>Comprehensive Shoulder Screws</Name><Description>Screw, Locking, Ti</Description><Size>4.75 dia x (15-45)mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>210290</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ116</BillingCode><Name>SuperCable Trochanteric Grips and Cable Plate System</Name><Description>Locking Screw Titanium</Description><Size>5.0mm diameter 10mm to 50mm length</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>260682</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW910</BillingCode><PriorBillingCodes><PriorBillingCode>WR387</PriorBillingCode></PriorBillingCodes><Name>MaxTorque Cannulated Screw System - Standard screws</Name><Description>Bone screws, Titanium, Cannulated, Short or Long Thread</Description><Size>Ø5.5mm Short Thread, Length 26-70mm  Ø5.5mm Long Thread, Length 45-70mm  Ø7.0mm Short thread, Length 40-130mm  Ø7.0mm long Thread, Length 45-130mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>214671</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ017</BillingCode><PriorBillingCodes><PriorBillingCode>LM288</PriorBillingCode><PriorBillingCode>LM288</PriorBillingCode></PriorBillingCodes><Name>Bone Screw</Name><Description>Bone Screw</Description><Size>4.5mm diameter and larger</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>266217</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KO001</BillingCode><PriorBillingCodes><PriorBillingCode>LM395</PriorBillingCode></PriorBillingCodes><Name>Cannulated Screws</Name><Description>Cannulated Screws</Description><Size>4.50 mm or larger diameter</Size><SupplierCode>40387</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>329613</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW820</BillingCode><PriorBillingCodes><PriorBillingCode>WR248</PriorBillingCode></PriorBillingCodes><Name>Darco Headed Compression Screw System 4.5, 6.5, 7.5</Name><Description>Cannulated titanium compression screws</Description><Size>4.5mm x 8-60mm; 6.5mm x 35-120mm; 7.5mm x 35-120mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK002</BillingCode><PriorBillingCodes><PriorBillingCode>UQ002</PriorBillingCode></PriorBillingCodes><Name>OsteoMed Plating &amp; Fixation System</Name><Description>Plates - Fracture; Screws - Cannulated Lag</Description><Size>6 Hole Fracture Plate 47 - 52mm; 2 x 2 Hole Angled Fracture Plate; 3 x 3 Hole Angled Fracture Plate; 6.5mm x (30 -150)mm; 7.3mm x (30 - 150)mm</Size><SupplierCode>40456</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>130508</ARTG><ARTG>130509</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BP031</BillingCode><Name>Tyber Medical Trauma headed screw</Name><Description>Trauma screw for compression and fixation of bone  Sterile or Non sterile, Titanium or stainless steel</Description><Size>4.5mm-7.5mm</Size><SupplierCode>40061</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>324189</ARTG><ARTG>324190</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO117</BillingCode><Name>APTUS headedCCS</Name><Description>Headed Cannulated screws</Description><Size>≥4.50mm</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>206157</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK034</BillingCode><Name>eight-Plate Plus Cannulated Screw</Name><Description>The guided growth plate system plus consists of different sizes of plates and cannulated screws. The device is designed for the gradual correction of paediatric congenital as well as acquired deformities in both upper and lower extremities.</Description><Size>4.5mm x 16mm  4.5mm x 24mm  4.5mm x 32mm  4.5mm x 36mm</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>289252</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN001</BillingCode><Name>Newclip cannulated screws</Name><Description>Cannulated screws</Description><Size>Standard (≥4.5mm)</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>260233</ARTG><ARTG>260234</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI176</BillingCode><Name>Zimmer Internal Fixation Systems: Cannulated Screw</Name><Description>Magna-FX - Stainless Steel</Description><Size>16 mm Thread - 30-30 mm; 32 mm Thread - 40-120 mm; Fully Threaded - 30-130 mm Long</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ056</BillingCode><Name>Valens Shoulder and Elbow - Screws</Name><Description>Cortex/Cancellous Screws</Description><Size>4.5mm, 6.5mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW005</BillingCode><Name>WEGO Trauma Systems</Name><Description>Standard Locking Screw Systems</Description><Size>Standard ( ≥4.5mm) 10-120mm</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324381</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI872</BillingCode><Name>Zimmer Cannulated Screw System</Name><Description>7.0mm Cannulated Screw 32mm Thread
7.0mm Cannulated Screw Full Thread</Description><Size>7.0mm Cannulated Screw 32mm Thread. L=140
7.0mm Cannulated Screw Full Thread. L=140
7.0mm Cannulated Screw 32mm Thread. L=145
7.0mm Cannulated Screw Full Thread. L=145
7.0mm Cannulated Screw 32mm Thread. L=150
7.0mm Cannulated Screw Full Thread. L=150
7.0mm Cannulated Screw 32mm Thread. L=155
7.0mm Cannulated Screw Full Thread. L=155
7.0mm Cannulated Screw 32mm Thread. L=160
7.0mm Cannulated Screw Full Thread. L=160
7.0mm Cannulated Screw 32mm Thread. L=165
7.0mm Cannulated Screw Full Thread. L=165
7.0mm Cannulated Screw 32mm Thread. L=170
7.0mm Cannulated Screw Full Thread. L=170
7.0mm Cannulated Screw 32mm Thread. L=175
7.0mm Cannulated Screw Full Thread. L=175
7.0mm Cannulated Screw 32mm Thread. L=180
7.0mm Cannulated Screw Full Thread. L=180</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>204658</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ036</BillingCode><Name>Austofix Cannulated Screws</Name><Description>Cannulated Compression Screw</Description><Size>4.5mm, 6.5mm, 7.3mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>284755</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT015</BillingCode><Name>Superior Fusion Plate System - Locking screws</Name><Description>4.5mm locking screw set with lengths ranging from 35mm to 110mm.Locking screws to hold and aid an anatomical contoured locking plate used for primary, revision and pantalar anterior ankle fusions.</Description><Size>4.5mm in diameter with lengths of 35mm,37mm, 39mm, 41mm, 43mm, 45mm, 47mm, 49mm,
50mm, 55mm, 60mm, 65mm, 70mm, 75mm, 80mm, 85mm, 90mm, 95mm, 100mm, 105mm,
110mm each</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>191738</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD056</BillingCode><Name>Glenoid Baseplate Locking Bone Screws</Name><Description>Glenoid Baseplate Locking Bone Screws</Description><Size>5.0mm diameter, length 14-38mm in 4mm increments</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>212469</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW053</BillingCode><Name>WEGO Trauma Systems</Name><Description>Standard Cannulated Screw Systems</Description><Size>Standard ( ≥4.5mm) 20-120mm</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>324381</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT010</BillingCode><Name>Hawk 6.5mm Cannulated Screw System</Name><Description>6.5mm Cannulated Screw</Description><Size>6.5mm in diameter 45 to 115mm in length</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>230954</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ144</BillingCode><Name>Cannulated Screws</Name><Description>Cannulated, Cancellous  Short, Medium, Partial, Full Thread  Locking, Non-locking</Description><Size>4.5-7.0mm Diameter  14-120mm Length</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>191602</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER530</BillingCode><Name>Paragon 28 Monster Screw System-Screws, standard ( ≥ 4.5mm), locking</Name><Description>Paragon 28 Monster Screw System-Joust Beaming Screws, standard, locking, headless, Titanium</Description><Size>dia (5.0-7.2mm) x Length (50-185mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>289308</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JD014</BillingCode><Name>Screws - Locking</Name><Description>Locking</Description><Size>≥4.5mm</Size><SupplierCode>40214</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>222648</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY653</BillingCode><Name>AO/ASIF Screws</Name><Description>Locking Screws</Description><Size>≥ 4.5mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157068</ARTG><ARTG>297881</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI548</BillingCode><Name>Zimmer Universal Locking System</Name><Description>2.7mm Universal Locking Screw</Description><Size>Length:8mm; 10mm; 12mm; 14mm; 16mm; 18mm; 20mm; 22mm; 24mm; 26mm; 28mm; 30mm; 32mm; 34mm; 36mm; 38mm; 40mm; 42mm; 44mm; 46mm; 48mm; 50mm; 55mm; 60mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ256</BillingCode><Name>Colink 4.5 Variable Angle locking Screws</Name><Description>Variable Angle Locking Titanium Alloy Screws 4.5 mm</Description><Size>20mm - 50mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ254</BillingCode><Name>Colink 4.5 locking Screws</Name><Description>Locking Titanium Alloy Screws 4.5 mm</Description><Size>20mm - 50 mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ255</BillingCode><Name>Colink 4.5 Non-locking Screws</Name><Description>Non-Locking Titanium Alloy Screws 4.5 mm</Description><Size>20mm - 95 mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM277</BillingCode><Name>PANTERA Proximal Humerus Fracture Fixation Plate System - Post with Cross Element</Name><Description>Threaded Locking Screw</Description><Size>5.2mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,LK</Suffix><ARTGs><ARTG>182168</ARTG></ARTGs><MinimumBenefit>246</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK564</BillingCode><Name>Stryker Plating System</Name><Description>SPS Locking Plate System</Description><Size>Locking Screws - 5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>139635</ARTG><ARTG>119660</ARTG></ARTGs><MinimumBenefit>123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER523</BillingCode><Name>Paragon 28 Monster Screw System-Screws, standard ( ≥4.5mm), cannulated, locking</Name><Description>Paragon 28 Monster Screw System-Joust Beaming Screws, standard, cannulated, locking, headless, Titanium</Description><Size>dia (5.0-7.2mm) x Length (50-185mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,LK</Suffix><ARTGs><ARTG>289308</ARTG></ARTGs><MinimumBenefit>246</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW877</BillingCode><PriorBillingCodes><PriorBillingCode>WR347</PriorBillingCode></PriorBillingCodes><Name>Aequalis Humeral Nail Screws</Name><Description>Screws for Aequalis Humeral Nail. Cannulated Proximal screws: 5mm Diameter cannulated Ti, PE insert with thread inside. Distal screws 4.5mm Diameter, Ti.  Sterile and non sterile.</Description><Size>Proximal Screws length: From 36 to 60 every 4mm Distal Screws length: From 20 to 32 every 2mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>148960</ARTG></ARTGs><ChangeExplanation>Change to Group benefit</ChangeExplanation><MinimumBenefit>246</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK593</BillingCode><Name> Total Wrist Implant System</Name><Description>Carpal Screws</Description><Size>15, 18, 22, 26, 30mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,LK</Suffix><ARTGs><ARTG>237794</ARTG></ARTGs><MinimumBenefit>246</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ558</BillingCode><Name>DELTA Xtend</Name><Description>Locking Metaglene Screw Dia 4.5</Description><Size>4.5mm; 24, 30, 36, 42, 48</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,LK</Suffix><ARTGs><ARTG>150913</ARTG></ARTGs><MinimumBenefit>246</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN200</BillingCode><Name>Bristow-Latarjet Instability Shoulder Set - Screw</Name><Description>Cannulated locking screw</Description><Size>≥4.5mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>215753</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY631</BillingCode><Name>AO/ASIF Screws</Name><Description>Cannulated Locking Screws</Description><Size>≥4.50mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,LK</Suffix><ARTGs><ARTG>297881</ARTG><ARTG>157068</ARTG></ARTGs><MinimumBenefit>246</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL171</BillingCode><Name>Smith &amp; Nephew Plate and Screw System- EVOS</Name><Description>Standard Screws - Cannulated Locking  </Description><Size>≥4.5mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,LK</Suffix><ARTGs><ARTG>368491</ARTG><ARTG>230143</ARTG></ARTGs><MinimumBenefit>246</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN769</BillingCode><Name>Peri-Loc</Name><Description>Locking Cannulated Screws</Description><Size>≥4.5mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,LK</Suffix><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>246</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH046</BillingCode><Name>Biomet Phoenix Ankle Nailing System - 5mm Double-lead thread screw</Name><Description>Double lead screw - Ti-6Al-4V</Description><Size>5mm Dia x (20 to 110)mm length</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>210296</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH318</BillingCode><Name>Affixus Hip Fracture Nail System</Name><Description>Anti- rotational screw</Description><Size>5mm diameter</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>210296</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT097</BillingCode><Name>Nexos Screw</Name><Description>4.5mm Screws</Description><Size>4.5mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>276650</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW337</BillingCode><Name>Stryker Plating System</Name><Description>Screws Ti or StST</Description><Size>4.5-6.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>119660</ARTG><ARTG>340042</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW838</BillingCode><PriorBillingCodes><PriorBillingCode>WR296</PriorBillingCode></PriorBillingCodes><Name>SALVATION 3Di Plating System - Osteopenic Screws</Name><Description>Osteopenic screws</Description><Size>Diameter: 5.5mm  Length: 16, 18, 20, 22, 25, 30, 35, 40, 45, 50, 55, 60mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER391</BillingCode><Name>Paragon 28 Monster Screw System-Screws, standard ( ≥4.5mm)</Name><Description>Paragon 28 Monster Screw System-Screws, headed, blunt tip, solid, various thread lengths</Description><Size>dia (4.5-7.0 mm) x length (18-200 mm) x thread length (6-200 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>289308</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF094</BillingCode><Name>Versa Screw</Name><Description>Self Drilling self tapping Cannulated Compression Screw</Description><Size>6.5 to 8mm Dia x 40 to 120mm length</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BU020</BillingCode><Name>MAGNEZIX CS 4.8</Name><Description>Compression screw for bone fixation.</Description><Size>Diameter 4.8mm
Length 24 - 70mm</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>283491</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL031</BillingCode><Name>Headless Cannulated Screw</Name><Description>Headless cannulated screw</Description><Size>&gt;4.5mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY691</BillingCode><Name>Midfoot Fusion Bolt</Name><Description>Solid intramedullary arthodesis implant</Description><Size>6.5mm diameter; 50-160mm Length</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>DT</Suffix><ARTGs><ARTG>182343</ARTG></ARTGs><MinimumBenefit>229</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY645</BillingCode><Name>AO/ASIF Screws</Name><Description>HCS Countersinkable Compression Screw</Description><Size>4.5mm-6.5mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>157068</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BU012</BillingCode><Name>Nexis osteosynthesis screws</Name><Description>Bone screw titanium alloy (compressive)</Description><Size>Diameter 5-7 mm, Length 26-120mm</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>235765</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO093</BillingCode><Name>APTUS SpeedTip CCS</Name><Description>APTUS SpeedTip CCS 5.0/7.0</Description><Size>5.0mm diameter and 7.0mm diameter. Short and long thread</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>206157</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BP026</BillingCode><Name>Tyber Medical trauma headless screw</Name><Description>Headless trauma screw for compression and fixation of bone  Sterile or Non sterile, Titanium or stainless steel</Description><Size>4.5mm-9.0mm</Size><SupplierCode>40061</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>324190</ARTG><ARTG>324189</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN073</BillingCode><Name>Newclip Compression Screws</Name><Description>Self-compressive cannulated screw</Description><Size>≥4.5 mm diameter, length 20-70 mm</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>260233</ARTG><ARTG>260234</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN002</BillingCode><Name>Newclip cannulated DT screws</Name><Description>Cannulated screws</Description><Size>Standard (≥4.5mm)</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>260233</ARTG><ARTG>260234</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB037</BillingCode><Name>Headless Compression Screw System</Name><Description>Headless Compression Screw</Description><Size>≥4.5mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>223188</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU154</BillingCode><PriorBillingCodes><PriorBillingCode>DE481</PriorBillingCode></PriorBillingCodes><Name>Headless Compression Screw System</Name><Description>Headless Compression Screw for bone fixation</Description><Size>6.5mm Diameter (30-120mm Diameter)</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>350672</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW065</BillingCode><Name>WEGO Trauma Systems</Name><Description>Self-tapping Cannulated Screw</Description><Size>Standard ( ≥4.5mm)</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>324381</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ057</BillingCode><Name>Valens Shoulder and Elbow - Screws</Name><Description>Cannulated Screws</Description><Size>4.5mm, 5.0mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ105</BillingCode><PriorBillingCodes><PriorBillingCode>EF004</PriorBillingCode></PriorBillingCodes><Name>Merete - Cannulated HCS (headless Compression Screws) 6.5mm</Name><Description>Bone screws, Titanium, Cannulated Compression</Description><Size>Diameter + 6.5mm, length 40-120mm (in 5mm increments)</Size><SupplierCode>40063</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>212520</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ037</BillingCode><Name>Valens - Cannulated Screws</Name><Description>Countersunk Cannulated Partial-Thread Screw</Description><Size>5.0mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO383</BillingCode><Name>Acumed Headless Compression Screw</Name><Description>Acutrak 6/7 screw, Acutrak Plus</Description><Size>&gt;4.5mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU141</BillingCode><Name>Compression FT</Name><Description>Compression Screw</Description><Size>5.0mm &amp; 7.0mm Diameters</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH547</BillingCode><Name>Dynafit System</Name><Description>Compressive Screws</Description><Size>4.7-6.5mm x 18-120mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>216161</ARTG><ARTG>216162</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JD013</BillingCode><Name>Screws - Non Locking</Name><Description>≥4.5mm)</Description><Size>≥4.5mm</Size><SupplierCode>40214</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>222648</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST005</BillingCode><Name>Stryker Plating System Screws - Cancellous</Name><Description>6.5mm Stainless Steel or Titanium</Description><Size>20-50mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>119660</ARTG><ARTG>25735</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GG002</BillingCode><Name>Contile Fin II</Name><Description>Bone Screw</Description><Size>20 to 50mm</Size><SupplierCode>40371</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>246519</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW873</BillingCode><PriorBillingCodes><PriorBillingCode>WR343</PriorBillingCode></PriorBillingCodes><Name>Fixation Screw for Articular Implant</Name><Description>Titanium, sterile and non-sterile</Description><Size>D 4.5mm, L 18mm to 50mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>214803</ARTG><ARTG>291613</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM505</BillingCode><Name>Non-Locking Screw (Standard)</Name><Description>Non-Locking Screw (Standard)</Description><Size> ≥4.5mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>306780</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV013</BillingCode><Name>Perform Reverse Peripheral Fixation Screw</Name><Description>Locking Fixation Screw</Description><Size>5.0mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>314266</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST004</BillingCode><Name>Stryker Plating System Screws - Cortical 4.5mm</Name><Description>Titanium or Stainless Steel</Description><Size>10-20mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>119660</ARTG><ARTG>25735</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH167</BillingCode><Name>Comprehensive Shoulder Screws</Name><Description>Screw, Non-Locking</Description><Size>(4.75 or 6.5)mm x 15-50mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>153087</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EX046</BillingCode><Name>Equinoxe Compression Screw</Name><Description>The compression screw compresses the glenoid plate to the bone while providing 30 degrees of angular variability</Description><Size>4.5x18mm white, 4.5x22mm black, 4.5x26mm orange, 4.5x30mm blue, 4.5x34mm red, 4.5x38mm green, 4.5x42mm yellow, 4.5x46mm purple</Size><SupplierCode>40074</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>252473</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH331</BillingCode><Name>Small / Large  Fragment Set</Name><Description>Bone Screw Titanium</Description><Size>4.5 to 6.5mm diameter</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>203607</ARTG><ARTG>153087</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX052</BillingCode><Name>CLAVO™ 4.9mm Locking Bolt, Self Tapping, (TAN), L26mm – L100mm</Name><Description>Locking Bolts, Titanium Alloy</Description><Size>Diameter - 4.9 mm, Length: 26 - 100 mm</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>378490</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN030</BillingCode><Name>Newclip Non Locking Bone Screw</Name><Description>Non Locking Bone Screw</Description><Size>≥4.5mm diameter, Length 20 - 110mm</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>260233</ARTG><ARTG>260234</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH444</BillingCode><Name>Hinge Pediatric Plating System - Screws</Name><Description>2 screws for articulated growth-correction fixation plate</Description><Size>4.5 x 35mm, 4.5 x 30mm, 4.5 x 25mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>161505</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL152</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Standard screws</Description><Size>≥4.5mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>104369</ARTG><ARTG>230143</ARTG><ARTG>368491</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL014</BillingCode><Name>Peri-Loc &amp; Peri-Loc VLP</Name><Description>Cortical &amp; Osteopenia Screws</Description><Size>≥4.5mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL013</BillingCode><Name>TC-100</Name><Description>Cortical &amp; Cancellous Screws</Description><Size>≥4.5mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL214</BillingCode><PriorBillingCodes><PriorBillingCode>IG113</PriorBillingCode></PriorBillingCodes><Name>Bone Screws</Name><Description>Titanium screws (2) for use with the Universal2 Total Wrist System only</Description><Size>4.5mm x (15, 20, 25, 30, 35mm)</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>177632</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI149</BillingCode><Name>Periarticular Plates</Name><Description>Periarticular 6.5mm Cancellous Screws - Stainless Steel</Description><Size>16mm Thread - 35-90mm Long, 32mm Thread - 45-90mm Long, Fully Threaded - 25-90mm Long</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT007</BillingCode><Name>Hawk Anterior Ankle Fusion Set</Name><Description>4.5mm screw set with lengths ranging from 35mm to 110mm.</Description><Size>4.5mm x length (35mm to 110mm)</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>191738</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW007</BillingCode><Name>WEGO Trauma Systems</Name><Description>Standard Bone Screw Systems</Description><Size>Standard ( ≥4.5mm) 10-130mm</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>324381</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ113</BillingCode><Name>SuperCable Trochanteric Grips and Cable Plate System</Name><Description>Compression Screws Titanium</Description><Size>4.5mm Diameter 10mm to 50 mm length</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>260682</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU191</BillingCode><Name>MSS - Medacta Shoulder System Polyaxial Non-Locking Screws</Name><Description>Polyaxial Non-Locking Screws</Description><Size>from 14 to 50 mm in 4mm steps</Size><SupplierCode>40166</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>400831</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER510</BillingCode><Name>Paragon 28 Gorilla Plating System-Screws, standard ( ≥ 4.5mm)</Name><Description>Paragon 28 Gorilla Plating System-Screws, standard ( ≥ 4.5mm)</Description><Size>dia (4.5-5.2 mm) x length (14-60 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>289308</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI207</BillingCode><Name>Zimmer Screws</Name><Description>6.5mm Cancellous Screws</Description><Size>25 - 120mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112121</SubGroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO370</BillingCode><Name>Acumed Tap-Loc</Name><Description>Tap screws, Tap-Loc Screws</Description><Size>3.6mm -60 mm Length</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO377</BillingCode><Name>Acu-Loc Distal Radius Plate System</Name><Description>Cortical Screw</Description><Size>3.5mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU297</BillingCode><Name>KreuLock Locking Compression Screws, Ti</Name><Description>Locking Compression Screws</Description><Size>3.0mm-3.5mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU143</BillingCode><Name>Locking Cortical land Cancellous Screws, Small</Name><Description>Locking Cortical and Cancellous Screws, Small</Description><Size>3-3.5mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ132</BillingCode><Name>Bone Screws</Name><Description>Cortical, Locking, Self-tapping, Standard, T15, trans-physeal</Description><Size>3.5-4.0mm   10-70mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>191602</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM133</BillingCode><Name>TriMed Compression Screws</Name><Description>'Compression Screws</Description><Size>3.0-4.5mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>229704</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW904</BillingCode><PriorBillingCodes><PriorBillingCode>WR381</PriorBillingCode></PriorBillingCodes><Name>MaxLock Extreme System - 3.5/4mm Non Locking Screws</Name><Description>Bone screws, Titanium, non locking</Description><Size>Ø 3.5mm, length 8-50mm  Ø 4mm, length 8-60mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>214671</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM549</BillingCode><Name>Skeletal Dynamics Bone Screw Non-Locking</Name><Description>Non-Locking Cortical Bone Screws  </Description><Size>3.5mm diameter, 14 to 44mm length</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER381</BillingCode><Name>Paragon 28 Phantom Lapidus Nail-Screws, small (2.71mm – 4.49mm), dual thread, locking</Name><Description>Paragon 28 Phantom Lapidus Nail-Screws, small (2.71mm – 4.49mm), dual thread, locking</Description><Size>dia 3.5 mm x length (10-26 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>290443</ARTG></ARTGs><ChangeExplanation>Change to Group benefit</ChangeExplanation><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF008</BillingCode><Name>Arthrodesis Screws</Name><Description>Titanium Alloy Compression Screws</Description><Size>10mm - 60mm</Size><SupplierCode>40106</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>Breakoff, DT</Suffix><ARTGs><ARTG>141164</ARTG></ARTGs><MinimumBenefit>455</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF002</BillingCode><Name>BePOD</Name><Description>Self-Compressive Screw</Description><Size>Lengths 10mm - 60mm</Size><SupplierCode>40106</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>Breakoff, DT</Suffix><ARTGs><ARTG>141164</ARTG></ARTGs><MinimumBenefit>455</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN069</BillingCode><Name>Small cannulated Locking screws </Name><Description>Small cannulated Locking screws </Description><Size>2.8 mm diameter ; 14-30 mm length</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,LK</Suffix><ARTGs><ARTG>260233</ARTG><ARTG>260234</ARTG></ARTGs><MinimumBenefit>183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI853</BillingCode><Name>Zimmer Periarticular Plating System</Name><Description>5.5mm Cannulated Periarticular Locking Screws</Description><Size>30 - 150mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,LK</Suffix><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL209</BillingCode><PriorBillingCodes><PriorBillingCode>IG108</PriorBillingCode></PriorBillingCodes><Name>Newdeal Surfix Style Screws</Name><Description>Titanium bone screw +locking screw for the fixation of specific Newdeal bone plates</Description><Size>Diameter 3.5mm, Length 10-50mm; Diameter 4.5mm, length 14-65mm; Diameter 6.5, length 20-100mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,LK</Suffix><ARTGs><ARTG>173963</ARTG></ARTGs><MinimumBenefit>183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL204</BillingCode><PriorBillingCodes><PriorBillingCode>IG093</PriorBillingCode></PriorBillingCodes><Name>Newdeal Screws/Lock Screws</Name><Description>Screws - Cancellous, Cancellous cannulated, cortical, cortical cannulated plus Lock screws</Description><Size>Cancellous/Cancellous cannulated - Diameter 6.5mm, Length 20mm - 100mm + Lock Screw, Cortical - Diameter 5.0mm, Length 25mm - 45mm + Lock Screw, Cortical - Diameter 4.5mm, Length 14mm - 65mm + Lock Screw, Cortical - Diameter 3.5mm, Length 14mm - 32mm + Lo</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,LK</Suffix><ARTGs><ARTG>173963</ARTG></ARTGs><MinimumBenefit>183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY797</BillingCode><Name>AO/ASIF Screws</Name><Description>Philos Cannulated locking screw</Description><Size>3.5mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,LK</Suffix><ARTGs><ARTG>157068</ARTG></ARTGs><MinimumBenefit>183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BU009</BillingCode><Name>Nexis osteosynthesis screws</Name><Description>Bone screw titanium alloy (compressive)</Description><Size>Diameter 2.9-4 mm, Length 10-60mm</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>235765</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HJ003</BillingCode><Name>HBS Self-Drilled High Compression Screw</Name><Description>Headless compression screw, cannulated, dual thread, self-drilling, self-tapping, </Description><Size>Distal thread Diameter 3mm, Length 12-40mm</Size><SupplierCode>40478</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>340314</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY644</BillingCode><Name>AO/ASIF Screws</Name><Description>HCS Countersinkable Compression Screw</Description><Size>2.71mm - 4.49mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>157068</ARTG><ARTG>297881</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU316</BillingCode><Name>KrueLock Locking Compression Screws SS</Name><Description>locking compression screw </Description><Size>3.5mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ047</BillingCode><Name>Valetis Screws</Name><Description>Titanium Locking Screws</Description><Size>3.5mm width, 10-65mm length
4.0mm width, 10-75mm length</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>284755</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO415</BillingCode><Name>Acumed Screws</Name><Description>Screws</Description><Size>2.71mm - 4.49mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ095</BillingCode><Name>Small Fragment Screws</Name><Description>Locking Screws</Description><Size>3.5mm diameter,   10mm-90mm length </Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO426</BillingCode><Name>ACUMED Hexalobe Low Profile 4.3mm screws</Name><Description>ACUMED Hexalobe low profile 4.3mm locking screws, Titanium, fully threaded</Description><Size>4.3mm in diameter, 18mm to 64mm in length</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ181</BillingCode><Name>PediFoot Deformity Correction System  </Name><Description>3.5mm Variable Angle Locking Screws</Description><Size>8-60mm length</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>191602</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW037</BillingCode><Name>WEGO Trauma Systems</Name><Description>Small Bone Screw Systems</Description><Size>Small (2.71mm – 4.49mm)</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324381</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW905</BillingCode><PriorBillingCodes><PriorBillingCode>WR382</PriorBillingCode></PriorBillingCodes><Name>MaxLock Extreme System - 3.5mm locking screws</Name><Description>Bone screws, titanium, fixed or variable angle locking</Description><Size>Ø 3.5mm Fixed angle, Length 8-45mm  Ø 3.5mm Variable angle, Length 10-50mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>214671</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO322</BillingCode><Name>Acumed Hexalobe Locking Screws</Name><Description>Acumed Hexalobe Locking Screws</Description><Size>Small (2.71mm-4.49mm)</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH477</BillingCode><Name>DynafitSystem</Name><Description>Self-compressive screws</Description><Size>3.2 x 10-40mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>DT</Suffix><ARTGs><ARTG>216161</ARTG><ARTG>216162</ARTG></ARTGs><MinimumBenefit>245</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO374</BillingCode><Name>Acutrak Fusion Screws</Name><Description>Fusion Screws Titanium</Description><Size>2.71mm - 4.49mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>DT</Suffix><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>245</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN017</BillingCode><Name>Newclip Compression Screws</Name><Description>Self-Compressive Screws</Description><Size>2.71-4.49mm diameter, Length 10-30mm</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>DT</Suffix><ARTGs><ARTG>260233</ARTG><ARTG>260234</ARTG></ARTGs><MinimumBenefit>245</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU254</BillingCode><PriorBillingCodes><PriorBillingCode>DE272</PriorBillingCode></PriorBillingCodes><Name>Bio-Compression Screw System</Name><Description>Fixation Device</Description><Size>16mm, 18mm, 20mm, 22mm, 24mm, 26mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>DT</Suffix><ARTGs><ARTG>360378</ARTG><ARTG>140794</ARTG></ARTGs><MinimumBenefit>245</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO092</BillingCode><Name>APTUS SpeedTip C System</Name><Description>APTUS SpeedTip C Screws</Description><Size>2.8mm diameter</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>206157</ARTG></ARTGs><ChangeExplanation>Change to Group benefit</ChangeExplanation><MinimumBenefit>245</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER396</BillingCode><Name>Paragon 28 Monster Screw System-Screws, small (2.71mm – 4.49mm), cannulated, dual thread, locking</Name><Description>Paragon 28 Monster Screw System-Screws, small, cannulated, dual thread, locking, headless, Titanium</Description><Size>dia (3.0-4.0) x length (10-100 mm) x length of thread (3.5-100 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>289308</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW817</BillingCode><PriorBillingCodes><PriorBillingCode>WR245</PriorBillingCode></PriorBillingCodes><Name>Charlotte Claw Locking Screws</Name><Description>3.5mm stainless steel locking screws for use with Claw Plate</Description><Size>3.5mm: 12-40mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI852</BillingCode><Name>Zimmer Periarticular Plating System</Name><Description>4.5mm Periarticular Locking Screws</Description><Size>12 - 110mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI854</BillingCode><Name>Zimmer Universal Locking System</Name><Description>3.5mm Universal Locking Screws</Description><Size>12 - 90mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL090</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Bone Screws</Description><Size>2.71mm – 4.49mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JD001</BillingCode><Name>CarboFix Piccolo Plate Systems – Locking Screws: Small</Name><Description>Titanium alloy screws (locking) for fixation of CarboFix plate shaft and head.</Description><Size>Locking Proximal Screw 4.0mm x 25.0mm, 30.0mm, 32.5mm, 35.0mm, 37.5mm, 40.0mm, 42.5mm, 45.0mm, 47.5mm, 50.0mm, 55.0mm, 60.0mm
Locking Distal Screw 3.5mm x 10mm, 12mm, 14mm, 16mm, 18mm, 22.5mm, 25.0mm, 27.5mm, 30.0mm, 32.5mm, 35.0mm, 40.0mm, 45.0mm
Locking Screw 3.5mm x 12mm, 14mm, 16mm, 18mm, 20mm, 22mm, 24mm, 26mm</Size><SupplierCode>40214</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>222648</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL192</BillingCode><PriorBillingCodes><PriorBillingCode>IG068</PriorBillingCode></PriorBillingCodes><Name>Surfix Screw plus Surfix Lock-Screw</Name><Description>Locking screws with an independent lock-screw head that screw into fixation plates. This combination effects dynamic compression.</Description><Size>3.5mm: 10-28mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>173963</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN944</BillingCode><Name>Peri-Loc</Name><Description>Locking Screws</Description><Size>2.71mm - 4.49mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF124</BillingCode><Name>Islay non-LOCKING SCREW</Name><Description>2.7mm non locking screw
GENII 2.7mm non-locking screw
3.5mm non-locking screw
GENII 3.5mm non-locking screw</Description><Size>8-30mm (FPS 2.7mm non locking)
10-50mm (FPS 3.5mm non-locking)</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL220</BillingCode><PriorBillingCodes><PriorBillingCode>IG120</PriorBillingCode></PriorBillingCodes><Name>Surfix Locking Screws</Name><Description>Locking screws with an independent lock-screw head</Description><Size>3mm; 10-24mm length</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>173963</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL203</BillingCode><PriorBillingCodes><PriorBillingCode>IG092</PriorBillingCode></PriorBillingCodes><Name>Newdeal Lock Screws</Name><Description>For use with Newdeal bone screws and plates</Description><Size>Diameter 2.7mm - 6.5mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>173963</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF084</BillingCode><Name>Signature FAA Screw</Name><Description>Titanium Locking Screw.</Description><Size>2.7mm diameter from 8-30mm in length.</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL191</BillingCode><PriorBillingCodes><PriorBillingCode>IG067</PriorBillingCode></PriorBillingCodes><Name>Surfix screw plus Surfix Lock-Screw</Name><Description>Locking screws with an independent lock-screw head</Description><Size>2.7mm: 10-32mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>173963</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY652</BillingCode><Name>AO/ASIF Screws</Name><Description>Locking Head Screws</Description><Size>&gt;2.7mm to &amp;lt; 4.5mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157068</ARTG><ARTG>297881</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BU004</BillingCode><Name>Airlock Bone screw</Name><Description>Bone Screws Titanium Alloy (Locking screws)</Description><Size>Diameter 3-3.5mm, Length 8-30mm</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>235767</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ071</BillingCode><PriorBillingCodes><PriorBillingCode>EF010</PriorBillingCode></PriorBillingCodes><Name>Bone Screw</Name><Description>Locking Screw</Description><Size>2.71mm – 4.49mm</Size><SupplierCode>40063</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>239817</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ104</BillingCode><PriorBillingCodes><PriorBillingCode>EF006</PriorBillingCode></PriorBillingCodes><Name>Merete - MetaFix LS - Locking Screws</Name><Description>Bone screws, Titanium, Locking</Description><Size>2.71mm - 4.49mm diameter, lengths 12 - 48mm</Size><SupplierCode>40063</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>212520</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ014</BillingCode><Name>Austofix Proximal Humeral Plating System - Austofix PHP Locking Screw</Name><Description>Locking Screw Titanium</Description><Size>3.5mm, 16-100mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM278</BillingCode><Name>PANTERA Proximal Humerus Fracture Fixation Plate System - Locking Cortical Screw</Name><Description>Locking Cortical Screw</Description><Size>3.5mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>182168</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW805</BillingCode><PriorBillingCodes><PriorBillingCode>WR228</PriorBillingCode></PriorBillingCodes><Name>Titanium Screw</Name><Description>Locking, non-locking or cannulated, for use only with Darco titanium plates, self-tapping</Description><Size>8-40mm, 3.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM521</BillingCode><Name>OMNI Plating System</Name><Description>Locking Screws</Description><Size>2.8mm &amp; 3.5mm diameter; 8-70 length</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>306780</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ237</BillingCode><Name>Low Profile Screw, Cortical</Name><Description>Low Profile Screw, Cortical</Description><Size>3-3.5mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>284416</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM252</BillingCode><Name>OsteoMed FPS</Name><Description>Bone screws</Description><Size>3.5/4mm x 10-70mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>202319</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA005</BillingCode><Name>ALPS Plating System &amp; DVR Plating System</Name><Description>Locking screws and pegs</Description><Size>2.7-4.0mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>209305</ARTG><ARTG>210296</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN023</BillingCode><Name>Newclip Locking Bone Screws</Name><Description>Locking Bone Screws</Description><Size>2.71-4.49mm diameter, length 10-95 mm</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>260233</ARTG><ARTG>260234</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB022</BillingCode><Name>Calcaneal Locking Plate MIPO System - Locking Screw</Name><Description>Locking Screws</Description><Size>2.71mm - 4.49mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>223188</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ076</BillingCode><PriorBillingCodes><PriorBillingCode>AE155</PriorBillingCode><PriorBillingCode>AE155</PriorBillingCode></PriorBillingCodes><Name>ASDM Clavicle Plating System - Screws</Name><Description>Fixation Device, Internal, Locking, Stainless Steel, Cortical Screw Size: 3.5mm</Description><Size>3.5mm Locking Screws, 10-30mm (2mm increments)</Size><SupplierCode>40480</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>137369</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM147</BillingCode><Name>TriMed Bone Screw</Name><Description>Locking Compression Bone Screw</Description><Size>4mm x 35-60mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM553</BillingCode><Name>Skeletal Dynamics Bone Screw Locking  </Name><Description>Bone Screw Locking  </Description><Size>3.5mm diameter, 16 to 44mm length</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM145</BillingCode><Name>TriMed Bone Screw</Name><Description>Locking Cortical Bone Screw</Description><Size>3.2mm x 10-40mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW460</BillingCode><Name>Memometal Anchorage Bone Screws</Name><Description>Anchorage Bone Screws</Description><Size>3.0-3.5mm diameter to 10 - 40mm in length</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>149535</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM359</BillingCode><Name>Hex Locking Screws</Name><Description>Hex plate fixation locking screws</Description><Size>2.71 to 4.49mm diameter</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>178232</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV021</BillingCode><Name>VariAx Plating System - Screws</Name><Description>Titanium Locking Screws</Description><Size>3.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>352530</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU205</BillingCode><PriorBillingCodes><PriorBillingCode>DE365</PriorBillingCode></PriorBillingCodes><Name>QuickFix Screw, Small</Name><Description>Titanium Snapp-off Small Bone Screw, small</Description><Size>3.0mm Diameter x 13-19mm Lengths</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>351000</ARTG><ARTG>350871</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL225</BillingCode><PriorBillingCodes><PriorBillingCode>IG134</PriorBillingCode></PriorBillingCodes><Name>Snap-Off screws</Name><Description>Titanium break-off barrel screws for Hallu-Fix</Description><Size>Diameter 3.0mm, Length 10 - 18mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>173963</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN025</BillingCode><Name>Newclip Cannulated Screws</Name><Description>Cannulated Screws</Description><Size>3.0 - 4.0mm diameter, lengths 14 - 75mm</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>260233</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BP033</BillingCode><Name>Tyber Medical Headed Trauma screw</Name><Description>Headed trauma screw for compression and fixation of bone  Sterile or Non sterile, Titanium or stainless steel</Description><Size>3.0mm - 4.0mm</Size><SupplierCode>40061</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>324189</ARTG><ARTG>324190</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO116</BillingCode><Name>APTUS headedCCS</Name><Description>Headed Cannulated screws</Description><Size>&gt;2.7mm-4.49mm</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>206157</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW717</BillingCode><PriorBillingCodes><PriorBillingCode>WR068</PriorBillingCode></PriorBillingCodes><Name>Cannulated Screw</Name><Description>Titanium cannulated screw intended for use in conjunction with a plate for fixation of midfoot fusion</Description><Size>3.5mm diameter x 34, 36 &amp; 38mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM523</BillingCode><Name>OMNI Plating System</Name><Description>Cannulated Screws</Description><Size>3.5mm diameter; 20-70mm length</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>306780</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW819</BillingCode><PriorBillingCodes><PriorBillingCode>WR247</PriorBillingCode></PriorBillingCodes><Name>Darco Headed Compression Screw System</Name><Description>Cannulated titanium compression screws</Description><Size>3.0-4.0mm x 16-50mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI835</BillingCode><Name>NCB Polyaxial Locking System</Name><Description>4.0mm Cannulated Variable Angle Locking Screws - Ti Alloy</Description><Size>14 - 65mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>100337</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW909</BillingCode><PriorBillingCodes><PriorBillingCode>WR386</PriorBillingCode></PriorBillingCodes><Name>MaxTorque Cannulated Screw System - Small Screws</Name><Description>Bone screws, Titanium, Cannulated, Short or Long Thread</Description><Size>Ø3.2mm Short Thread, Length 12-30mm  Ø3.2mm Long Thread, Length 12-38mm  Ø3.8mm Short Thread,Length 16-50mm  Ø4.0mm Long Thread, Length 14-50mm  Ø4.0mm Long Thread, Length 24-50mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>214671</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH186</BillingCode><Name>Small / Large  Fragment Set</Name><Description>Cannulated Titanium Bone Screw</Description><Size>3.0mm - 4.0mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>153087</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER395</BillingCode><Name>Paragon 28 Monster Screw System-Screws, small (2.71mm – 4.49mm), cannulated</Name><Description>Paragon 28 Monster Screw System-Screws, small, cannulated, headed, partial or full thread</Description><Size>dia (3.0-4.0) x length (10-150 mm) x thread length (3-150 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>289308</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL011</BillingCode><Name>TC-100</Name><Description>Cortical and Cancellous Screws</Description><Size>2.71mm-4.49mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK528</BillingCode><Name>'Stryker Cannulated Screw System</Name><Description>Asnis III Cannulated screws</Description><Size>4.0mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>119660</ARTG><ARTG>155633</ARTG><ARTG>340042</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM536</BillingCode><Name>Omni Stable AF Plating System</Name><Description>Cannulated Screws</Description><Size>4.0 x 20-70mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>306780</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Description, Size</ChangeExplanation><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR094</BillingCode><Name>Stryker Cannulated Screw System</Name><Description>Asnis Micro Cannulated screw</Description><Size>2.71mm-3.0mm, Diameters, 8mm-40mm lengths</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>155633</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ018</BillingCode><PriorBillingCodes><PriorBillingCode>LM286</PriorBillingCode><PriorBillingCode>LM286</PriorBillingCode></PriorBillingCodes><Name>Bone Screw</Name><Description>Bone Screw</Description><Size>2.71 to 4.49mm diameter</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>266217</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KO004</BillingCode><PriorBillingCodes><PriorBillingCode>LM399</PriorBillingCode></PriorBillingCodes><Name>Cannulated Screws</Name><Description>Cannulated Screws</Description><Size>2.71mm – 4.49mm diameter</Size><SupplierCode>40387</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>329613</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB040</BillingCode><Name>Cannulated Screws 4mm</Name><Description>Cannulated 4mm</Description><Size>4mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>223188</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK003</BillingCode><PriorBillingCodes><PriorBillingCode>UQ003</PriorBillingCode></PriorBillingCodes><Name>OsteoMed Plating &amp; Fixation System</Name><Description>Screws - Cannulated Lag</Description><Size>Diameter 2.71mm – 4.49mm</Size><SupplierCode>40456</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>130509</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH277</BillingCode><Name>ALPS Plating System &amp; Biodrive Screws</Name><Description>Cannulated Bone Screws</Description><Size>3.0 to 4.0mm diameter</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>210296</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN971</BillingCode><Name>Cannulated Screw</Name><Description>Stainless Steel</Description><Size>2.71mm - 4.49mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY071</BillingCode><Name>AO/ASIF Screws</Name><Description>Cannulated screws</Description><Size>&gt;2.7mm-4.49mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>157068</ARTG><ARTG>297881</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BU003</BillingCode><Name>Nexis osteosynthesis screws</Name><Description>Bone screw titanium alloy (headed)</Description><Size>Diameter 2.9-4mm, Length 10-60mm</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>235765</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU218</BillingCode><Name>Cannulated Low Profile Screws, Small</Name><Description>Cannulated Low Profile Screws, Small</Description><Size>3-4mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ137</BillingCode><Name>Cannulated Screws</Name><Description>Cannulated, Cancellous  Short, Medium, Partial, Full Thread  Locking, Non-locking</Description><Size>3.0-4.0mm Diameter  8-70mm Length</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>191602</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU142</BillingCode><PriorBillingCodes><PriorBillingCode>DE696</PriorBillingCode></PriorBillingCodes><Name>Patella Fracture Screw</Name><Description>4mm Blunt Tip Cannulated Lag Screw</Description><Size>4mm x 24mm - 4mm x 60mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO450</BillingCode><Name>Cannulated Screw  New Information - Acumed Cannulated Screws</Name><Description>4.0mm Cannulated Screw</Description><Size>4.0mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT011</BillingCode><Name>Hawk 4.0mm Cannulated Screw System</Name><Description>4.0mm Cannulated screw</Description><Size>4.0mm in diameter with lengths of 26mm to 70mm</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>230954</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW006</BillingCode><Name>WEGO Trauma Systems</Name><Description>Cannulated Bone Screw Systems</Description><Size>Small (2.71mm – 4.49mm)</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>324381</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ045</BillingCode><Name>Valens Hand - Screws</Name><Description>Cannulated Screws</Description><Size>3.0mm, 3.5mm, 4.0mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT073</BillingCode><PriorBillingCodes><PriorBillingCode>OH480</PriorBillingCode></PriorBillingCodes><Name>HBS 2 midi</Name><Description>Self-compressive screws</Description><Size>3.0mm x 10-40mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>276650</ARTG><ARTG>276674</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF001</BillingCode><Name>FH Screw Systems</Name><Description>Canulated Self-Compressive Screws</Description><Size>lengths 10mm to 50mm</Size><SupplierCode>40106</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>141164</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB043</BillingCode><Name>Cannulated Screws 3mm</Name><Description>Cannulated Screws</Description><Size>3mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>223188</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KO009</BillingCode><PriorBillingCodes><PriorBillingCode>LM394</PriorBillingCode></PriorBillingCodes><Name>Headless Compression Screw</Name><Description>Headless Compression Screw</Description><Size>2.71mm – 4.49mm diameter</Size><SupplierCode>40387</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>329613</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM504</BillingCode><Name>Locking Screws (Small)</Name><Description>Locking Screws (Small)</Description><Size>2.71mm – 4.49mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>306780</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL210</BillingCode><PriorBillingCodes><PriorBillingCode>IG109</PriorBillingCode></PriorBillingCodes><Name>Qwix Screw</Name><Description>Self drilling, self tapping, cannulated, titanium screws.</Description><Size>Diameter 3.0mm-7.5mm, length 10mm-120mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>173963</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF114</BillingCode><Name>Twinlock Screw - Standard</Name><Description>Twinlock Screw - Standard</Description><Size>5.2/5.5mm to 6.0/7.0mm Dia x 25 to 120 mm Length</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL193</BillingCode><PriorBillingCodes><PriorBillingCode>IG069</PriorBillingCode></PriorBillingCodes><Name>Bold Compression Screw</Name><Description>Cannulated titanium</Description><Size>3mm diam 10-34mm length</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>173963</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF093</BillingCode><Name>TwinLock Screw - Small</Name><Description>TwinLock Screw - Small</Description><Size>3.5/3.6mm to 4.0/4.1mm Dia x 16 to 34 mm length</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BU019</BillingCode><Name>MAGNEZIX CS 3.2</Name><Description>Compression screw for bone fixation.</Description><Size>Diameter 3.2mm
Length 10-40mm</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>283491</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW837</BillingCode><PriorBillingCodes><PriorBillingCode>WR295</PriorBillingCode></PriorBillingCodes><Name>SALVATION 3Di Plating System - Osteopenic Screws</Name><Description>Osteopenic screws</Description><Size>Diameter: 4.0mm  Length: 16, 18, 20, 22, 25, 30, 35, 40, 45, 50, 55, 60mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM279</BillingCode><Name>PANTERA Proximal Humerus Fracture Fixation Plate System - Cortical Screw</Name><Description>Cortical Screw</Description><Size>3.5mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>182168</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ021</BillingCode><PriorBillingCodes><PriorBillingCode>LM341</PriorBillingCode><PriorBillingCode>LM341</PriorBillingCode></PriorBillingCodes><Name>Bone Screws - Locking</Name><Description>Locking</Description><Size>2.71mm - 4.49mm diameter
All lengths</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>266216</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ192</BillingCode><Name>DartFire Edge Screw System</Name><Description>Titanium Headless Cannulated Screws</Description><Size>3.0MM, 3.5MM, 4.0MM</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>295072</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ191</BillingCode><Name>DartFire Edge Screw System</Name><Description>Titanium Headed Cannulated Screws</Description><Size>3.0MM, 3.5MM, 4.0MM</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>295072</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ181</BillingCode><Name>Skeletal Dynamics Bone Screw</Name><Description>Polyaxial locking cannulated screw</Description><Size>3.0mm x 20-40mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,LK</Suffix><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>183</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI203</BillingCode><Name>Zimmer ECT Screws</Name><Description>4.0mm Cancellous Screws</Description><Size>10 - 60 mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL012</BillingCode><Name>Peri-Loc and Peri-Loc VLP</Name><Description>Cortical and Osteopenia Screws</Description><Size>2.71mm-4.49mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ278</BillingCode><Name>Colink 3.0mm Locking Screws</Name><Description>Locking Screws 3.0mm Titanium Type II Anodised </Description><Size>8 - 30 mm </Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM326</BillingCode><Name>Extremilock Screws</Name><Description>Screws</Description><Size>2.7mm - 4.49mm x 8-70mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>149435</ARTG><ARTG>202319</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW801</BillingCode><PriorBillingCodes><PriorBillingCode>WR219</PriorBillingCode></PriorBillingCodes><Name>Evolve Ortholoc EPS System 3.5 NL Screws</Name><Description>Stainless Steel, Cortical &amp; Cancellous Screws</Description><Size>3.5mm diameter 10-60mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL194</BillingCode><PriorBillingCodes><PriorBillingCode>IG070</PriorBillingCode></PriorBillingCodes><Name>ICOS Screw: Ideal Compression Screw</Name><Description>Cannulated titanium</Description><Size>4.0mm diam 26-60mm length, 6.5mm diam 40-150mm length</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>173963</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ241</BillingCode><Name>Low Profile Locking Screw</Name><Description>Low Profile Locking Screw </Description><Size>3-3.5mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW064</BillingCode><Name>WEGO Trauma Systems</Name><Description>Self-tapping Cannulated Screw</Description><Size>Small (2.71mm – 4.49mm)</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>324381</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ279</BillingCode><Name>Colink 3.0mm Low-Pro Cortical Screws</Name><Description>Low-profile 3.0mm Cortical Screws Titanium Type II Anodised </Description><Size>8 - 30 mm </Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM317</BillingCode><Name>Skeletal Dynamics Bone Screw Non-Locking</Name><Description>Non-Locking Cortical Bone Screws</Description><Size>3.0mm, 3.5mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV022</BillingCode><Name>VariAx Plating System - Screws</Name><Description>Titanium Non-Locking Screws</Description><Size>3.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>352530</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW955</BillingCode><PriorBillingCodes><PriorBillingCode>WR445</PriorBillingCode></PriorBillingCodes><Name>ORTHOLOC SPS Non-Locking Screws</Name><Description>Stainless steel, cortical, non-locking screws</Description><Size>Dia. 3.5mm  Length: 10mm - 60mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>148960</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR073</BillingCode><Name>Stryker Locking Plate System</Name><Description>Locking Screws</Description><Size>Diameter 2.7 to 3.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>124318</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH546</BillingCode><Name>Dynafit System</Name><Description>Compressive Screws</Description><Size>2.8-4mm x 10-70mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>216161</ARTG><ARTG>216162</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY068</BillingCode><Name>AO/ASIF Screws</Name><Description>Cortex, Conical, Cancellous, Compression Screws</Description><Size>2.71mm-4.49mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>297881</ARTG><ARTG>157068</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JD003</BillingCode><Name>CarboFix Piccolo Plate Systems – Non-Locking Screws: Small</Name><Description>Titanium alloy screws (non-locking) for fixation of CarboFix plate shaft and head.</Description><Size>Non-Locking Distal Screw 3.5mm x 10mm, 12mm, 14mm, 16mm, 18mm, 22.5mm, 25.0mm, 27.5mm, 30.0mm, 32.5mm, 35.0mm, 40.0mm, 45.0mm
Non-Locking Screw 3.5mm x 10mm, 12mm, 14mm, 16mm, 18mm, 20mm, 22mm, 24mm, 26mm, 30mm, 35mm, 40mm, 45mm, 50mm, 55mm</Size><SupplierCode>40214</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>222648</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL091</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Bone Screws</Description><Size>2.71mm – 4.49mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL190</BillingCode><PriorBillingCodes><PriorBillingCode>IG063</PriorBillingCode></PriorBillingCodes><Name>Tibiaxys Distal tibia system</Name><Description>Titanium screw for use with Tibiaxys distal tibia system</Description><Size>4mm diameter with 6mm head; 40mm - 100mm length</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>173963</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BU007</BillingCode><Name>Airlock Bone screw</Name><Description>Bone Screws Titanium Alloy (non locking screws)</Description><Size>Diameter 3-3.5mm, Length 8-30mm</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>235767</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK005</BillingCode><PriorBillingCodes><PriorBillingCode>UQ004</PriorBillingCode></PriorBillingCodes><Name>OsteoMed Plating &amp; Fixation System</Name><Description>Lag Screws - Maxi, MMF, 3.0mm</Description><Size>2.4mm x (8 - 42)mm; 2.4 x (12 - 18)mm; 3.0mm x (12 - 36)mm;</Size><SupplierCode>40456</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>130509</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB021</BillingCode><Name>Cortex, Cancellous and Non Locking Screw</Name><Description>Cortex, Cancellous, Non locking Screws</Description><Size>2.71mm - 4.49mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>223188</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG</ChangeExplanation><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN022</BillingCode><Name>Newclip Bone Screws</Name><Description>Non-Locking Bone Screws</Description><Size>2.71mm – 4.49mm diameter, length 08-150 mm</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>260233</ARTG><ARTG>260234</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO077</BillingCode><Name>APTUS Screws</Name><Description>Cortical Screws</Description><Size>2.71mm – 4.49mm</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>206157</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ075</BillingCode><PriorBillingCodes><PriorBillingCode>AE154</PriorBillingCode><PriorBillingCode>AE154</PriorBillingCode></PriorBillingCodes><Name>ASDM Clavicle Plating System - Screws</Name><Description>Fixation Device, Internal, Non-locking, Stainless Steel, Cortical Screw Size: 3.5mm &amp; Cancellous Screw sizes 4.0mm</Description><Size>3.5mm Low-profile Cortex Screws, 10-30mm (2mm increments)
4.0mm Low-profile Cortex Screws, 10-30mm (2mm increments)</Size><SupplierCode>40480</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>137369</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT012</BillingCode><Name>Hawk 3.0mm Cannulated Screw system</Name><Description>3.0mm cannulated screw</Description><Size>3.0mm in diameter with lengths of 14mm to 50mm</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>230954</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO382</BillingCode><Name>Acutrak Headless Compression Screw</Name><Description>Acutrak 4/5 screw</Description><Size>2.71mm - 4.49mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO368</BillingCode><Name>Acumed Fixation Screw</Name><Description>Acutrak Compression Screw Titanium</Description><Size>2.71mm - 4.49mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO355</BillingCode><Name>Acutrak 2</Name><Description>Headless compression screw</Description><Size>2.71mm - 4.49mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ090</BillingCode><Name>Headless Compression Cannulated Screw System</Name><Description>Fully-threaded headless cannulated screws</Description><Size>3.0mm, 3.5mm, 4.0mm diameter   14-30mm length</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>276915</ARTG><ARTG>284755</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU296</BillingCode><Name>Beveled FT Screw</Name><Description>Screw for osteotomy</Description><Size>3.5mm and 4.0mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU151</BillingCode><PriorBillingCodes><PriorBillingCode>DE480</PriorBillingCode></PriorBillingCodes><Name>Headless Compression Screw System</Name><Description>Headless Compression Screw for bone fixation</Description><Size>3mm Diameter ( 10-36mm Lengths)  4.3mm Diameter (14-80mm Lengths)</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>350672</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ068</BillingCode><Name>Austofix Cannulated Compression Screws</Name><Description>Headless Cannulated Compression Screws</Description><Size>3.0mm width, 10-48mm length;   3.8mm width, 10-60mm length</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>284755</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU158</BillingCode><PriorBillingCodes><PriorBillingCode>DE466</PriorBillingCode></PriorBillingCodes><Name>Compression FT</Name><Description>Headless Compression Screw for bone fixation</Description><Size>3.5mm/4.0mm x 12-60mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT032</BillingCode><Name>Integrant 4.0mm Cannulated Screws</Name><Description>Cannulated screws with variable pitch/dynamic thread screw heads</Description><Size>4.0mm Diameter with lenghts from 26mm-70mm</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>230954</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL208</BillingCode><PriorBillingCodes><PriorBillingCode>IG107</PriorBillingCode></PriorBillingCodes><Name>Bold Compression Screw</Name><Description>Cannulated Titanium</Description><Size>Diameter 3.0-3.70mm, length 10-34mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>173963</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF092</BillingCode><Name>Twinlock Screw - Standard</Name><Description>Twinlock Screw - Standard</Description><Size>5.2/5.5mm to 6.0/7.0mm Dia x 25 to 120 mm Length</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM173</BillingCode><Name>Smith and Nephew Headless Compression Screw</Name><Description>Headless Cannulated Screw</Description><Size>2.71mm-4.49mm Headless Cannulated Screw 8mm - 40mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF115</BillingCode><Name>TwinLock Screw - Small</Name><Description>TwinLock Screw - Small</Description><Size>3.5/3.6mm to 4.0/4.1mm Dia x 16 to 34 mm length</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW824</BillingCode><PriorBillingCodes><PriorBillingCode>WR264</PriorBillingCode></PriorBillingCodes><Name>MICA Compression Screw</Name><Description>Compression Screw for Minimally Invasive Surgery</Description><Size>Sizes: 3mm - 4mm diameter,  14mm - 70mm length</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>198485</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ232</BillingCode><Name>Colink 4.0 Cancellous Screws</Name><Description>Cancellous Titanium Type II Anodised Screws 4.0 mm</Description><Size>4.0 mm Diam x Length (10 - 60 mm)</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ231</BillingCode><Name>Colink 3.5 Variable Angle Locking Screws</Name><Description>Variable Angle Locking Titanium Type II Anodised Screws 3.5 mm</Description><Size>3.5 mm Diam x Length (10 - 60 mm)</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ230</BillingCode><Name>Colink 3.5 Low-Pro Non-Locking Screws</Name><Description>Low-profile Non-Locking Titanium Type II Anodised Screws 3.5 mm</Description><Size>3.5 mm Diam x Length (10 - 60 mm)</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ229</BillingCode><Name>Colink 3.5 Low-Pro Locking Screws</Name><Description>Low-profile Locking Titanium Type II Anodised Screws 3.5 mm</Description><Size>3.5 mm Diam x Length (10 - 60 mm)</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX012</BillingCode><Name>MBOSS 4.0 mm Cancellous Screw</Name><Description>4.0 mm Cancellous screw with short or long thread</Description><Size>Diameter: 4mm
Length: 10-100mm</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>286843</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM358</BillingCode><Name>Hex Screw</Name><Description>Hex plate fixation screw</Description><Size>2.71 to 4.49mm diameter</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>178232</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT098</BillingCode><Name>Nexos Screw</Name><Description>3.5mm Screws</Description><Size>3.5mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>276650</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW954</BillingCode><PriorBillingCodes><PriorBillingCode>WR444</PriorBillingCode></PriorBillingCodes><Name>ORTHOLOC SPS Locking Screws</Name><Description>Stainless steel locking head screws: cortical or cancellous</Description><Size>Dia 3.5mm  Length: 10mm - 60mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>148960</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI947</BillingCode><Name>Screws -Locking</Name><Description>Locking Screw</Description><Size>10 - 70mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>140687</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM310</BillingCode><Name>Skeletal Dynamics Bone Screw Locking</Name><Description>Bone Screw Locking</Description><Size>3.0m and 3.5mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ040</BillingCode><PriorBillingCodes><PriorBillingCode>LM351</PriorBillingCode><PriorBillingCode>LM351</PriorBillingCode></PriorBillingCodes><Name>Orthopaedic locking Screws</Name><Description>Orthopaedic locking Screws</Description><Size>2.71 to 4.49 mm diameter, all lengths</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER425</BillingCode><Name>Paragon 28 Gorilla Plating System-Screws, small</Name><Description>Paragon 28 Gorilla Plating System-Screws, small, locking; compact, recon/Tuffneck</Description><Size>dia (3.5-4.2 mm) x length (8-100 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>289308</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW932</BillingCode><PriorBillingCodes><PriorBillingCode>WR416</PriorBillingCode></PriorBillingCodes><Name>WAVE Calcaneal Fracture System - Locking Screw</Name><Description>The WAVE Calcaneal Fracture System is a low profile, anatomical plate and screw system designed for the minimally invasive fixation of the calcaneal fractures. The plate and associated locking and non-locking screws facilitate the reconstruction of the height and width of the calcaneus, and remodelling of the lateral calcaneal wall. The WAVE calcaneal System is provided non-sterile. The Locking Screw is used with the WAVE Calcaneal Fracture Plate</Description><Size>Screws: Diameter = 4.0mm, Length - 14-44 in 2mm increments</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>168890</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM535</BillingCode><Name>Omni Stable AF Plating System</Name><Description>Fully Threaded Syndesmosis Screws</Description><Size>4.0 x 40-60mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>306780</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM475</BillingCode><Name>TriMed ASET Foot Plating System</Name><Description>Non-Locking Cortical Bone Screws (Small)</Description><Size>2.71mm – 4.49mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER386</BillingCode><Name>Hintermann Series H3™ Total Ankle Prosthesis-Screw</Name><Description>Hintermann Series H3™ Total Ankle Prosthesis-Screw, cortical, stainless steel</Description><Size>dia 3.5 mm x length (12-42 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>289320</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW719</BillingCode><PriorBillingCodes><PriorBillingCode>WR072</PriorBillingCode></PriorBillingCodes><Name>Ortholoc Fracture System Screws</Name><Description>Titanium, variable angle locking screws</Description><Size>2.7, 3.5 &amp; 4.0mm diameter, 8-100mm length</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK630</BillingCode><Name>SBi Locking Screws</Name><Description>Titanium Cortical Locking Self-tapping screws</Description><Size>2.7mm Cortical Locking, Self-tapping 10 - 30mm
3.5mm Cortical, Locking, Self tapping 8 -20mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>167057</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ033</BillingCode><PriorBillingCodes><PriorBillingCode>LM290</PriorBillingCode><PriorBillingCode>LM290</PriorBillingCode></PriorBillingCodes><Name>NEOFIT - Screws</Name><Description>NEOFIT screws</Description><Size>2.7 &amp; 3.0mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>266216</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW793</BillingCode><PriorBillingCodes><PriorBillingCode>WR078</PriorBillingCode></PriorBillingCodes><Name>Charlotte Lisfranc Recontruction System - Screw.</Name><Description>Solid core stainless steel screw.</Description><Size>3.7mm diameter, 8-100mm length.</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK563</BillingCode><Name>Stryker Plating System</Name><Description>SPS Locking Plate System</Description><Size>Locking screws 3-4mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>139635</ARTG><ARTG>119660</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW835</BillingCode><PriorBillingCodes><PriorBillingCode>WR293</PriorBillingCode></PriorBillingCodes><Name>SALVATION 3Di Plating System - OP Locking Screws</Name><Description>Osteopenic locking screws</Description><Size>Diameter: 4.0mm  Length: 16mm to 60mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM477</BillingCode><Name>TriMed ASET Foot Plating System</Name><Description>VA Locking Screws (small) </Description><Size>2.71mm – 4.49mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM280</BillingCode><Name>PANTERA Proximal Humerus Fracture Fixation Plate System - Post Cap Screw</Name><Description>Post Cap Screw</Description><Size>2.7 mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>182168</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI856</BillingCode><Name>Zimmer Universal Locking System</Name><Description>3.5mm Universal Locking Screws - Ti Alloy</Description><Size>12 - 60mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO074</BillingCode><Name>APTUS Screws</Name><Description>Aptus Locking Screws</Description><Size>2.8mm - 3.5mm Diameter</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>141171</ARTG></ARTGs><ChangeExplanation>Change to Group benefit</ChangeExplanation><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ131</BillingCode><PriorBillingCodes><PriorBillingCode>LM380</PriorBillingCode><PriorBillingCode>LM380</PriorBillingCode></PriorBillingCodes><Name>Screw and Locking Cap</Name><Description>Screw and Locking Cap</Description><Size>2.71 to 4.49 mm diameter</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>266216</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT091</BillingCode><PriorBillingCodes><PriorBillingCode>OH642</PriorBillingCode></PriorBillingCodes><Name>KLS Martin - Radial Plating System</Name><Description>smartDrive Screw</Description><Size>3.0 x 8-30mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>276650</ARTG><ARTG>276674</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI150</BillingCode><Name>Periarticular Plates</Name><Description>Periarticular 4.0mm Cancellous Screws - Stainless Steel</Description><Size>Part thread - 30-60 mm, Full thread 30-110 mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI152</BillingCode><Name>Periarticular Plates</Name><Description>3.5mm screws</Description><Size>lengths up to 130mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM520</BillingCode><Name>OMNI Plating System</Name><Description>Non-Locking Screws</Description><Size>2.8-3.5mm x 8-70mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>306780</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM146</BillingCode><Name>TriMed Bone Screws</Name><Description>Non-Locking Cortical Bone Screw</Description><Size>3.2mm; Length 08-20mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ210</BillingCode><Name>ARIX 2.0-3.5mm Locking screws </Name><Description>Locking screws</Description><Size>2.0-3.5mm</Size><SupplierCode>40063</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>409165</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ172</BillingCode><Name>Non-Locking Screw</Name><Description>Non Locking Screw</Description><Size>2.71mm - 4.49mm</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>429400</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO378</BillingCode><Name>Acu-Loc Distal Radius Plate System</Name><Description>Cortical Screw Locking</Description><Size>3.5mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ076</BillingCode><Name>Cannulated Humeral Nail</Name><Description>Nail Locking Screw</Description><Size>3.5mm Width  20mm-30mm Length</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>111818</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ099</BillingCode><Name>Austofix Small Fragment System</Name><Description>Cortex/Cancellous Screws</Description><Size>3.5mm width, 12-50mm length 4.0mm width, 12-60mm length</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>284755</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT008</BillingCode><Name>Hawk Anterior Ankle Fusion Set</Name><Description>3.5mm diameter screw set lengths 35mm to 110mm</Description><Size>3.5mm x length 35mm to 110mm</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>191738</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU206</BillingCode><Name>Low Profile Cancellous Bone Screws</Name><Description>Low Profile Cancellous Bone Screws</Description><Size>4mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD055</BillingCode><Name>Glenoid Baseplate Non Locking Bone Screw</Name><Description>Glenoid Baseplate Non Locking Bone Screw</Description><Size>3.5mm diameter, length 14-34mm in 2mm increments</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>212470</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ078</BillingCode><Name>Cannulated Humeral Nail</Name><Description>Humeral Head Screw</Description><Size>4.3mm diameter  25mm to 45mm length</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>111818</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ049</BillingCode><Name>Valetis Screws</Name><Description>Titanium Cortical Screws</Description><Size>3.5mm width, 10-80mm length
4.0mm width, 10-80mm length</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>284755</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF120</BillingCode><Name>Islay Locking screw</Name><Description>FPS 3.5mm locking screw
FPS GENII 3.5mm locking screw
FPS 2.7mm locking screw
FPS GENII 2.7mm locking screw</Description><Size>10-50MM(FPS 3.5MM locking) 
8-30MM (FPS 2.7MM locking)</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK004</BillingCode><PriorBillingCodes><PriorBillingCode>UQ046</PriorBillingCode></PriorBillingCodes><Name>ExtremiFix Screws</Name><Description>Headless Cannulated Compression Screw</Description><Size>Diameter 3.0mm, 4.0mm. Length 10mm to 52mm; Diameter 2.71mm - 4.49mm.</Size><SupplierCode>40456</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>130509</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BP034</BillingCode><Name>Tyber Medical Trauma headless screw</Name><Description>Headless trauma screw for compression and fixation of bone  Sterile or Non sterile, Titanium or stainless steel</Description><Size>3.0mm-4.0mm</Size><SupplierCode>40061</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>324189</ARTG><ARTG>324190</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO058</BillingCode><Name>APTUS CCS</Name><Description>Cannulated Screws</Description><Size>2.71 – 4.49 mm</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>206157</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB036</BillingCode><Name>Headless Compression Screw System</Name><Description>Headless Compression Screw</Description><Size>2.71 - 4.49mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>223188</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB052</BillingCode><Name>The HN Intramedullary Nail locking screw</Name><Description>The HN Intramedullary Nail locking screw, cannulated, dual-threaded</Description><Size>Length 16mm - 60mm, Diameter 3.0mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>223188</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN016</BillingCode><Name>Newclip Compression Screws</Name><Description>Self-compressive cannulated screw</Description><Size>2.71-4.49mm diameter, length 10-70mm</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>260234</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW452</BillingCode><Name>Fixos Screws</Name><Description>Bone Fixation Srews, Cannulated, Double Threaded</Description><Size>3.0mm-7.0mm diamter</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>269713</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM315</BillingCode><Name>Headless Compression Screws</Name><Description>Compression Screws</Description><Size>3.5mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>279795</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ175</BillingCode><Name>VAL Locking Screw</Name><Description>VAL Locking Screw</Description><Size>2.71mm - 4.49mm</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>429400</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI892</BillingCode><Name>NCB System</Name><Description>NCB Screws</Description><Size>4mm x 14-90mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>100337</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM052</BillingCode><Name>Ascension Compression Screw</Name><Description>Titanium Compression Screw</Description><Size>2-5mm diameter ; 12 - 40mm length</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>118626</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW974</BillingCode><PriorBillingCodes><PriorBillingCode>WR062</PriorBillingCode></PriorBillingCodes><Name>Headless Compression screws</Name><Description>Compression screw cannulated, titanium, self tapping, self drilling.</Description><Size>2.5-3.2mm diameter x 10-32mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>326629</ARTG><ARTG>198485</ARTG><ARTG>291613</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH190</BillingCode><Name>Headless Compression Screws</Name><Description>Headless Compression Screws</Description><Size>3mm-4mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>210290</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK256</BillingCode><Name>TwinFix Cannulated Compression Screw System</Name><Description>The Stryker TwinFix Cannulated Compression Screw System is intended to be used for fractures or arthrodesis.</Description><Size>Diameter 3.2mm, lengths 14-34mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>124318</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW915</BillingCode><PriorBillingCodes><PriorBillingCode>WR395</PriorBillingCode></PriorBillingCodes><Name>NexFix 3.0mm Compression Screw</Name><Description>The NexFix Compression Screw is a stainless steel, cannulated, self tapping, and self drilling fixation device for osteotomies, fusions and fracture fixation of small bones</Description><Size>3.0mm diameter x 10 - 34mm length in 2mm increments</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>148960</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW972</BillingCode><PriorBillingCodes><PriorBillingCode>WR034</PriorBillingCode></PriorBillingCodes><Name>Charlotte Foot &amp; Ankle System</Name><Description>Multi use compression screw, cannulated, stainless steel</Description><Size>3.0 &amp; 4.3mm dia. 10-60mm in 2mm increments</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH185</BillingCode><Name>Small / Large  Fragment Set</Name><Description>Bone Screw, Titanium</Description><Size>3.5 - 4.0mm diameter</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>153087</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW451</BillingCode><Name>Stryker Cannulated Compression Screw Systems</Name><Description>Double threaded compression screws</Description><Size>2.71mm to 4.49mm diameter</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>149535</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ038</BillingCode><PriorBillingCodes><PriorBillingCode>LM349</PriorBillingCode><PriorBillingCode>LM349</PriorBillingCode></PriorBillingCodes><Name>Orthopaedic Fixation Screw</Name><Description>Fixation Screw</Description><Size>2.71 to 4.49mm diameter all lengths</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>266217</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX054</BillingCode><Name>MBOSS-3.5 mm Meril Cancellous Screw system - Cancellous Screw, Self Tapping </Name><Description>Cancellous Screw</Description><Size>Length- 30- 90  </Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>286843</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK631</BillingCode><Name>Sbi Non-Locking Screws</Name><Description>Titanium Cortical Non-Locking Self tapping screws</Description><Size>2.7mm Cortical, Non Locking, Self-tapping 10 -30mm
2.7mm Lag, Non Locking, self tapping 10 -30mm
3.5mm Cortical, Non Locking,Self tapping 8 -20mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>167057</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW461</BillingCode><Name>Memometal Anchorage Bone Screws</Name><Description>Anchorage Locking Bone Screws</Description><Size>3.0 - 3.5mm diameter to 10 - 40mm in length</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>352530</ARTG><ARTG>352531</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK229</BillingCode><Name>Omega Plus Compression Hip Screw System</Name><Description>Cephalic Implants</Description><Size>Hansson Twin Hook Compression Screw 25mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>94876</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU313</BillingCode><Name>Low Profile Cancellous Screws, SS</Name><Description>Cancellous Screws</Description><Size>2.71mm-4.49mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>351000</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW814</BillingCode><PriorBillingCodes><PriorBillingCode>WR241</PriorBillingCode></PriorBillingCodes><Name>Stainless Steel Screw</Name><Description>Stainless steel plate screw, non locking</Description><Size>2.7 &amp; 3.2 dia. 8-50mm length in 2mm increments</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX010</BillingCode><Name>MBOSS 3.5 mm Cortex Screw</Name><Description>3.5 mm Cortex Screw, Self Tapping</Description><Size>Diameter: 3.5mm
Length: 10-150mm</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>286843</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA004</BillingCode><Name>ALPS Plating System &amp; DVR Plating System</Name><Description>Non-locking bone screw</Description><Size>2.7-4.0mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>209305</ARTG><ARTG>210296</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI940</BillingCode><Name>Screws - Standard</Name><Description>Standard Screws</Description><Size>10 - 70mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>140687</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ295</BillingCode><Name>Cannulated Low Profile Screws, Small</Name><Description>Cannulated Low Profile Screws, Small</Description><Size>4mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>284416</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ293</BillingCode><Name>Variable Angle Locking Screw</Name><Description>Stainless steel screw</Description><Size>Diameter 3.5mm, Length 10mm to 90mm</Size><SupplierCode>40482</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>433151</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST006</BillingCode><Name>Stryker Plating System</Name><Description>Cancelleous screws</Description><Size>2.7-4.0mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>119660</ARTG><ARTG>269713</ARTG><ARTG>139635</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM503</BillingCode><Name>Non-Locking Screws (Small)</Name><Description>Non-Locking Screws (Small)</Description><Size>2.71mm – 4.49mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>306780</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ193</BillingCode><Name>ARIX 3.5mm Non-Locking screws </Name><Description>3.5mm Non-Locking screws</Description><Size>3.5mm </Size><SupplierCode>40063</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>409165</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ202</BillingCode><Name>IBS - B Neutralization Screws</Name><Description>Titanium Headless Neutralisation Screws</Description><Size>3.3, 4.0 mm Neutralisation Screws, 16 - 60 mm</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>348714</ARTG></ARTGs><MinimumBenefit>178</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU144</BillingCode><Name>Non-Locking Cortical and Cancellous Screws, Small</Name><Description>Non-Locking Cortical and Cancellous Screws, Small</Description><Size>3-3.5mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>355042</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ145</BillingCode><Name>Bone Screws</Name><Description>Cortical, Cancellous, Self-tapping, Full Thread, Partial Thread, Standard, T15</Description><Size>3.5-4.0mm Diameter
10-70mm Length</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>191602</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW976</BillingCode><PriorBillingCodes><PriorBillingCode>WR218</PriorBillingCode></PriorBillingCodes><Name>Evolve Ortholoc EPS System 3.5 locking</Name><Description>Stainless Steel, Variable Angle Locking, Cortical &amp; Cancellous Screws</Description><Size>3.5mm Diameter, 10-60mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX011</BillingCode><Name>MBOSS 3.5mm Locking Screw</Name><Description>3.5mm Locking Screw, Self Tapping</Description><Size>Diameter: 3.5mm
Length: 10-95mm</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286843</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW966</BillingCode><PriorBillingCodes><PriorBillingCode>WR457</PriorBillingCode></PriorBillingCodes><Name>ORTHOLOC SPS Blunt-tipped Locking Screws </Name><Description>Stainless steel locking head screws, blunt tipped</Description><Size>Dia 3.5mm   Length: 18mm - 54mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>148960</ARTG></ARTGs><MinimumBenefit>102</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ027</BillingCode><PriorBillingCodes><PriorBillingCode>LM285</PriorBillingCode><PriorBillingCode>LM285</PriorBillingCode></PriorBillingCodes><Name>IBS Screw</Name><Description>Compression Screw</Description><Size>3.00 &amp; 3.5mm diameter</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>266217</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ050</BillingCode><Name>Valetis Screws</Name><Description>Titanium Cancellous Screws</Description><Size>3.5mm width, 10-80mm length
4.0mm width, 10-80mm length</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>284755</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ013</BillingCode><Name>Austofix Proximal Humeral Plating System - Austofix PHP Cancellous Screw</Name><Description>Cancellous Screw, Titanium</Description><Size>4mm 20-40mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>111818</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ077</BillingCode><Name>Cannulated Humeral Nail</Name><Description>Nail Locking Screw</Description><Size>4.0mm diameter  20mm to 50mm length</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>111818</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB063</BillingCode><Name>MCS</Name><Description>MCS System</Description><Size>2.71mm - 4.49mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>223188</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU185</BillingCode><Name>PAO Cortical Screw Ø3.5</Name><Description>Peri-Acetabular Osteotomy Cortical Screw</Description><Size>Ø3.5 L 20-140 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>219907</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ015</BillingCode><Name>Austofix Proximal Humeral Plating System - Austofix Cortical Screw</Name><Description>Cortical Screw, Titanium</Description><Size>3.5mm, 20-40mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>111818</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW054</BillingCode><Name>WEGO Trauma Systems</Name><Description>Small Bone Screw Systems</Description><Size>Small (2.71mm – 4.49mm)</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>324381</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO321</BillingCode><Name>Acumed Hexalobe Non Locking Screws</Name><Description>Acumed Hexalobe Non Locking Screws</Description><Size>3.0mm,3.5mm and 4.0mm diameter, 8-65mm length</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH675</BillingCode><Name>MUTARS Cancellous Screws</Name><Description>MUTARS Cancellous Screws</Description><Size>10-40mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>237075</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ292</BillingCode><Name>Cortical Bone Screw</Name><Description>Stainless steel bone screw</Description><Size>Diameter 3.5mm, Length 10mm to 90mm</Size><SupplierCode>40482</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>433151</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM143</BillingCode><Name>Extremity Medical Compression Screw System</Name><Description>Compression Screws</Description><Size>3.0-4.5mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>164980</ARTG></ARTGs><MinimumBenefit>362</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK452</BillingCode><Name>Stryker Plating System</Name><Description>Non-Locking Bone Screws (Small)</Description><Size>2.7mm - 4.5mm Diameter 8mm - 150mm Length</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>119660</ARTG><ARTG>340042</ARTG><ARTG>352530</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ070</BillingCode><PriorBillingCodes><PriorBillingCode>EF007</PriorBillingCode></PriorBillingCodes><Name>Bone Screw</Name><Description>Cortical Bone Screw</Description><Size>2.71mm – 4.49mm</Size><SupplierCode>40063</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>239817</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER394</BillingCode><Name>Paragon 28 Monster Screw System-Screws, small (2.71mm – 4.49mm)</Name><Description>Paragon 28 Monster Screw System-Screws, small, headed, with and without blunt tip, solid, recon/Tuffneck</Description><Size>dia (3.0-4.2 mm) x length (10-150 mm) x thread length (3-150 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>289308</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ055</BillingCode><Name>Valens Shoulder and Elbow - Screws</Name><Description>Cortex/Cancellous Screws</Description><Size>3.5mm, 4.0mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ020</BillingCode><PriorBillingCodes><PriorBillingCode>LM340</PriorBillingCode><PriorBillingCode>LM340</PriorBillingCode></PriorBillingCodes><Name>Bone Screws</Name><Description>Plate Fixation Bone Screws</Description><Size>2.71 to 4.49mm diameter  All lengths</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ176</BillingCode><Name>PediFoot Deformity Correction System  </Name><Description>3.5mm Cortical Screws</Description><Size>8-60mm length</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112122</SubGroupID><ARTGs><ARTG>191602</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI768</BillingCode><Name>Mandibular Fracture System</Name><Description>Screw, IMF 2./2.4 Mandibular Fracture, Titanium</Description><Size>2.0 x(5 - 13)mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>128459</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER397</BillingCode><Name>Paragon 28 Monster Screw System-Screws, mini (2.01 – 2.7 mm)</Name><Description>Paragon 28 Monster Screw System-Screws, mini, headed, with or without a blunt tip, recon/Tuffneck, Titanium</Description><Size>dia (2.5-2.7 mm) x length (10-100 mm) x length of thread (3-100 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>289308</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI179</BillingCode><Name>Zimmer Herbert/Whipple Bone Screw</Name><Description>Cannulated Double Threaded Compression Bone Screw</Description><Size>12 mm - 30 mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>DT</Suffix><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>247</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ043</BillingCode><Name>Mini Fragment - Screws</Name><Description>Locking Screws</Description><Size>2.4mm, 2.5mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ179</BillingCode><Name>PediFoot Deformity Correction System</Name><Description>2.7mm Variable Angle Locking Screws</Description><Size>6-60mm length</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>191602</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO435</BillingCode><Name>RibLoc Dual Locking Screw</Name><Description>Locking Screws</Description><Size>2.7mm diameter,6mm to 14mm length</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>158694</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM061</BillingCode><Name>Xpode Screws</Name><Description>Xpode screws</Description><Size>2.4mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT080</BillingCode><PriorBillingCodes><PriorBillingCode>OH515</PriorBillingCode></PriorBillingCodes><Name>KLS Martin Hand fracture system - multidirectional screw</Name><Description>Multidirectional screw</Description><Size>2.3mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>276650</ARTG><ARTG>276674</ARTG></ARTGs><ChangeExplanation>Change to Group benefit</ChangeExplanation><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO073</BillingCode><Name>APTUS Screws</Name><Description>Aptus Locking Screws</Description><Size>2.5mm Diameter</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>141171</ARTG></ARTGs><ChangeExplanation>Change to Group benefit</ChangeExplanation><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW977</BillingCode><PriorBillingCodes><PriorBillingCode>WR227</PriorBillingCode></PriorBillingCodes><Name>Titanium Screw</Name><Description>Locking, non-locking or cannulated, for use only with Darco titanium plates, self-tapping</Description><Size>8-40mm, 2.7mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW795</BillingCode><PriorBillingCodes><PriorBillingCode>WR081</PriorBillingCode></PriorBillingCodes><Name>Ortholoc Fracture System</Name><Description>Titanium, variable angle locking screws</Description><Size>2.4, 2.7mm diameter, 8-100mm length</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM313</BillingCode><Name>Volar Bearing Plate Screws</Name><Description>Volar Bearing Plate Screws</Description><Size>2.5mm x 10mm-30mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI201</BillingCode><Name>Zimmer Cortical Screws</Name><Description>Cortical Screws</Description><Size>6 - 50mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW901</BillingCode><PriorBillingCodes><PriorBillingCode>WR377</PriorBillingCode></PriorBillingCodes><Name>Mini MaxLock Extreme System - 2.4/2.7mm Locking Screws</Name><Description>Bone screws, Titanium, fixed or variable angle locking</Description><Size>Ø2.4/2.7mm Fixed angle locking, Length 6-40mm  Ø2.4mm Variable angle locking, Length 6-30mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>214671</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ042</BillingCode><PriorBillingCodes><PriorBillingCode>LM345</PriorBillingCode><PriorBillingCode>LM345</PriorBillingCode></PriorBillingCodes><Name>Orthopaedic Plate Fixation Screw</Name><Description>Orthopaedic Plate Fixation Screw</Description><Size>2.01 to 2.7 mm diameter
all lengths</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>266216</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI929</BillingCode><Name>RibFix/Sternalock</Name><Description>Screws Ti</Description><Size>2.4-2.7mm x 7-20mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>128459</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM185</BillingCode><Name>Trimed Locking Cortical Screws</Name><Description>Locking cortical screw</Description><Size>2.01 to 2.7mm diameter</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV008</BillingCode><Name>SternalPlate Closure System - Screws   </Name><Description>Titanium Sternal Fixation System</Description><Size>2.3mm  2.7mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>386783</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO369</BillingCode><Name>Acumed Tap-Loc</Name><Description>Tap screws, Tap-Loc Screws</Description><Size>2.7mm 36mm-60mm length</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ077</BillingCode><PriorBillingCodes><PriorBillingCode>EF026</PriorBillingCode></PriorBillingCodes><Name>Arix Locking Screw</Name><Description>Locking Screw</Description><Size>2.01 – 2.7 mm</Size><SupplierCode>40063</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>239817</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO320</BillingCode><Name>Acumed Hexalobe Locking Screws</Name><Description>Acumed Hexalobe Locking Screws</Description><Size>2.7mm diameter, 8-65mm length</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU315</BillingCode><Name>KreuLock Locking Compression Screws SS</Name><Description>Locking Compression Screw</Description><Size>2.7mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU298</BillingCode><Name>KreuLock Locking Compression Screws, Ti</Name><Description>Locking Compression Screws</Description><Size>2.4mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU355</BillingCode><Name>Mini Fragment System - 2.4mm VAL Screws</Name><Description>2.4mm Variable Angle Locking Screws for Bone Fixation</Description><Size>2.4mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>284416</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ147</BillingCode><Name>Bone Screws</Name><Description>Cortical, Locking, Self-tapping, Standard, T10,</Description><Size>2.7mm Diameter
5-60mm Length</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>191602</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO421</BillingCode><Name>ACUMED Hexalobe 2.3mm Multiscrews</Name><Description>ACUMED Hexalobe 2.3 Multiscrew</Description><Size>2.3mm in diameter, 5mm to 20mm in length</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ041</BillingCode><PriorBillingCodes><PriorBillingCode>LM344</PriorBillingCode><PriorBillingCode>LM344</PriorBillingCode></PriorBillingCodes><Name>Orthopaedic Plate Fixation Screw</Name><Description>Orthopaedic Plate Fixation Screw</Description><Size>2.01 to 2.7mm diameter
All lengths</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>266216</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM325</BillingCode><Name>Osteomed Screws</Name><Description>Bone Screw standard and threaded/lag.</Description><Size>2.01-2.7mm x 4-50mm.</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>202319</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER559</BillingCode><Name>Osteomed ExtremiLock Screw, Mini (2.01 – 2.7 mm), standard </Name><Description>Cortex screw</Description><Size>dia (2.4-2.7 mm) x lenth (8-40 mm) </Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>337240</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM552</BillingCode><Name>Skeletal Dynamics Bone Screw Non-Locking  </Name><Description>Non-Locking Cortical Bone Screws  </Description><Size>2.7mm diameter, 10 to 70mm length</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM111</BillingCode><Name>Ascension Radial Head Plate Screws</Name><Description>Ascension radial Head Plate Non-Locking Screws</Description><Size>2.7mm x 10-26mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>118625</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW903</BillingCode><PriorBillingCodes><PriorBillingCode>WR380</PriorBillingCode></PriorBillingCodes><Name>MaxLock Extreme System - 2.4/2.7mm Non locking screws</Name><Description>Bone screws, Titanium, Non locking</Description><Size>Ø 2.4/2.7mm, length 6-40mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>214671</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ034</BillingCode><PriorBillingCodes><PriorBillingCode>LM354</PriorBillingCode></PriorBillingCodes><Name>Non-Locking Screws</Name><Description>Non-Locking Screws</Description><Size>2.7mm diameter, multiple lengths</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>266216</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ203</BillingCode><Name>5MS 2.4 / 2.7 mm Locking Screws</Name><Description>2.4 / 2.7 mm Cortical Bone Screws Locking Titanium Type II Anodised </Description><Size>2.4 / 2.7 mm Diam x Length (8mm - 30mm)</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA006</BillingCode><Name>ALPS Plating System, DVR Plating System &amp; F3 Plating System</Name><Description>Non-locking bone screw</Description><Size>2.01-2.7mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>210296</ARTG><ARTG>209305</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ190</BillingCode><Name>DartFire Edge Screw System</Name><Description>Titanium Headless Cannulated Screws</Description><Size>2.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>295072</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ189</BillingCode><Name>DartFire Edge Screw System</Name><Description>Titanium Headed Cannulated Screws</Description><Size>2.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>295072</ARTG></ARTGs><MinimumBenefit>156</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ186</BillingCode><Name>DartFire Edge Screw System</Name><Description>Titanium Snap Off Screws</Description><Size>2.7mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>295072</ARTG></ARTGs><MinimumBenefit>295</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ180</BillingCode><Name>Skeletal Dynamics Bone Screw</Name><Description>Polyaxial locking cannulated screw</Description><Size>2.5mm x 10-30mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,LK</Suffix><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>177</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL045</BillingCode><Name>VLP EVOS</Name><Description>VAL Cortical Screws</Description><Size>Mini Screws (2.01 – 2.7 mm)</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ078</BillingCode><PriorBillingCodes><PriorBillingCode>EF029</PriorBillingCode></PriorBillingCodes><Name>Bone Screw</Name><Description>Cortical Bone Screw</Description><Size>2.01mm – 2.7mm</Size><SupplierCode>40063</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>239817</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO323</BillingCode><Name>Acumed Hexalobe Non Locking Screws</Name><Description>Acumed Hexalobe Non Locking Screws</Description><Size>2.7mm diameter,8-65mm length</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ148</BillingCode><Name>Bone Screws</Name><Description>Cortical Screw, Self-tapping, Standard, T10</Description><Size>2.7mm Diameter
5-60mm Length</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>191602</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW008</BillingCode><Name>WEGO Trauma Systems</Name><Description>Mini Bone Screw Systems</Description><Size>Mini (2.01 – 2.7 mm); lengths 5 - 70mm.</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>324381</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO375</BillingCode><Name>Acu-Loc Distal Radius Plate System</Name><Description>Threaded, non-threaded,locking, non-locking screw peg, titanium</Description><Size>2.3 mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ180</BillingCode><Name>PediFoot Deformity Correction System  </Name><Description>2.7mm Cortical Screw</Description><Size>6-60mm length</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>191602</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU347</BillingCode><Name>Mini Fragment System - 2.7mm Cortical Screws</Name><Description>Cortical Screws for Plate Fixation of Fracture</Description><Size>2.7mm x 6.0mm-15mm (1mm) Increments      2.7mm x 16mm-50mm (2mm) Increments      2.7mm x 55-80mm (5mm) Increments</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>284416</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO423</BillingCode><Name>ACUMED Hexalobe 2.3mm Lag screw</Name><Description>ACUMED Hexalobe 2.3mm Lag screw</Description><Size>2.3mm in diameter, 5mm to 20mm in length</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU147</BillingCode><Name>Mini Fragment System – Cortical Screws</Name><Description>Cortical Screw</Description><Size>2.4mm x (06-80mm)</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>351000</ARTG><ARTG>284416</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ096</BillingCode><Name>Mini Fragment Screws</Name><Description>Cortex/Cancellous Screws</Description><Size>2.4mm diameter,   6mm-60mm length </Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU146</BillingCode><Name>Cortical Screw</Name><Description>Screw for Bone fixation</Description><Size>2.01-2.7mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN082</BillingCode><Name>TC 100 </Name><Description>Cortical Screws</Description><Size>2.01mm - 2.7mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN833</BillingCode><Name>Peri-Loc &amp; Peri-Loc VLP</Name><Description>Cortical Screws</Description><Size>2.01-2.7mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY352</BillingCode><Name>A/ASIF Screw</Name><Description>Cortex, Cancellous, Compression Screws</Description><Size>2.01mm-2.7mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>157068</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB033</BillingCode><Name>Mini Locking System - Cortex Screw</Name><Description>Non locking screw</Description><Size>2.01mm - 2.7mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>223188</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Description, Size</ChangeExplanation><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO076</BillingCode><Name>APTUS Screws</Name><Description>Cortical Screws</Description><Size>2.3mm - 2.5mm Diameter</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>141171</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ077</BillingCode><PriorBillingCodes><PriorBillingCode>AE149</PriorBillingCode><PriorBillingCode>AE149</PriorBillingCode></PriorBillingCodes><Name>ASDM Clavicle Plating System - Screws</Name><Description>Fixation Device, Internal, Non-locking, Stainless Steel, Cortical Screw Size: 2.7mm</Description><Size>2.7mm Low-profile cortex screws, 10-30mm (2mm increments)</Size><SupplierCode>40480</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>134456</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN036</BillingCode><Name>Newclip Bone Screws</Name><Description>Non-locking Bone Screw</Description><Size>2.01-2.7mm diameter, lengths 8 - 34mm</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>260233</ARTG><ARTG>260234</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT082</BillingCode><PriorBillingCodes><PriorBillingCode>OH518</PriorBillingCode></PriorBillingCodes><Name>KLS Martin Hand fracture system - standard screw</Name><Description>Standard screw</Description><Size>2.3mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>276650</ARTG><ARTG>276674</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ251</BillingCode><Name>Colink 2.4 mm Low-Pro Non-Locking Screws</Name><Description>Low-profile Non-Locking Titanium Type II Anodised Screws 2.4 mm</Description><Size>2.4 mm Diam x Length (8mm - 24 mm)</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ250</BillingCode><Name>Colink 2.4 mm Locking Screws</Name><Description>Low-profile Locking Titanium Type II Anodised Screws 2.4 mm</Description><Size>2.4 mm Diam x Length (8mm - 24 mm)</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK618</BillingCode><Name>Percufix</Name><Description>Titanium</Description><Size>Diameter: 2-2.5mm, Length 22-40mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>252452</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM474</BillingCode><Name>TriMed ASET Foot Plating System </Name><Description>Cortical Bone Screws (mini)</Description><Size>2.01 to 2.7mm diameter</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM144</BillingCode><Name>TriMed Bone Screw</Name><Description>Non-Locking Cortical Bone Screws</Description><Size>2.3mm - 2.7mm x 7mm - 32mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>182677</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ204</BillingCode><Name>5MS 2.4 / 2.7 mm Non-Locking Screws</Name><Description>2.4 / 2.7 mm Cortical Bone Screws Non-Locking Titanium Type II Anodised </Description><Size>2.4 / 2.7 mm Diam x Length (8mm - 30 mm)</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT088</BillingCode><PriorBillingCodes><PriorBillingCode>OH639</PriorBillingCode></PriorBillingCodes><Name>KLS Martin - Radial Plating Sysem</Name><Description>smartDrive Locking Screw</Description><Size>2.5 x 8-30mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>276650</ARTG><ARTG>276674</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BU029</BillingCode><Name>CentroLock Screws</Name><Description>CentroLock Screw System</Description><Size>smaller than 2.7mm</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>235767</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN969</BillingCode><Name>Peri-Loc VLP</Name><Description>VAL Locking Screws 2.01mm - 2.7mm</Description><Size>2.01mm - 2.7mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN968</BillingCode><Name>Peri-Loc</Name><Description>Locking screws</Description><Size>2.01mm - 2.7mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL042</BillingCode><Name>VLP EVOS</Name><Description>VAL Locking Screws</Description><Size>Mini Screws (2.01 – 2.7 mm)</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL221</BillingCode><PriorBillingCodes><PriorBillingCode>IG126</PriorBillingCode></PriorBillingCodes><Name>Surfix Locking Screws</Name><Description>Locking screws with an independent lock-screw head</Description><Size>2.7mm, 10 - 24mm length</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>173963</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY651</BillingCode><Name>AO/ASIF Cortex Screws</Name><Description>Locking Head Screws</Description><Size>2.4mm-2.7mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157068</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JD007</BillingCode><Name>CarboFix Piccolo Plate Systems – Locking Screws: Mini</Name><Description>Titanium alloy screws (locking) for fixation of CarboFix plate shaft and head.</Description><Size>Locking Proximal Screw 2.5mm x 14mm, 16mm, 18mm, 20mm, 22mm, 24mm, 26mm

Locking Screw 2.7mm x 10mm, 12mm, 14mm, 16mm, 18mm, 20mm, 22mm, 24mm</Size><SupplierCode>40214</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>222648</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ228</BillingCode><Name>Colink 2.7 Variable Angle Locking Screws</Name><Description>Variable Angle Locking Titanium Type II Anodised Screws 2.7 mm</Description><Size>2.7 mm Diam x Length (8 - 60 mm)</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL030</BillingCode><Name>D-RAD SMART PACK</Name><Description>VAL Locking screws 2.01mm - 2.7mm</Description><Size>2.01mm - 2.7mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB020</BillingCode><Name>Calcaneal Locking Plate MIPO System - Locking Screw</Name><Description>Locking Screws</Description><Size>Mini (2.01mm-2.7mm)</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>223188</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN041</BillingCode><Name>Newclip Locking Bone Screws</Name><Description>Locking Bone Screw</Description><Size>2.01 - 2.7mm diameter, lengths 8 - 34mm</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>260233</ARTG><ARTG>260234</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU145</BillingCode><Name>Low Profile Locking Screws</Name><Description>Locking screws for Arthrex Fracture Plate Fixation</Description><Size>2.01mm to 2.7mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ054</BillingCode><Name>Valens Shoulder and Elbow - Screws</Name><Description>Self-Tapping Locking Screws</Description><Size>2.4mm, 2.7mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO394</BillingCode><Name>RibLoc rib fracture plating system screws</Name><Description>RibLoc Screws</Description><Size>Mini 2.01-2.7mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>158694</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ010</BillingCode><Name>VRP Distal Radius Fixation System</Name><Description>VRP Distal Radius Fixation System, Variable Angle, Threaded, non-threaded, partially threaded locking, non-locking screw, peg, titanium</Description><Size>2.5-2.7mm diameter, 10-34mm length</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>149433</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO376</BillingCode><Name>Acu-Loc Distal Radius Plate System</Name><Description>Locking screws</Description><Size>2.01-2.7mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ074</BillingCode><Name>Austofix PHP - Proximal Humeral Plating System</Name><Description>Locking Screws</Description><Size>2.7mm diameter, 16-70mm length</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW039</BillingCode><Name>WEGO Trauma Systems</Name><Description>Mini Bone Screw Systems</Description><Size>Mini (2.01 – 2.7 mm)</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324381</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU348</BillingCode><Name>Mini Fragment System - VAL Screws</Name><Description>Variable Angle Locking Screws for Plate Fixation of Fracture</Description><Size>2.7mm x 6.0mm-15mm (1mm) Increments      2.7mm x 16mm-50mm (2mm) Increments      2.7mm x 55mm-80mm (5mm) Increments</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>284416</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ227</BillingCode><Name>Colink 2.7 Low-Pro Non-Locking Screws</Name><Description>Low-profile Non-Locking Titanium Type II Anodised Screws 2.7 mm</Description><Size>2.7 mm Diam x Length (8 - 50 mm)</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JD002</BillingCode><Name>CarboFix Piccolo Plate Systems – Non-Locking Screws: Mini</Name><Description>Titanium alloy screws (non-locking) for fixation of CarboFix plate shaft and head.</Description><Size>Non-Locking Proximal Screw 2.5mm x 14mm, 16mm, 18mm, 20mm, 22mm, 24mm, 26mm

Non-Locking Screw 2.7mm x 12mm, 14mm, 16mm, 18mm, 20mm, 22mm, 24mm</Size><SupplierCode>40214</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>222648</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK103</BillingCode><Name>Stryker Plating System</Name><Description>Non-Locking Screws </Description><Size>2.01-2.7mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>119660</ARTG><ARTG>258002</ARTG><ARTG>340043</ARTG><ARTG>352531</ARTG><ARTG>269713</ARTG><ARTG>340044</ARTG><ARTG>352530</ARTG><ARTG>357433</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM319</BillingCode><Name>Screws</Name><Description>Non Locking</Description><Size>2.01 - 2.7mm diameter
all lengths</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW454</BillingCode><Name>Fixos Screws, Cannulated, Double Threaded, 2.5mm</Name><Description>Done Fixation Screws, Cannulated Threaded, 2.5mm</Description><Size>2.5mm  diameter, 10 to 30 (each 2mm)</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>149535</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KO010</BillingCode><PriorBillingCodes><PriorBillingCode>LM396</PriorBillingCode></PriorBillingCodes><Name>Headless Compression Screw</Name><Description>Headless Compression Screw</Description><Size>2.01 – 2.7 mm</Size><SupplierCode>40387</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>329613</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ039</BillingCode><PriorBillingCodes><PriorBillingCode>LM348</PriorBillingCode><PriorBillingCode>LM348</PriorBillingCode></PriorBillingCodes><Name>Orthopaedic Fixation Screw</Name><Description>Fixation Screw</Description><Size>2.01 to 2.7mm all lengths</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>266217</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM314</BillingCode><Name>Headless Compression Screws</Name><Description>Compression Screws</Description><Size>2.5mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>279795</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM320</BillingCode><Name>Screws</Name><Description>Screws, Locking</Description><Size>2.01 to 2.7mm diameter</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT104</BillingCode><Name>L1® Rib Screws</Name><Description>Rib Osteosynthesis Screws</Description><Size>2.3mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>276650</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ284</BillingCode><Name>Variable Angle Locking Screw Diameter 2.5mm</Name><Description>Variable Angle Locking Screw</Description><Size>10mm to 30mm</Size><SupplierCode>40482</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>433151</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO115</BillingCode><Name>APTUS headedCCS</Name><Description>Headed Cannulated screws</Description><Size>&gt;2.01mm-2.7mm</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>206157</ARTG></ARTGs><MinimumBenefit>156</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL028</BillingCode><Name>D-RAD SMART PACK</Name><Description>Cortical screws</Description><Size>2.01 mm - 2.7 mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW822</BillingCode><PriorBillingCodes><PriorBillingCode>WR255</PriorBillingCode></PriorBillingCodes><Name>Evolve EPS System Non-Locking</Name><Description>Stainless Steel Cortical Screws</Description><Size>2.5 - 2.7mm Diameter, 10-50mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT090</BillingCode><PriorBillingCodes><PriorBillingCode>OH641</PriorBillingCode></PriorBillingCodes><Name>KLS Martin - Radial Plating System</Name><Description>smartDrive Screw</Description><Size>2.5 x 8-30mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>276674</ARTG><ARTG>276650</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX029</BillingCode><Name>ARMAR 2.4 Locking Distal Radial Plate System - Cortex and Compression Screws</Name><Description>TAN Cortex and Compression Screws</Description><Size>2.4-2.7mm Diameter
6-60mm Length</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>286843</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW916</BillingCode><PriorBillingCodes><PriorBillingCode>WR396</PriorBillingCode></PriorBillingCodes><Name>NexFix 2.5mm Compression Screw</Name><Description>The NexFix Compression Screw is a stainless steel, cannulated, self tapping, and self drilling fixation device for osteotomies, fusions and fracture fixation of small bones</Description><Size>2.5mm diameter x 10 - 34mm length in 2mm increments</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>291613</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF122</BillingCode><Name>2.5 mm Speyside B Screw</Name><Description>Speyside B Screw</Description><Size>2.5mm length 10 up to 2.5mm length 26mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HJ005</BillingCode><Name>MICRO HBS Self-Drilled High Compression Screw</Name><Description>Micro headless compression screw, cannulated, dual threads, self-drilling, self- tapping, </Description><Size>Distal thread Diameter 2.5mm, Length 10-30mm</Size><SupplierCode>40478</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>340314</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HJ002</BillingCode><Name>Surgifeet Cannulated Compression Screw</Name><Description>Compression screw. Cannulated, Dual thread, self drilling/tapping, Headless</Description><Size>Diameter 2.55mm. Length 10-34mm, Left or Right thread.</Size><SupplierCode>40478</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>336654</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY646</BillingCode><Name>AO/ASIF Screws</Name><Description>HCS Countersinkable Compression Screw</Description><Size>2.01mm-2.7mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>297881</ARTG><ARTG>157068</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF088</BillingCode><Name>Speyside HVS Bone Screw</Name><Description>Self drilling, self threading double threaded cannulated screw</Description><Size>Length 10-34mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BU018</BillingCode><Name>MAGNEZIX CS 2.7</Name><Description>Compression screw for bone fixation.</Description><Size>Diameter 2.7mm
Length 10 - 34mm</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>283491</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BU010</BillingCode><Name>Nexis osteosynthesis screws</Name><Description>Bone screw titanium alloy (compressive)</Description><Size>Diameter 2.3mm, Length 10-30mm</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>235765</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC062</BillingCode><Name>HVS BONE SCREW</Name><Description>Self drilling, self threading double threaded cannulated screw</Description><Size>Length 10-34mm</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>173930</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN018</BillingCode><Name>Newclip Compression Screws</Name><Description>Self-Compressive Cannulated Screws</Description><Size>2.01mm - 2.7mm diameter, length 10 - 38mm</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>260233</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ283</BillingCode><Name>Cortical Screw Diameter 2.5mm</Name><Description>Cortical Screw</Description><Size>10mm to 30mm</Size><SupplierCode>40482</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>433151</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI921</BillingCode><Name>Twistoff Screws</Name><Description>Twistoff Screws</Description><Size>2.7mm x 8mm-24mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>210296</ARTG></ARTGs><MinimumBenefit>295</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW830</BillingCode><PriorBillingCodes><PriorBillingCode>WR284</PriorBillingCode></PriorBillingCodes><Name>EOS Footset - Entos</Name><Description>Footscrew</Description><Size>11-14mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>214803</ARTG></ARTGs><MinimumBenefit>295</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF007</BillingCode><Name>Forefoot Snap off Screws</Name><Description>Titanium Alloy Screws with Snap-off Grip</Description><Size>Weil self tapping L9 - L15</Size><SupplierCode>40106</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>141164</ARTG></ARTGs><MinimumBenefit>295</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW922</BillingCode><PriorBillingCodes><PriorBillingCode>WR402</PriorBillingCode></PriorBillingCodes><Name>NexFix Snap-Off Screw</Name><Description>The NexFix Snap-Off Screw System is a self-drilling and self-tapping screw system for fixation of fractures, fusions and osteotomies. The design allows the holding device to break off once the screw head is in contact with the distal cortex.</Description><Size>2.0mm x 11mm, 2.0mm x 12mm, 2.0mm x 13mm, 2.7mm x 13mm, 2.7mm x 15mm, 2.7mm x 17 mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>148960</ARTG></ARTGs><MinimumBenefit>295</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BP028</BillingCode><Name>Tyber Medical Trauma headless screw</Name><Description>Headless trauma screw for compression and fixation of bone Sterile or Non sterile, Titanium or stainless steel</Description><Size>2.5mm</Size><SupplierCode>40061</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>324189</ARTG><ARTG>324190</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK007</BillingCode><PriorBillingCodes><PriorBillingCode>UQ006</PriorBillingCode></PriorBillingCodes><Name>ExtremiFix Screws</Name><Description>Headless Cannulated Compression Screw</Description><Size>Diameter 2.0mm, 2.4mm. Length 10mm to 52mm; Diameter 2.01mm - 2.7mm</Size><SupplierCode>40456</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>130509</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL224</BillingCode><PriorBillingCodes><PriorBillingCode>IG133</PriorBillingCode></PriorBillingCodes><Name>Snap-Off screws</Name><Description>Titanium break-off barrel screws for Hallu-Fix</Description><Size>Diameter 2.7mm; length 10-34mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>173932</ARTG></ARTGs><MinimumBenefit>295</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF117</BillingCode><Name>Speyside TWIST-OFF SCREW</Name><Description>11 mm TWIST-OFF SCREW2.5MM Cancellous thread
12 mm TWIST-OFF SCREW2.5MM Cancellous thread
13 mm TWIST-OFF SCREW2.5MM Cancellous thread
14 mm TWIST-OFF SCREW2.5MM Cancellous thread
15 mm TWIST-OFF SCREW2.5MM Cancellous thread
17 mm TWIST-OFF SCREW2.5MM Cancellous thread
TWIST-OFF SCREWS10mm (1.5mm Shank)
TWIST-OFF SCREWS11mm (1.5mm Shank)
TWIST-OFF SCREWS12mm (1.5mm Shank)
TWIST-OFF SCREWS13mm (1.5mm Shank)
TWIST-OFF SCREWS14mm (1.5mm Shank)
TWIST-OFF SCREWS15mm (1.5mm Shank)
TWIST-OFF SCREWS16mm (1.5mm Shank)
TWIST-OFF SCREWS17mm (1.5mm Shank)
TWIST-OFF SCREWS18mm (1.5mm Shank)
TWIST-OFF SCREWS10, 11, 12, 13, 14, 15, 16, 17, 18mm</Description><Size>10-18mm (1.5mm shank) 10-18mm, 11-17mm (cancellous thread)</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>295</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU344</BillingCode><Name>Snap-Off Compression FT Pins 2.4mm</Name><Description>Snap-Off Compression pins for fusion and fracture fixation</Description><Size>2.4mm Diameters</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>350672</ARTG></ARTGs><MinimumBenefit>295</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB049</BillingCode><Name>Break-Off Screws</Name><Description>A self-breaking, self-drilling screw used for the fixation of small bone osteotomies and fractures</Description><Size>Diameter 2.0mm, Length 10-20mm
Diameter 2.7mm, Length 10-20mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>223188</ARTG></ARTGs><MinimumBenefit>295</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN039</BillingCode><Name>Newclip Snap-off Screws</Name><Description>Snap-off screws</Description><Size>2.01 – 2.7 mm</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>260233</ARTG><ARTG>260234</ARTG></ARTGs><MinimumBenefit>295</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ045</BillingCode><PriorBillingCodes><PriorBillingCode>LM352</PriorBillingCode></PriorBillingCodes><Name>Snap Off Screws</Name><Description>Snap Off Screws</Description><Size>2.01 to 2.7mm diameter</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>266217</ARTG></ARTGs><MinimumBenefit>295</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO057</BillingCode><Name>Aptus CCS</Name><Description>2.01 - 2.7 Cannulated Compression Screw</Description><Size>(2.01 – 2.7 mm) diameter</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>206157</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN049</BillingCode><Name>Screws 2.01 - 2.7 CN</Name><Description>Mini screws 2.01-2.7  CN</Description><Size>2.01mm – 2.7mm diameter, length 14-50 mm</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>260233</ARTG><ARTG>260234</ARTG></ARTGs><MinimumBenefit>156</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BP027</BillingCode><Name>Tyber Medical Trauma headed screw</Name><Description>Headed trauma screw for compression and fixation of bone  Sterile or Non sterile, Titanium or stainless steel</Description><Size>2.5mm</Size><SupplierCode>40061</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>324189</ARTG><ARTG>324190</ARTG></ARTGs><MinimumBenefit>156</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK006</BillingCode><PriorBillingCodes><PriorBillingCode>UQ005</PriorBillingCode></PriorBillingCodes><Name>OsteoMed Plating &amp; Fixation System</Name><Description>Screws - Cannulated Lag</Description><Size>Diameter 2.01 – 2.7 mm</Size><SupplierCode>40456</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>130509</ARTG></ARTGs><MinimumBenefit>156</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO356</BillingCode><Name>Acutrak 2</Name><Description>Headless compression screw</Description><Size>2.5mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU152</BillingCode><PriorBillingCodes><PriorBillingCode>DE479</PriorBillingCode></PriorBillingCodes><Name>Headless Compression Screw System</Name><Description>Headless Compression Screw for bone fixation</Description><Size>2.5mm Diameter x (8-34mm Length)</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>350672</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH475</BillingCode><Name>DynafitSystem</Name><Description>Self-compressive screws</Description><Size>2.6mm x 10-40mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>216161</ARTG><ARTG>216162</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU159</BillingCode><PriorBillingCodes><PriorBillingCode>DE465</PriorBillingCode></PriorBillingCodes><Name>Compression FT</Name><Description>Headless Compression Screw for bone fixation</Description><Size>2.5mm x 8-50mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>351000</ARTG><ARTG>350871</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ070</BillingCode><Name>Austofix Cannulated Compression Screws</Name><Description>2.4mm Headless Cannulated Compression Screws</Description><Size>2.4mm diameter
10-30mm length</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW908</BillingCode><PriorBillingCodes><PriorBillingCode>WR385</PriorBillingCode></PriorBillingCodes><Name>MaxTorque Cannulated Screw System - Mini Cannulated Screws</Name><Description>Bone screws, Titanium, Cannulated, Short or Long Thread</Description><Size>Ø2.5mm Short Thread, Length 18-30mm  Ø2.5mm Long Thread, Length 10-30mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>214671</ARTG></ARTGs><MinimumBenefit>156</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW815</BillingCode><PriorBillingCodes><PriorBillingCode>WR243</PriorBillingCode></PriorBillingCodes><Name>Charlotte Claw Locking Screws</Name><Description>2.7mm stainless steel locking screws for use with Claw Plate</Description><Size>2.7mm, 12-36mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM476</BillingCode><Name>TriMed ASET Foot Plating System </Name><Description>VA Locking Screw (Mini)</Description><Size>2.01 – 2.7 mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW831</BillingCode><PriorBillingCodes><PriorBillingCode>WR285</PriorBillingCode></PriorBillingCodes><Name>EOS Footset-Pyxis</Name><Description>Footscrew</Description><Size>11-28mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>291613</ARTG></ARTGs><MinimumBenefit>156</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW818</BillingCode><PriorBillingCodes><PriorBillingCode>WR246</PriorBillingCode></PriorBillingCodes><Name>Headed Compression Screw System</Name><Description>Cannulated compression screws - titanium or stainless steel</Description><Size>2.0-2.7mm x 10-50mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>156</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR095</BillingCode><Name>Stryker Cannulated Screw System</Name><Description>Asnis Micro Cannulated Screw</Description><Size>2.01mm-2.7mm, Diameters, 8mm-40mm lengths</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>155633</ARTG></ARTGs><MinimumBenefit>156</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER399</BillingCode><Name>Paragon 28 Monster Screw System-Screws, mini (2.01 – 2.7 mm), cannulated</Name><Description>Paragon 28 Monster Screw System-Screws, mini, cannulated, partially or fully threaded</Description><Size>dia 2.5mm x length (10-100 mm) x length of thread (3-100 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>289308</ARTG></ARTGs><MinimumBenefit>156</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KO005</BillingCode><PriorBillingCodes><PriorBillingCode>LM392</PriorBillingCode></PriorBillingCodes><Name>Cannulated Screws</Name><Description>Cannulated Screws</Description><Size>2.01 mm – 2.70 mm diameter</Size><SupplierCode>40387</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>329613</ARTG></ARTGs><MinimumBenefit>156</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY321</BillingCode><Name>AO/ASIF Screw</Name><Description>Cannulated screw</Description><Size>2.4mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>157068</ARTG></ARTGs><MinimumBenefit>156</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN970</BillingCode><Name>Cannulated Screw</Name><Description>Stainless Steel</Description><Size>2.01mm - 2.7mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>156</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM112</BillingCode><Name>Ascension Radial Head Plate Screws</Name><Description>Ascension Radial Head Plate Locking Screws</Description><Size>2.7mm x 10mm - 40mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>118625</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX028</BillingCode><Name>ARMAR 2.4 Locking Distal Radial Plate System - Self Tapping Locking Screws</Name><Description>TAN Self Tapping Locking Screws</Description><Size>2.4-2.7mm Diameter
6-60mm Length</Size><SupplierCode>40179</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>286843</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER560</BillingCode><Name>Osteomed ExtremiLock Screw, Mini (2.01 – 2.7 mm), variable angle locking</Name><Description>Variable angle locking screws, fully or partially threaded</Description><Size>dia (2.4-2.7 mm) x length (8-40 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>337240</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK527</BillingCode><Name>Stryker Locking Plate System</Name><Description>Locking Screws</Description><Size>2.01-2.7mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>340044</ARTG><ARTG>352530</ARTG><ARTG>357433</ARTG><ARTG>119660</ARTG><ARTG>258002</ARTG><ARTG>340043</ARTG><ARTG>352531</ARTG><ARTG>269713</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ128</BillingCode><PriorBillingCodes><PriorBillingCode>LM353</PriorBillingCode></PriorBillingCodes><Name>Locking Screws</Name><Description>Locking Screws</Description><Size>2.7mm diameter, multiple lengths</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>266216</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER426</BillingCode><Name>Paragon 28 Gorilla Plating System-Screws, mini</Name><Description>Paragon 28 Gorilla Plating System-Screws, mini, locking; recon/Tuffneck/baby</Description><Size>dia (2.5-2.7 mm) x length (8-50 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>289308</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT089</BillingCode><PriorBillingCodes><PriorBillingCode>OH640</PriorBillingCode></PriorBillingCodes><Name>KLS Martin - Radial Plating Sysem</Name><Description>smartDrive Locking Screws</Description><Size>3.0 x 8-30mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>276674</ARTG><ARTG>276650</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM551</BillingCode><Name>Skeletal Dynamics Bone Screw Locking  </Name><Description>Bone Screw Locking  </Description><Size>2.7mm diameter, 10 to 70mm length</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA007</BillingCode><Name>ALPS Plating System, DVR Plating System &amp; F3 Plating System</Name><Description>Locking titanium and multidirectional bone screws</Description><Size>2.2-2.7mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>209305</ARTG><ARTG>210296</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ019</BillingCode><PriorBillingCodes><PriorBillingCode>LM284</PriorBillingCode><PriorBillingCode>LM284</PriorBillingCode></PriorBillingCodes><Name>Bone Screw</Name><Description>Bone Screw</Description><Size>2.01-2.7mm diameter</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>266217</ARTG></ARTGs><MinimumBenefit>156</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ175</BillingCode><Name>Cannulated Screws</Name><Description>Cannulated, Short, Medium, Full Thread</Description><Size>2.5mm Diameter 8-30mm Length</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>191602</ARTG></ARTGs><MinimumBenefit>156</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN068</BillingCode><Name>Cannulated Locking Screws</Name><Description>Cannulated Locking Screws</Description><Size>2.01 – 2.7 mm diameter</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,LK</Suffix><ARTGs><ARTG>260234</ARTG><ARTG>260233</ARTG></ARTGs><MinimumBenefit>177</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO437</BillingCode><Name>Acu-Loc Distal Radius Plating System</Name><Description>Frag-Loc Cannulated Compression Screw with Compression Sleeve</Description><Size>Standard 16mm to 24mm,Long 20mm to 28mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,LK</Suffix><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>177</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW698</BillingCode><PriorBillingCodes><PriorBillingCode>WR035</PriorBillingCode></PriorBillingCodes><Name>Charlotte Foot &amp; Ankle System</Name><Description>Snap-off screws, titanium alloy</Description><Size>2.0 dia 11, 12, 14mm. 2.7 dia 13, 15, 17mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>326629</ARTG><ARTG>198485</ARTG></ARTGs><MinimumBenefit>295</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER398</BillingCode><Name>Paragon 28 Monster Screw System-Screw, mini (2.01 – 2.7 mm), breakoff</Name><Description>Paragon 28 Monster Bite screw, mini, snap-off, 1/2 threaded, Titanium</Description><Size>dia 2.7mm x length (8-24 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>289308</ARTG></ARTGs><MinimumBenefit>295</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT036</BillingCode><Name>Integrant 2.5 mm Screw</Name><Description>2.5 mm Cannulated Screw</Description><Size>8, 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30, 32, 34, 36 mm lengths</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>230954</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER547</BillingCode><Name>Osteomed ExtremiLock Screw, Mini (2.01 – 2.7 mm), variable angle locking, cannulated, dual thread</Name><Description>variable angle locking screw, cannulated, dual thread</Description><Size>dia 2.4 mm x lenght (12-40 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>337240</ARTG></ARTGs><ChangeExplanation>Change to Group benefit</ChangeExplanation><MinimumBenefit>431</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB042</BillingCode><Name>Compression Screws</Name><Description>Headless Compression Screws</Description><Size>less than 2.4mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>223188</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM132</BillingCode><Name>TriMed Compression Screws</Name><Description>Compression Screws</Description><Size>2.0mm – 2.5mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>229704</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM312</BillingCode><Name>Skeletal Dynamics Peg High Compression Locking</Name><Description>High Compression Locking Peg</Description><Size>2.7mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER400</BillingCode><Name>Paragon 28 Monster Screw System-Screws, mini (2.01 – 2.7 mm), cannulated, dual thread, locking</Name><Description>Paragon 28 Monster Screw System-screws, mini, cannulated, dual thread, locking, headless, partially threaded, Titanium</Description><Size>dia 2.5 mm x length (8-100 mm) x length of thread (3-32 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>289308</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO373</BillingCode><Name>Acutrak fusion Screws</Name><Description>Fusion Screws Titanium</Description><Size>2.01mm - 2.7mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>DT</Suffix><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>247</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH476</BillingCode><Name>DynafitSystem</Name><Description>Compressive Screws</Description><Size>2.4/2.6mm - 10x40mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>DT</Suffix><ARTGs><ARTG>216162</ARTG><ARTG>216161</ARTG></ARTGs><MinimumBenefit>247</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK620</BillingCode><Name>AutoFIX</Name><Description>The SBi AutoFIX Twin Pitch Cannulated Compression Screw System implants are indicated in the treatment of fractures, nonunions, pseudarthrosis and degenerative changes, as well as corrective osteotomies geared towards a functionally stable osteosynthesis</Description><Size>2.0mm and 2.5mm Cannulated Compression Screw</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><ARTGs><ARTG>119660</ARTG></ARTGs><ChangeExplanation>Change to Group benefit</ChangeExplanation><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH241</BillingCode><Name>Headless Compression Screws</Name><Description>Headless Compression Screws</Description><Size>2.5mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>210296</ARTG><ARTG>209305</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ028</BillingCode><PriorBillingCodes><PriorBillingCode>LM283</PriorBillingCode><PriorBillingCode>LM283</PriorBillingCode></PriorBillingCodes><Name>IBS Screw</Name><Description>Compression Screw</Description><Size>2.5mm diameter</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>266216</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM324</BillingCode><Name>Osteomed Screws</Name><Description>Bone Screws</Description><Size>2- 2.7m x 6-38mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>202319</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ226</BillingCode><Name>Colink 2.7 Low-Pro Locking Screws</Name><Description>Low-profile Locking Titanium Type II Anodised Screws 2.7 mm</Description><Size>2.7 mm Diam x Length (8 - 50 mm)</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>338649</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM327</BillingCode><Name>Osteomed Screws</Name><Description>Cannulated Compression Screws</Description><Size>Diameter 2.0mm, 2.4mm and 2.7mm. Length 6mm to 52mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112123</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>202319</ARTG></ARTGs><MinimumBenefit>348</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER401</BillingCode><Name>Paragon 28 Monster Screw System-Screws, micro (≤ 2.0mm)</Name><Description>Paragon 28 Monster Screw System-Screws, micro, headed, blunt tip, solid, partially or fully threaded</Description><Size>dia 2.0 mm x length (8-100 mm) x length of thread (3-100 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><ARTGs><ARTG>289308</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU278</BillingCode><Name>Low Profile Screws, Cortical</Name><Description>Cortical Screws</Description><Size>1.0mm - 2.0mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO422</BillingCode><Name>ACUMED Hexalobe 1.5mm Lag Screws</Name><Description>ACUMED Hexalobe 1.5mm Lag Screw</Description><Size>1.5mm in diameter, 5mm to 20mm in length</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ072</BillingCode><PriorBillingCodes><PriorBillingCode>EF015</PriorBillingCode></PriorBillingCodes><Name>Bone Screw</Name><Description>Cortical Bone Screw</Description><Size>≤ 2.0mm</Size><SupplierCode>40063</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><ARTGs><ARTG>239817</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN262</BillingCode><Name>AO/ASIF Screws</Name><Description>Quick Insertion Screws, Twist-Off</Description><Size>2.0mm x 11-18mm lengths</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>157068</ARTG><ARTG>297881</ARTG></ARTGs><MinimumBenefit>273</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ185</BillingCode><Name>DartFire Edge Screw System</Name><Description>Titanium Snap Off Screws</Description><Size>2.0MM</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>295072</ARTG></ARTGs><MinimumBenefit>273</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ187</BillingCode><Name>DartFire Edge Screw System</Name><Description>Titanium Headed Cannulated Screws</Description><Size>2.0mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>295072</ARTG></ARTGs><MinimumBenefit>180</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ188</BillingCode><Name>DartFire Edge Screw System</Name><Description>Titanium Headless Cannulated Screws</Description><Size>2.0mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>295072</ARTG></ARTGs><MinimumBenefit>346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW919</BillingCode><PriorBillingCodes><PriorBillingCode>WR399</PriorBillingCode></PriorBillingCodes><Name>NexFix Compression Pin</Name><Description>The NexFix Compression Pin is a tapered stainless steel compression pin for use in maintaining alignment and providing interfragmentary compression of small bones in osteotomies, fusions and fractures until a stable bony union occurs. It is self drilling </Description><Size>2.0mm x 10mm, 2.0mm x 12mm, 2.0mm x 14mm, 2.0mm x 16mm, 2.7mm x 20mm, 2.7mm x 24mm, 3.5mm x 25mm, 3.5mm x 30mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>DT</Suffix><ARTGs><ARTG>132072</ARTG></ARTGs><MinimumBenefit>200</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH544</BillingCode><Name>Dynafit System</Name><Description>Compressive Screw</Description><Size>2.0mm x 10-14mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>DT</Suffix><ARTGs><ARTG>216161</ARTG><ARTG>216162</ARTG></ARTGs><MinimumBenefit>200</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO367</BillingCode><Name>Acumed Fixation Screw</Name><Description>Acutrak Compression Screw Titanium</Description><Size>≤2mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>Breakoff, DT</Suffix><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>404</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH545</BillingCode><Name>Dynafit System</Name><Description>Snap Off, Compressive Screws</Description><Size>2.0mm x 10-14mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>Breakoff, DT</Suffix><ARTGs><ARTG>216161</ARTG><ARTG>216162</ARTG></ARTGs><MinimumBenefit>404</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO090</BillingCode><Name>APTUS SpeedTip C-Snap System</Name><Description>APTUS SpeedTip C-Snap Screws</Description><Size>2.0mm diameter</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>206157</ARTG></ARTGs><ChangeExplanation>Change to Group benefit</ChangeExplanation><MinimumBenefit>273</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL044</BillingCode><Name>VLP EVOS</Name><Description>VAL Locking Screws</Description><Size>Micro Screws (≤ 2.0mm)</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN064</BillingCode><Name>Newclip Locking Screws</Name><Description>VAL Locking screws</Description><Size>≤2.0 mm diameter, length 08-30 mm</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>260233</ARTG><ARTG>260234</ARTG></ARTGs><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB034</BillingCode><Name>Mini Locking System - Locking Screw, Stardrive, Self Tapping</Name><Description>Locking Screws</Description><Size>1.5mm &amp; 2mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>223188</ARTG></ARTGs><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY650</BillingCode><Name>AO/ASIF Cortex Screws</Name><Description>Locking head screws</Description><Size>1.3-2.0mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>157068</ARTG><ARTG>297881</ARTG></ARTGs><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL037</BillingCode><Name>VLP</Name><Description>VAL Locking screws</Description><Size>Micro Screws ≤ 2.0mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW011</BillingCode><Name>WEGO Trauma Systems</Name><Description>Micro Bone Screw Systems</Description><Size>Micro (≤ 2.0mm)</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>324381</ARTG></ARTGs><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ053</BillingCode><Name>Valens Shoulder and Elbow - Screws</Name><Description>Self-Tapping Locking Screws</Description><Size>2.0mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ042</BillingCode><Name>Valens Hand - Screws</Name><Description>Locking Screws</Description><Size>1.5mm, 2.0mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU279</BillingCode><Name>Variable Angle Locking Screw</Name><Description>VAL Screw</Description><Size>1.4mm - 2.0mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>350999</ARTG></ARTGs><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ079</BillingCode><PriorBillingCodes><PriorBillingCode>EF014</PriorBillingCode></PriorBillingCodes><Name>Bone Screw</Name><Description>Locking Screw</Description><Size>≤ 2.0mm</Size><SupplierCode>40063</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>239817</ARTG></ARTGs><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ066</BillingCode><Name>VRP Distal Radius Fixation System</Name><Description>VRP Distal Radius Fixation System, Locking Peg</Description><Size>2.0mm width, 14-30mm length</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>149433</ARTG></ARTGs><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO420</BillingCode><Name>ACUMED Hexalobe 1.5mm Multiscrews</Name><Description>ACUMED Hexalobe 1.5mm locking Multiscrew</Description><Size>1.5mm in diameter, 5mm to 20mm in length</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>99823</ARTG></ARTGs><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KO012</BillingCode><PriorBillingCodes><PriorBillingCode>LM478</PriorBillingCode></PriorBillingCodes><Name>Locking Screws</Name><Description>Locking Screws</Description><Size>≤ 2.0mm</Size><SupplierCode>40387</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>337193</ARTG></ARTGs><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK526</BillingCode><Name>Stryker Locking Plate System</Name><Description>Locking Screws</Description><Size>1.7-2.0mm diameter</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>269713</ARTG><ARTG>119660</ARTG></ARTGs><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW720</BillingCode><PriorBillingCodes><PriorBillingCode>WR073</PriorBillingCode></PriorBillingCodes><Name>Ortholoc Fracture System</Name><Description>Titanium, variable angle locking screws</Description><Size>2.0mm diameter, 8 - 100mm length</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BP030</BillingCode><Name>Tyber Medical Trauma headed screw</Name><Description>Trauma headed screw for compression and fixation of bone  Sterile or Non sterile, Titanium or stainless steel</Description><Size>1.5mm-2.0mm</Size><SupplierCode>40061</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><ARTGs><ARTG>324190</ARTG><ARTG>324189</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB032</BillingCode><Name>Mini Locking System - Cortex Screw</Name><Description>Cortex Screws</Description><Size>≤ 2.0mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><ARTGs><ARTG>223188</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BP032</BillingCode><Name>Tyber Medical Trauma Headless screw</Name><Description>Headless trauma screw for compression and fixation of bone Sterile or Non sterile, Titanium or stainless steel</Description><Size>2.0mm</Size><SupplierCode>40061</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><ARTGs><ARTG>324189</ARTG><ARTG>324190</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH299</BillingCode><Name>ALPS Plating System</Name><Description>Bone Screws</Description><Size>1.0 - 2.0mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><ARTGs><ARTG>210296</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ208</BillingCode><Name>ARIX 1.5-2.0 Locking screws</Name><Description>Locking screws</Description><Size>1.5-2.0mm</Size><SupplierCode>40063</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>409165</ARTG></ARTGs><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ209</BillingCode><Name>ARIX 1.5-2.3 Non-Locking screws</Name><Description>Non-Locking screws</Description><Size>1.5-2.0mm</Size><SupplierCode>40063</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><ARTGs><ARTG>409165</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY065</BillingCode><Name>AO/ASIF Screws</Name><Description>Cortex Screw</Description><Size>≤2.0mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><ARTGs><ARTG>157068</ARTG><ARTG>157706</ARTG><ARTG>295238</ARTG><ARTG>297881</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL043</BillingCode><Name>VLP EVOS</Name><Description>Cortical Screws</Description><Size>Micro (Screw size ≤ 2.0mm)</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL006</BillingCode><Name>TC-100</Name><Description>Cortical Screws</Description><Size>≤2.0mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ041</BillingCode><Name>Valens Hand - Screws</Name><Description>Cortical Screws</Description><Size>1.5mm, 2.0mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI742</BillingCode><Name>Zimmer ECT Screws</Name><Description>1.5mm Cortical Screws</Description><Size>6 - 18mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ211</BillingCode><Name>ARIX 2.0mm Non-Locking screws </Name><Description>Non-Locking screws</Description><Size>2.00mm</Size><SupplierCode>40063</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><ARTGs><ARTG>409165</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW661</BillingCode><Name>Stryker Plating System</Name><Description>Non-Locking Screws</Description><Size>1.2-1.9mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><ARTGs><ARTG>269713</ARTG><ARTG>252452</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ173</BillingCode><Name>Non-Locking Screw</Name><Description>Non-Locking Screw</Description><Size>2.0mm or Less</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><ARTGs><ARTG>429400</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ174</BillingCode><Name>VAL Locking Screw</Name><Description>VAL Locking Screw</Description><Size>2.0mm or Less</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>429400</ARTG></ARTGs><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT013</BillingCode><Name>Hawk 2.0mm Twist off Screw</Name><Description>2.0mm Twist off Screw</Description><Size>2.0mm in diameter with lengths of 11mm to 20mm</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>230954</ARTG></ARTGs><MinimumBenefit>273</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU207</BillingCode><PriorBillingCodes><PriorBillingCode>DE364</PriorBillingCode></PriorBillingCodes><Name>QuickFix Screw Micro</Name><Description>Titanium Snap-off Small Bone Screw</Description><Size>2.0mm Diameter x 10-14mm lengths</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>350871</ARTG><ARTG>351000</ARTG></ARTGs><MinimumBenefit>273</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU369</BillingCode><Name>Snap-Off Compression FT Pins 1.9mm</Name><Description>Snap-Off Compression pins for fusion and fracture fixation</Description><Size>1.9mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>350672</ARTG></ARTGs><MinimumBenefit>273</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL226</BillingCode><PriorBillingCodes><PriorBillingCode>IG135</PriorBillingCode></PriorBillingCodes><Name>Spin screw: Snap-off screws</Name><Description>Titanium break-off barrel screws</Description><Size>Diameter 2.0 mm, Length 11 -14mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>173963</ARTG></ARTGs><MinimumBenefit>273</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN065</BillingCode><Name>Newclip Cortical Screws</Name><Description>Cortical screws</Description><Size>≤2.0 mm diameter, length 08-30 mm</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><ARTGs><ARTG>260233</ARTG><ARTG>260234</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO075</BillingCode><Name>APTUS Screws</Name><Description>Cortical Screws</Description><Size>1.5mm - 2.0mm Diameter</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><ARTGs><ARTG>141171</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HJ004</BillingCode><Name>Snap-off Type II Screw</Name><Description>Snap-off screw, self-drilling, self-tapping, conical thread</Description><Size>Diameter 2mm. Length 10-17mm</Size><SupplierCode>40478</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>340314</ARTG></ARTGs><MinimumBenefit>273</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BU001</BillingCode><Name>Nexis osteosynthesis screws</Name><Description>Bone screw titanium alloy snap off</Description><Size>Diameter 2mm, Length 11-16mm</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>235767</ARTG></ARTGs><MinimumBenefit>273</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM172</BillingCode><Name>Smith and Nephew QFX Screw</Name><Description>2.0mm Twist-Off Screw</Description><Size>2.0mm Twist-Off Screw 8mm, 2.0mm Twist-Off Screw 10mm, 2.0mm Twist-Off Screw 12mm, 2.0mm Twist-Off Screw 14mm, 2.0mm Twist-Off Screw 16mm, 2.0mm Twist-Off Screw 18mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>273</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HJ001</BillingCode><Name>Surgifeet Weil Screw</Name><Description>Snap off screw , self drilling, self tapping.</Description><Size>Diameter 2mm  Length 11-15mm</Size><SupplierCode>40478</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>336654</ARTG></ARTGs><MinimumBenefit>273</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF091</BillingCode><Name>Speyside Self Breaking Screw - Micro</Name><Description>Speyside Self Breaking Screw - Micro</Description><Size>Dia 2.0 mm x Length 7-24 mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>273</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH193</BillingCode><Name>Twistoff Screw</Name><Description>TwistOff Screw Titanium</Description><Size>8-15mm Long</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>210290</ARTG></ARTGs><MinimumBenefit>273</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER402</BillingCode><Name>Paragon 28 Monster Screw System-Screws, micro (≤ 2.0mm), breakoff</Name><Description>Paragon 28 Monster Bite Screws, micro (≤ 2.0mm), snap-off, 1/2 or 3/4 threaded</Description><Size>dia 2.0 mm x length (8-24 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>289308</ARTG></ARTGs><MinimumBenefit>273</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW806</BillingCode><PriorBillingCodes><PriorBillingCode>WR229</PriorBillingCode></PriorBillingCodes><Name>Twist-off Screw</Name><Description>Unique feature of two thread diameters to suit variable bone quality, specifically designed for Weil-osteotomy, titanium, self drilling and self tapping, twist-off connector.</Description><Size>2.0mm diameter x 11-15mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>291613</ARTG></ARTGs><MinimumBenefit>273</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KO015</BillingCode><PriorBillingCodes><PriorBillingCode>LM398</PriorBillingCode></PriorBillingCodes><Name>Cannulated Screws</Name><Description>Cannulated Screws</Description><Size>2.0mm diameter and smaller</Size><SupplierCode>40387</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>329613</ARTG></ARTGs><MinimumBenefit>180</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM281</BillingCode><Name>PANTERA Proximal Humerus Fracture Fixation Plate System - Cross Element Screw</Name><Description>Cross Element Screw</Description><Size>1.9 mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>182168</ARTG></ARTGs><MinimumBenefit>180</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER403</BillingCode><Name>Paragon 28 Monster Screw System-Screws, micro (≤ 2.0mm), cannulated</Name><Description>Paragon 28 Monster Screw System-screws, micro, cannulated, headed</Description><Size>dia 2.0 mm x length (8-100mm) x length of thread (3-100 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>289308</ARTG></ARTGs><MinimumBenefit>180</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO113</BillingCode><Name>APTUS CCS</Name><Description>Cannulated Screws</Description><Size>Diameter ≤ 2.0mm  Length 6.0mm to 20.0mm</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>206157</ARTG></ARTGs><MinimumBenefit>180</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BP036</BillingCode><Name>Tyber Medical Trauma headed screw</Name><Description>Trauma headed screw for compression and fixation of bone Sterile or Non sterile, Titanium or stainless steel</Description><Size>2.00MM</Size><SupplierCode>40061</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>CN</Suffix><ARTGs><ARTG>324190</ARTG><ARTG>324189</ARTG></ARTGs><MinimumBenefit>180</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT079</BillingCode><PriorBillingCodes><PriorBillingCode>OH514</PriorBillingCode></PriorBillingCodes><Name>KLS Martin Hand fracture system - multidirectional locking screw</Name><Description>Multidirectional locking screw</Description><Size>1.2 – 2.0mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>276650</ARTG><ARTG>276674</ARTG></ARTGs><ChangeExplanation>Change to Group benefit</ChangeExplanation><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO072</BillingCode><Name>APTUS Screws</Name><Description>Aptus Locking Screws</Description><Size>1.5mm - 2.0mm Diameter</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>141171</ARTG></ARTGs><ChangeExplanation>Change to Group benefit</ChangeExplanation><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH300</BillingCode><Name>ALPS Hand Fracture System</Name><Description>Locking Bone Screws</Description><Size>1.0 - 2.0mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>153087</ARTG></ARTGs><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW457</BillingCode><Name>Fixos Screws</Name><Description>Bone Fixation Screws</Description><Size>2mm diam. X11mm lenth to 2mm x 16mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>Breakoff</Suffix><ARTGs><ARTG>149535</ARTG></ARTGs><MinimumBenefit>273</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ130</BillingCode><PriorBillingCodes><PriorBillingCode>LM371</PriorBillingCode></PriorBillingCodes><Name>Orthopaedic Fixation Screw</Name><Description>Fixation Screw</Description><Size>2.0mm or less diameter</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>266217</ARTG></ARTGs><MinimumBenefit>346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT074</BillingCode><PriorBillingCodes><PriorBillingCode>OH481</PriorBillingCode></PriorBillingCodes><Name>HBS 2 mini</Name><Description>Self-compressive screws</Description><Size>Diam: 1.7 - 2.0mm  Length: 10 - 40mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>276674</ARTG><ARTG>276650</ARTG></ARTGs><MinimumBenefit>346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM256</BillingCode><Name>Osteomed Screws</Name><Description>Bone Screws - threaded/lag</Description><Size>1.2/1.6/2.0mm x 4-36mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><ARTGs><ARTG>202319</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW010</BillingCode><Name>WEGO Trauma Systems</Name><Description>Micro Bone Screw Systems</Description><Size>Micro (≤ 2.0mm)</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><ARTGs><ARTG>324381</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT081</BillingCode><PriorBillingCodes><PriorBillingCode>OH517</PriorBillingCode></PriorBillingCodes><Name>KLS Martin Hand fracture system, standard screw</Name><Description>Bone screw</Description><Size>1.2 – 2.0mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><ARTGs><ARTG>276650</ARTG><ARTG>276674</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KO011</BillingCode><PriorBillingCodes><PriorBillingCode>LM393</PriorBillingCode></PriorBillingCodes><Name>Headless Compression Screws</Name><Description>Headless Compression Screws</Description><Size>2.0mm or smaller diameter</Size><SupplierCode>40387</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>329613</ARTG></ARTGs><MinimumBenefit>346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM258</BillingCode><Name>Bone Screws - cannulated</Name><Description>Screws - cannulated</Description><Size>2.0mm x 6.0-36.0mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>202320</ARTG></ARTGs><MinimumBenefit>346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ029</BillingCode><PriorBillingCodes><PriorBillingCode>LM282</PriorBillingCode><PriorBillingCode>LM282</PriorBillingCode></PriorBillingCodes><Name>IBS Screw</Name><Description>Compression Screw</Description><Size>2mm diameter</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>266217</ARTG></ARTGs><MinimumBenefit>346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BU017</BillingCode><Name>MAGNEZIX CS 2.0</Name><Description>Absorbable compression screw.</Description><Size>Diameter 2.0mm</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>DT</Suffix><ARTGs><ARTG>283491</ARTG></ARTGs><MinimumBenefit>200</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY647</BillingCode><Name>AO/ASIF Screws</Name><Description>HCS Countersinkable Compression Screw</Description><Size>≤ 2.0mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>297881</ARTG></ARTGs><MinimumBenefit>346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BP035</BillingCode><Name>Tyber Medical Trauma Headless screw</Name><Description>Headless trauma screw for compression and fixation of bone Sterile or Non sterile, Titanium or stainless steel</Description><Size>2.0mm</Size><SupplierCode>40061</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>324189</ARTG><ARTG>324190</ARTG></ARTGs><MinimumBenefit>346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN015</BillingCode><Name>Foot and Hand Motion S</Name><Description>1.7mm - 2.0mm cannulated self-drilling, self-tapping and compressive screws</Description><Size>1.7 &amp; 2.0mm diameter, length 8mm - 40mm</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>260233</ARTG><ARTG>260234</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Description, Size</ChangeExplanation><MinimumBenefit>346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB035</BillingCode><Name>Mini Locking System - Headless Compression Screw</Name><Description>Compression Screws</Description><Size>1.5mm &amp; 2mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>223188</ARTG></ARTGs><MinimumBenefit>346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ069</BillingCode><Name>Austofix Cannulated Compression Screws</Name><Description>1.7mm Cannulated Headless Compression Screws</Description><Size>1.7mm diameter
6mm to 14mm length</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM131</BillingCode><Name>TriMed Compression Screws</Name><Description>Compression screws</Description><Size>1.7mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>229704</ARTG></ARTGs><MinimumBenefit>346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER404</BillingCode><Name>Paragon 28 Monster Screw System-Screws, micro (≤ 2.0mm), cannulated, dual thread, locking</Name><Description>Paragon 28 Monster micro screws, cannulated, dual thread, locking, headless, partially threaded</Description><Size>dia 2.0 mm x length (8-100 mm) x length of thread (3mm-32 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>CN,DT</Suffix><ARTGs><ARTG>289308</ARTG></ARTGs><MinimumBenefit>346</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO091</BillingCode><Name>APTUS SpeedTip C System</Name><Description>APTUS SpeedTip C Screws</Description><Size>2.0mm diameter</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><ARTGs><ARTG>206157</ARTG></ARTGs><MinimumBenefit>200</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV020</BillingCode><Name>VariAx Plating System - Screws</Name><Description>Titanium Locking Screws</Description><Size>2.0mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>352530</ARTG></ARTGs><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL036</BillingCode><Name>VLP</Name><Description>Cortical Screws</Description><Size>Micro Screws ≤ 2.0mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW823</BillingCode><PriorBillingCodes><PriorBillingCode>WR256</PriorBillingCode></PriorBillingCodes><Name>Evolve EPS System Non-Locking</Name><Description>Stainless Steel Cortical Screws</Description><Size>1.5 - 2.0mm Diameter, 10-40mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><ARTGs><ARTG>326629</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM257</BillingCode><Name>OsteoMed HPS</Name><Description>Bone screws - angled locking</Description><Size>1.6/2mm x 6-36mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>202230</ARTG></ARTGs><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER427</BillingCode><Name>Paragon 28 Gorilla Plating System-Screws, micro</Name><Description>Paragon 28 Gorilla Plating System-Screws, locking, baby</Description><Size>dia 2.0 mm x length (8-40 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112124</SubGroupID><Suffix>LK</Suffix><ARTGs><ARTG>289308</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Description</ChangeExplanation><MinimumBenefit>104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN492</BillingCode><Name>Paediatric Osteotomy System</Name><Description>Lag Screw</Description><Size>22mm- 40mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112125</SubGroupID><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>155</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN279</BillingCode><Name>Femoral Neck System, Antirotation Screw</Name><Description> Orthopaedic bone screw,  sterile  </Description><Size>75 to 130 mm length</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112125</SubGroupID><ARTGs><ARTG>157068</ARTG></ARTGs><MinimumBenefit>155</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY054</BillingCode><Name>AO/ASIF Screws</Name><Description>DHS/DCS lag screw</Description><Size>50-145mm L</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112125</SubGroupID><ARTGs><ARTG>183900</ARTG><ARTG>297881</ARTG><ARTG>157068</ARTG></ARTGs><MinimumBenefit>155</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN489</BillingCode><Name>Intermediate Osteotomy System</Name><Description>Lag</Description><Size>35 mm - 85mm, 1 1/2" - 3-3/4"</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112125</SubGroupID><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>155</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW333</BillingCode><Name>Omega Plus Compression Hip Screw System</Name><Description>Lag Screw - Standard -  Stainless Steel</Description><Size>50-130mm length </Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112125</SubGroupID><ARTGs><ARTG>119660</ARTG></ARTGs><MinimumBenefit>155</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK228</BillingCode><Name>Omega Plus Compression Hip Screw System</Name><Description>Cephalic Implants</Description><Size>Hansson Twin Hook 50-140mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112125</SubGroupID><ARTGs><ARTG>94876</ARTG></ARTGs><MinimumBenefit>155</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW334</BillingCode><Name>Omega Plus Compression Hip Screw System</Name><Description>Lag Screw - Super -  Stainless Steel</Description><Size>50-130mm length </Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112125</SubGroupID><ARTGs><ARTG>76592</ARTG><ARTG>119660</ARTG></ARTGs><MinimumBenefit>155</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI158</BillingCode><Name>Zimmer Internal Fixation Systems: Compression Hip Screw</Name><Description>Versa-FX Femoral Fixation Screw - Stainless Steel</Description><Size>55 mm - 155 mm long</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112125</SubGroupID><ARTGs><ARTG>112735</ARTG><ARTG>169898</ARTG></ARTGs><MinimumBenefit>155</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ158</BillingCode><Name>Agomed Washers</Name><Description>Agomed Washers</Description><Size>Multiple</Size><SupplierCode>39964</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>429400</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW009</BillingCode><Name>WEGO Trauma Systems </Name><Description>Washers</Description><Size>10-13mm</Size><SupplierCode>40252</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>324402</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB041</BillingCode><Name>Washers</Name><Description>Washers</Description><Size>Thickness 1- 5.5mm
Width 7 - 13mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>223188</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO112</BillingCode><Name>APTUS Washer</Name><Description>Washers</Description><Size>5.0mm - 13.0mm</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>206157</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN003</BillingCode><Name>Washers</Name><Description>Washers</Description><Size>4-8 mm</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>260231</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM316</BillingCode><Name>Skeletal Dynamics Washer</Name><Description>Washer</Description><Size>One size</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW911</BillingCode><PriorBillingCodes><PriorBillingCode>WR388</PriorBillingCode></PriorBillingCodes><Name>MaxTorque Cannulated Screw System- Washers</Name><Description>Screw washer, Titanium, Contoured or Flat</Description><Size>Ø4.0 to 7.0mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>214671</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH189</BillingCode><Name>Small / Large Fragment Set S/S</Name><Description>Washer Spiked, Standard, Cancellous, Cortical &amp; Fastening Wire</Description><Size>One size only</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>200720</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM081</BillingCode><Name>Surgicraft Washers</Name><Description>Fixation Washers</Description><Size>All Sizes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>149434</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH489</BillingCode><Name>DynafitSystem</Name><Description>washer</Description><Size>8-10mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>221403</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY092</BillingCode><Name>AO/ASIF Washers</Name><Description>Washers</Description><Size>1.0mm - 18mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>332027</ARTG><ARTG>133921</ARTG><ARTG>332026</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL007</BillingCode><Name>Universal Washers</Name><Description>Screw Washers</Description><Size>All sizes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>120321</ARTG><ARTG>108428</ARTG><ARTG>368492</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF095</BillingCode><Name>Versa Screw Washer</Name><Description>Versa Screw Washer</Description><Size>One Size</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH332</BillingCode><Name>Small / Large  Fragment Set</Name><Description>Washer Titanium - Flat/Cup/Countersink</Description><Size>One size only</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>200720</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU161</BillingCode><Name>Washer</Name><Description>Screw Washer</Description><Size>6mm - 18mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>350851</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ129</BillingCode><Name>Screw Washer</Name><Description>Stainless Steel</Description><Size>Screw sizes 4.0mm - 7.0mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>191602</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO158</BillingCode><Name>Polarus Humeral Fixation System</Name><Description>Polarus Washer</Description><Size>3.8mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>169180</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ304</BillingCode><Name>OMNI Plating System</Name><Description>Screw Washer</Description><Size>4.5mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>306780</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM346</BillingCode><Name>Screw Washer</Name><Description>Screw Washer</Description><Size>All sizes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>296619</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT083</BillingCode><PriorBillingCodes><PriorBillingCode>OH519</PriorBillingCode></PriorBillingCodes><Name>KLS Martin Hand fracture system - washer</Name><Description>Washer</Description><Size>4.5 – 5mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>276650</ARTG><ARTG>276674</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN362</BillingCode><Name>Bristow-Latarjet Instability Shoulder Set - Top Hat Screw Washer</Name><Description>Cannulated titanium top hat screw washer</Description><Size>One size</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>215753</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ023</BillingCode><Name>Austofix Femoral &amp; Tibial Nailing System</Name><Description>Washer for screws; s-s</Description><Size>Dia 11mm &amp; 13mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>111818</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT002</BillingCode><Name>Hawk 6.5mm Cannulated Screw System - Washer</Name><Description>Titanium Washer</Description><Size>Internal diameter 6.6mm and external diameter 14mm</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>232499</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ038</BillingCode><Name>Valens - Cannulated Screw Washer</Name><Description>Washer</Description><Size>8mm, 10mm, 12mm</Size><SupplierCode>40057</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>276915</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT003</BillingCode><Name>Hawk 4.0mm Cannulated Screw System - Washer</Name><Description>Titanium washer</Description><Size>internal diameter of 4.13mm and external diameter of 10mm</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>232499</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER405</BillingCode><Name>Paragon 28 Monster Screw System-washer</Name><Description>Paragon 28 Monster Screw System-washer, deep well, flat/dome</Description><Size>dia 2-7 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>289309</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM255</BillingCode><Name>OsteoMed FPS</Name><Description>Screw Washers</Description><Size>2/2.7/3.5/4.0mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>202319</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW918</BillingCode><PriorBillingCodes><PriorBillingCode>WR398</PriorBillingCode></PriorBillingCodes><Name>NexFix Washer</Name><Description>The NexFix Washer is a threaded circular piece of stainless steel through which is inserted a NexFix Compression Screw. The Compression Screw is locked to the washer to form a headed screw that will increase bone coverage and prevent the screw from sinking</Description><Size>9mm, 11mm, 13mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>163237</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK201</BillingCode><Name>Stryker Trauma Locking Nail System</Name><Description>Proximal Humeral Nail</Description><Size>Proximal Humerous Washer round/square</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>76714</ARTG><ARTG>119849</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI210</BillingCode><Name>Zimmer Washers</Name><Description>Washer</Description><Size>Small &amp; Large</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>112735</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER561</BillingCode><Name>Osteomed ExtremiLock Screw, Mini (2.01 – 2.7 mm), screw washer</Name><Description>Screw washer</Description><Size>2.4/2.7 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>337240</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA008</BillingCode><Name>ALPS Plating System &amp; Biodrive Screws</Name><Description>Flat and cupped Titanium washers</Description><Size>3.0-6.5mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>213857</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW712</BillingCode><PriorBillingCodes><PriorBillingCode>WR060</PriorBillingCode></PriorBillingCodes><Name>Ring washer</Name><Description>Screw Washers</Description><Size>2.7/3.7/4.0/4.5</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>198486</ARTG><ARTG>326629</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK565</BillingCode><Name>Stryker Plating System</Name><Description>Washers</Description><Size>7-13mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>119849</ARTG><ARTG>269713</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BP029</BillingCode><Name>Tyber Medical Trauma screw washer</Name><Description>Screw washer intended to be used with bone screws to improve fixation. Sterile or Non sterile, Titanium or stainless steel</Description><Size>2.0mm -7.5mm</Size><SupplierCode>40061</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>324373</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW299</BillingCode><Name>Asnis Guided Screw System</Name><Description>Washer -  Titanium</Description><Size>4, 5, 6.5,8mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>119849</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW298</BillingCode><Name>Asnis Guided Screw System</Name><Description>Washer, Stainless Steel</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112126</SubGroupID><ARTGs><ARTG>119849</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO088</BillingCode><Name>Aptus Shoulder (Spiral Blades )</Name><Description>Spiral Blades Proximal Humerus</Description><Size>3.5mm System</Size><SupplierCode>40165</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112128</SubGroupID><ARTGs><ARTG>141170</ARTG></ARTGs><MinimumBenefit>122</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TN048</BillingCode><Name>Screws peg locking</Name><Description>Locking screws peg</Description><Size>&lt; 2.0 mm</Size><SupplierCode>40135</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112128</SubGroupID><ARTGs><ARTG>260233</ARTG><ARTG>260234</ARTG></ARTGs><MinimumBenefit>122</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK154</BillingCode><Name>Stryker Cross-Screw</Name><Description>HA/PLLA screw for ligament/tendon fixation</Description><Size>Dia 6mm: Length 40-60mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112128</SubGroupID><ARTGs><ARTG>143030</ARTG></ARTGs><MinimumBenefit>122</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM311</BillingCode><Name>Skeletal Dynamics Pegs</Name><Description>Smooth Pegs:Locking, Threaded Pegs: Locking &amp; Non Locking</Description><Size>2mm, 2.3mm &amp; 2.7mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112128</SubGroupID><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>122</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM522</BillingCode><Name>Omni Plating System</Name><Description>Post</Description><Size>12 &amp; 16 mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112128</SubGroupID><ARTGs><ARTG>306780</ARTG></ARTGs><MinimumBenefit>122</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM041</BillingCode><Name>Trimed Fixation Pegs</Name><Description>Plate fixation pegs</Description><Size>10-32mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112128</SubGroupID><ARTGs><ARTG>182677</ARTG></ARTGs><MinimumBenefit>122</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK155</BillingCode><Name>Wedge Interference screw</Name><Description>Threaded PLLA screw with cross pin for ligament/tendon fixation</Description><Size>Dia 7-12mm, Length 20-40mm; pin length standard</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112128</SubGroupID><ARTGs><ARTG>139735</ARTG></ARTGs><MinimumBenefit>122</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY110</BillingCode><Name>AO/ASIF Screws</Name><Description>Buttress Pin</Description><Size>Various lengths</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112128</SubGroupID><ARTGs><ARTG>157068</ARTG><ARTG>133927</ARTG><ARTG>297881</ARTG></ARTGs><MinimumBenefit>122</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL029</BillingCode><Name>D-RAD SMART PACK</Name><Description>Variable angle locking screw or peg</Description><Size>1.0 - 2.0mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112128</SubGroupID><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>122</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN278</BillingCode><Name>Femoral Neck System, Bolt</Name><Description>Orthopaedic bone bolt</Description><Size>75 to 130 mm length</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112128</SubGroupID><ARTGs><ARTG>183900</ARTG></ARTGs><MinimumBenefit>122</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN422</BillingCode><Name>Fixation Post</Name><Description>Tibial fixation device</Description><Size>25 -55mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112128</SubGroupID><ARTGs><ARTG>109451</ARTG></ARTGs><MinimumBenefit>122</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY649</BillingCode><Name>AO/ASIF Screws</Name><Description>Self Drilling, self tapping, conical screws/pins/bar</Description><Size>≥ 3.5mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112128</SubGroupID><ARTGs><ARTG>133927</ARTG><ARTG>297881</ARTG></ARTGs><MinimumBenefit>122</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL150</BillingCode><Name>Smith &amp; Nephew Plate and Screw System - EVOS</Name><Description>Locking Peg</Description><Size>Various length</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112128</SubGroupID><ARTGs><ARTG>104369</ARTG></ARTGs><MinimumBenefit>122</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK566</BillingCode><Name>Stryker Plating System</Name><Description>Nuts</Description><Size>4.5-5.0mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112129</SubGroupID><ARTGs><ARTG>139635</ARTG><ARTG>120234</ARTG></ARTGs><MinimumBenefit>35</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK204</BillingCode><Name>Stryker Trauma Locking Nail System</Name><Description>SCN</Description><Size>Nut for Condyle Screws 5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112129</SubGroupID><ARTGs><ARTG>139632</ARTG></ARTGs><MinimumBenefit>35</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW274</BillingCode><Name>Stryker Plating System</Name><Description>Locking Insert/Plug Assembly</Description><Size>4.0mm to 5 mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108797</GroupID><SubGroupID>112130</SubGroupID><ARTGs><ARTG>295226</ARTG><ARTG>139635</ARTG><ARTG>119660</ARTG></ARTGs><MinimumBenefit>83</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ163</BillingCode><Name>Monoplanar Fixator System  </Name><Description>Rail</Description><Size>100 - 300 mm  </Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112155</SubGroupID><Suffix>Mini</Suffix><ARTGs><ARTG>341661</ARTG></ARTGs><MinimumBenefit>1405</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK013</BillingCode><Name>Orthofix External Fixation Systems</Name><Description>MiniRail System</Description><Size>Short, Standard, Long and Articulated Horizontal and Vertical Axis</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112155</SubGroupID><Suffix>Mini</Suffix><ARTGs><ARTG>197364</ARTG></ARTGs><MinimumBenefit>1405</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST947</BillingCode><Name>Monotube External Fixation System</Name><Description>Anodized metal alloy, dynamic tube assembly rod</Description><Size>25mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112155</SubGroupID><Suffix>CDD</Suffix><ARTGs><ARTG>112434</ARTG></ARTGs><MinimumBenefit>6243</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK612</BillingCode><Name>MiniFix</Name><Description>Finger Mini Fixator System</Description><Size>One size</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112155</SubGroupID><Suffix>Mini</Suffix><ARTGs><ARTG>141004</ARTG></ARTGs><MinimumBenefit>1405</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK613</BillingCode><Name>RadioFix</Name><Description>Radio Fixator System</Description><Size>One size</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112155</SubGroupID><Suffix>Small</Suffix><ARTGs><ARTG>141004</ARTG></ARTGs><MinimumBenefit>1353</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK616</BillingCode><Name>Poing Fix</Name><Description>Wrist Fixator System</Description><Size>One size</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112155</SubGroupID><Suffix>Small</Suffix><ARTGs><ARTG>141004</ARTG></ARTGs><MinimumBenefit>1353</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK615</BillingCode><Name>Wrist Fixator PFII</Name><Description>Wrist Fixator System</Description><Size>One size</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112155</SubGroupID><Suffix>Small</Suffix><ARTGs><ARTG>141004</ARTG></ARTGs><MinimumBenefit>1353</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK002</BillingCode><Name>Orthofix External Fixation System Pennig Wrist Fixator</Name><Description>Anodised aluminium and stainless steel</Description><Size>One size only</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112155</SubGroupID><Suffix>Small</Suffix><ARTGs><ARTG>118320</ARTG><ARTG>123604</ARTG></ARTGs><MinimumBenefit>1353</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ162</BillingCode><Name>Monoplanar Fixator System</Name><Description>Micro and Mini Rails</Description><Size>80 - 100 mm  </Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112155</SubGroupID><Suffix>Mini</Suffix><ARTGs><ARTG>341661</ARTG></ARTGs><MinimumBenefit>1405</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK014</BillingCode><Name>Orthofix External Fixation Systems</Name><Description>Pennig Minifixator</Description><Size>Short, Standard, Long</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112155</SubGroupID><Suffix>Small, 3D, CDD</Suffix><ARTGs><ARTG>197364</ARTG></ARTGs><MinimumBenefit>1824</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM336</BillingCode><Name>Osteo-x External Mini Fixator</Name><Description>The Osteo-x® external fixator is a device used for the fixation and distraction of small bones, primarily in the hand. It incorporates four K-wires which are driven into the bone and placed to provide three-dimensional stability.</Description><Size>One Size Only</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112155</SubGroupID><Suffix>Small, CDD</Suffix><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>1824</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK617</BillingCode><Name>MicroFix</Name><Description>Finger Mini Fixator System</Description><Size>one size</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112155</SubGroupID><Suffix>Mini</Suffix><ARTGs><ARTG>252452</ARTG></ARTGs><MinimumBenefit>1405</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM197</BillingCode><Name>MiniFlo Fixator</Name><Description>Finger mini fixator system</Description><Size>Radius: 25 and 30mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112155</SubGroupID><Suffix>Mini</Suffix><ARTGs><ARTG>222613</ARTG></ARTGs><MinimumBenefit>1405</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM244</BillingCode><Name>Ligamentotaxor</Name><Description>Finger Mini Fixator System</Description><Size>1 size only</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112155</SubGroupID><Suffix>Mini</Suffix><ARTGs><ARTG>235592</ARTG></ARTGs><MinimumBenefit>1405</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK001</BillingCode><Name>Orthofix External Fixation System Ankle Fixator</Name><Description>Anodised aluminium and stainless steel</Description><Size>One size only</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112155</SubGroupID><ARTGs><ARTG>117273</ARTG><ARTG>118320</ARTG><ARTG>123604</ARTG><ARTG>177324</ARTG></ARTGs><MinimumBenefit>4035</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK046</BillingCode><Name>LRS Knee Hinge</Name><Description>Knee spanning and limb salvage external fixator - fully assembled.</Description><Size>One size.</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112155</SubGroupID><ARTGs><ARTG>123604</ARTG><ARTG>172152</ARTG><ARTG>197638</ARTG></ARTGs><MinimumBenefit>4035</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK009</BillingCode><Name>Orthopaedic External Fixation System - Xcaliber External Fixator</Name><Description>Metadiaphyseal Fixator</Description><Size>One size</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112155</SubGroupID><ARTGs><ARTG>117273</ARTG><ARTG>118320</ARTG><ARTG>123604</ARTG></ARTGs><MinimumBenefit>4035</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT019</BillingCode><Name>Frame IT - Pre-assembled Frame</Name><Description>Pre assembled Frame - used for the correction of deformities</Description><Size>120mm-180mm</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112155</SubGroupID><ARTGs><ARTG>282764</ARTG></ARTGs><MinimumBenefit>4035</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA061</BillingCode><Name>FastFrame External Fixation System</Name><Description>Ankle Spanning - fully assembled, sterile</Description><Size>Length: 100-200mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112155</SubGroupID><ARTGs><ARTG>315769</ARTG></ARTGs><MinimumBenefit>4035</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST945</BillingCode><Name>Monotube External Fixation System</Name><Description>Anodized metal alloy, dynamic tube assembly yellow</Description><Size>15mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112155</SubGroupID><ARTGs><ARTG>112434</ARTG></ARTGs><MinimumBenefit>4035</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA060</BillingCode><Name>FastFrame External Fixation System</Name><Description>Knee Spanning and damage control external fixator system - fully assembled, sterile</Description><Size>Length: 200mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112155</SubGroupID><ARTGs><ARTG>315769</ARTG></ARTGs><MinimumBenefit>4035</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST946</BillingCode><Name>Monotube External Fixation System</Name><Description>Anodized metal alloy, dynamic tube assembly blue</Description><Size>20mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112155</SubGroupID><ARTGs><ARTG>112434</ARTG></ARTGs><MinimumBenefit>4035</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO431</BillingCode><Name>ACUMED Small Bone External Fixation System</Name><Description>Designed for Metacarpal and Phalangeal bones</Description><Size>mini</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112155</SubGroupID><Suffix>Mini</Suffix><ARTGs><ARTG>101930</ARTG></ARTGs><MinimumBenefit>1405</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST968</BillingCode><Name>TenXor External Fixation System</Name><Description>Anodized metal alloy, ring to monotube triax tube clamp</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112156</SubGroupID><ARTGs><ARTG>16241</ARTG><ARTG>112434</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW850</BillingCode><PriorBillingCodes><PriorBillingCode>WR312</PriorBillingCode></PriorBillingCodes><Name>SALVATION Limb Salvage Clamp</Name><Description>Clamp</Description><Size>5mm and 6mm, 1 hole to 4 hole cube</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112156</SubGroupID><ARTGs><ARTG>198486</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL247</BillingCode><Name>MAVERICK External Fixation</Name><Description>Clamps</Description><Size>Up to 75mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112156</SubGroupID><ARTGs><ARTG>401572</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK045</BillingCode><Name>LRS Clamps</Name><Description>Monoplanar clamp - 3 dimensional.</Description><Size>Small.</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112156</SubGroupID><ARTGs><ARTG>123604</ARTG><ARTG>172152</ARTG><ARTG>197638</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW517</BillingCode><Name>HOFFMANN3 EXTERNAL FIXATION SYSTEM</Name><Description>MULTIPLANAR CLAMP PIN/ROD-ROD</Description><Size>STANDARD</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112156</SubGroupID><Suffix>3D</Suffix><ARTGs><ARTG>112434</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL254</BillingCode><Name>MAVERICK Mini</Name><Description>Clamps for 6mm rods</Description><Size>6mm to 4mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112156</SubGroupID><Suffix>Small</Suffix><ARTGs><ARTG>401572</ARTG></ARTGs><MinimumBenefit>1267</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN966</BillingCode><Name>Smith &amp; Nephew External Fixation (Llizarov, Taylor Spatial Frame, Jet-X, Compass)</Name><Description>Monoplanar Clamp, 3 Dimensional</Description><Size>Small</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112156</SubGroupID><Suffix>Small</Suffix><ARTGs><ARTG>97612</ARTG></ARTGs><MinimumBenefit>1267</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY664</BillingCode><Name>Orthopaedic External Fixator Systems</Name><Description>Mini Frame Holding Clamp</Description><Size>3.0-4.0mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112156</SubGroupID><Suffix>Mini</Suffix><ARTGs><ARTG>155806</ARTG></ARTGs><MinimumBenefit>312</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN947</BillingCode><Name>Smith &amp; Nephew External Fixation (Llizarov, Taylor Spatial Frame, Jet-X, Compass)</Name><Description>Monoplanar Clamp</Description><Size>Standard</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112156</SubGroupID><ARTGs><ARTG>97612</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL021</BillingCode><Name>Modular Rail System</Name><Description>Monoplanar Clamp</Description><Size>50mm - 100mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112156</SubGroupID><ARTGs><ARTG>97612</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ164</BillingCode><Name>Monoplanar Clamp  </Name><Description>Clamp</Description><Size>Standard</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112156</SubGroupID><ARTGs><ARTG>341661</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN949</BillingCode><Name>Smith &amp; Nephew External Fixation (Llizarov, Taylor Spatial Frame, Jet-X, Compass)</Name><Description>Monoplanar clamp, Compresion Distraction Device</Description><Size>Standard</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112157</SubGroupID><ARTGs><ARTG>97612</ARTG></ARTGs><MinimumBenefit>746</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN948</BillingCode><Name>Smith &amp; Nephew External Fixation (Llizarov, Taylor Spatial Frame, Jet-X, Compass)</Name><Description>Monoplanar Clamp, 3 Dimensional</Description><Size>Standard</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112157</SubGroupID><ARTGs><ARTG>97612</ARTG></ARTGs><MinimumBenefit>746</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST943</BillingCode><Name>Hoffman II External Fixation System</Name><Description>Anodised metal alloy, adjustable connecting rod</Description><Size>Long, short</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112157</SubGroupID><ARTGs><ARTG>16241</ARTG><ARTG>112434</ARTG></ARTGs><MinimumBenefit>746</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST953</BillingCode><Name>Monotube External Fixation System</Name><Description>Anodized metal alloy, T-Adapter yellow, blue, red</Description><Size>15, 20, 25mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112157</SubGroupID><ARTGs><ARTG>16241</ARTG><ARTG>112434</ARTG></ARTGs><MinimumBenefit>746</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW476</BillingCode><Name>HOFFMANN LRF - FULL CIRCULAR RING</Name><Description>FULL CURCULAR RING</Description><Size>DIAMETER - 80 - 270MM</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112158</SubGroupID><ARTGs><ARTG>197935</ARTG></ARTGs><MinimumBenefit>685</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL238</BillingCode><Name>SMART TSF (Taylor Spatial Frame)</Name><Description>Full Circular Ring</Description><Size>105 - 230 mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112158</SubGroupID><ARTGs><ARTG>384817</ARTG></ARTGs><MinimumBenefit>685</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW960</BillingCode><PriorBillingCodes><PriorBillingCode>WR450</PriorBillingCode></PriorBillingCodes><Name>SALVATION Full Ring</Name><Description>Salvation External Fixation Full Ring</Description><Size>120mm - 220mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112158</SubGroupID><ARTGs><ARTG>198486</ARTG></ARTGs><MinimumBenefit>685</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT023</BillingCode><Name>Frame It Full Ring</Name><Description>Full Circular Ring</Description><Size>Diameter 80mm-220mm</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112158</SubGroupID><ARTGs><ARTG>282764</ARTG></ARTGs><MinimumBenefit>685</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ170</BillingCode><Name>Orthex Full Circular Rings</Name><Description>Ring, Full</Description><Size>75-280mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112158</SubGroupID><ARTGs><ARTG>341661</ARTG></ARTGs><MinimumBenefit>685</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN952</BillingCode><Name>Smith &amp; Nephew External Fixation (Llizarov, Taylor Spatial Frame, Jet-X, Compass)</Name><Description>Full Circular Ring</Description><Size>standard</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112158</SubGroupID><ARTGs><ARTG>97612</ARTG></ARTGs><MinimumBenefit>685</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY425</BillingCode><Name>MAXFRAME Distraction Osteogenesis External Fixation System</Name><Description>Full Ring</Description><Size>90mm-270mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112158</SubGroupID><ARTGs><ARTG>326183</ARTG><ARTG>289708</ARTG></ARTGs><MinimumBenefit>685</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW845</BillingCode><PriorBillingCodes><PriorBillingCode>WR307</PriorBillingCode></PriorBillingCodes><Name>SALVATION Limb Salvage Full Rings</Name><Description>Full Rings</Description><Size>120mm - 200mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112158</SubGroupID><ARTGs><ARTG>198486</ARTG></ARTGs><MinimumBenefit>685</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK030</BillingCode><Name>Orthofix Circular Frame Full ring</Name><Description>The Orthofix circular frame is a surgeon designed, user friendly ring fixation system for trauma applications, limb lengthening and deformity correction. It is based on the science, methodology and principles of Prof Ilizarov. The circular frame is simple, offering preassembled functional components that are easy to connect and operate. The frame is stable with anti-rotational feature on connection elements that prevents any undesirable movement. Its unique wire and half pin fixation elements provide efficient bone segment stabilisation. A biomechanically superior metal-plastic interface is stable both during and between adjustments. The system is versatile, consisting of rings, half-rings, foot plates, 5/8 rings and arches. Full control of bone segments accomplished with Orthofix circular frame allows precise movement of segments without compromising stability.</Description><Size>80mm - 300mm full rings</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112158</SubGroupID><ARTGs><ARTG>177324</ARTG><ARTG>229624</ARTG></ARTGs><MinimumBenefit>685</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL239</BillingCode><Name>SMART TSF (Taylor Spatial Frame)</Name><Description>Partial Circular Ring</Description><Size>105 - 230 mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112159</SubGroupID><ARTGs><ARTG>384817</ARTG></ARTGs><MinimumBenefit>978</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK011</BillingCode><Name>Orthopaedic External Fixation System - Xcaliber External Fixator</Name><Description>Hybrid Fixator</Description><Size>One size only</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112159</SubGroupID><ARTGs><ARTG>117273</ARTG><ARTG>118320</ARTG><ARTG>123604</ARTG></ARTGs><MinimumBenefit>978</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK029</BillingCode><Name>Orthofix Circular Frame Partial ring</Name><Description>The Orthofix circular frame is a surgeon designed, user-friendly ring fixation system for trauma applications, limb lengthening and deformity correction. It is based on the science, methodology and principles of Prof Ilizarov. The circular frame is simple offering pre-assembled functional components that are easy to connect and operate. The frame is stable with anti-rotational feature on connection elements that prevents any undesirable movement. It's unique wire and half pin fixation elements provide efficient bone segment stabilisation. A biomechanically superior metal-plastic interface is stable both during and between adjustments. The system is versatile, consisting of rings, half-rings, foot plates, 5/8 rings and arches. Full control of bone segments accomplished with orthodox circular frame allows precise movement of segments without compromising stability.</Description><Size>100mm - 300mm partial rings</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112159</SubGroupID><ARTGs><ARTG>177324</ARTG><ARTG>229624</ARTG></ARTGs><MinimumBenefit>978</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW959</BillingCode><PriorBillingCodes><PriorBillingCode>WR449</PriorBillingCode></PriorBillingCodes><Name>SALVATION Partial Ring</Name><Description>Salvation External Fixation Partial Ring</Description><Size>140mm - 220mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112159</SubGroupID><ARTGs><ARTG>198486</ARTG></ARTGs><MinimumBenefit>978</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ171</BillingCode><Name>Orthex Partial Circular Rings</Name><Description>Ring, 5/8, Half, Toe</Description><Size>75-230mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112159</SubGroupID><ARTGs><ARTG>341661</ARTG></ARTGs><MinimumBenefit>978</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT024</BillingCode><Name>Frame It Partial Ring</Name><Description>Partial circular ring</Description><Size>2/3 rings and half rings

Diameter 80mm-220mm</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112159</SubGroupID><ARTGs><ARTG>282764</ARTG></ARTGs><MinimumBenefit>978</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY422</BillingCode><Name>MAXFRAME Distraction Osteogenesis External Fixation System</Name><Description>Partial Circular Ring, Arch Plate</Description><Size>80-240mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112159</SubGroupID><ARTGs><ARTG>383992</ARTG><ARTG>289708</ARTG><ARTG>326183</ARTG></ARTGs><MinimumBenefit>978</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW846</BillingCode><PriorBillingCodes><PriorBillingCode>WR308</PriorBillingCode></PriorBillingCodes><Name>SALVATION Limb Salvage Partial Ring</Name><Description>Partial Ring</Description><Size>120mm - 200mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112159</SubGroupID><ARTGs><ARTG>198486</ARTG></ARTGs><MinimumBenefit>978</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW478</BillingCode><Name>HOFFMANN LRF - PARTIAL CIRCULAR RING</Name><Description>PARTIAL CIRCULAR RING</Description><Size>DIAMETER - 100-240MM</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112159</SubGroupID><ARTGs><ARTG>197935</ARTG></ARTGs><MinimumBenefit>978</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL019</BillingCode><Name>Modular Rail System</Name><Description>Rail Arc</Description><Size>Various</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112159</SubGroupID><ARTGs><ARTG>97612</ARTG></ARTGs><MinimumBenefit>978</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN953</BillingCode><Name>Smith &amp; Nephew External Fixation (Llizarov, Taylor Spatial Frame, Jet-X, Compass)</Name><Description>Partial Circular Ring</Description><Size>Standard</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112159</SubGroupID><ARTGs><ARTG>156686</ARTG><ARTG>97612</ARTG></ARTGs><MinimumBenefit>978</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST965</BillingCode><Name>TenXor External Fixation System</Name><Description>Anodized metal alloy, open ring</Description><Size>150, 180, 210, 250mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112159</SubGroupID><ARTGs><ARTG>112434</ARTG><ARTG>16241</ARTG></ARTGs><MinimumBenefit>978</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK043</BillingCode><Name>Linear Distractor</Name><Description>Linear Distractor.</Description><Size>70mm to 200mm.</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112160</SubGroupID><ARTGs><ARTG>177324</ARTG></ARTGs><MinimumBenefit>836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL235</BillingCode><Name>SMART TSF (Taylor Spatial Frame)</Name><Description>Struts</Description><Size>XX Short – Long</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112160</SubGroupID><ARTGs><ARTG>384817</ARTG></ARTGs><MinimumBenefit>836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN955</BillingCode><Name>Smith &amp; Nephew External Fixation (Ilizarov, Taylor Spatial Frame, Jet-X, Compass)</Name><Description>Circular Frame Strut Device, 3 Dimensional</Description><Size>standard</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112160</SubGroupID><ARTGs><ARTG>384817</ARTG><ARTG>97612</ARTG></ARTGs><MinimumBenefit>836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ166</BillingCode><Name>Orthex Distractor Strut</Name><Description>Distractor </Description><Size>100-155mm; Short and Long</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112160</SubGroupID><ARTGs><ARTG>341661</ARTG></ARTGs><MinimumBenefit>836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW854</BillingCode><PriorBillingCodes><PriorBillingCode>WR316</PriorBillingCode></PriorBillingCodes><Name>SALVATION Limb Salvage Struts</Name><Description>Struts</Description><Size>60mm - 230mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112160</SubGroupID><ARTGs><ARTG>198486</ARTG></ARTGs><MinimumBenefit>836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW964</BillingCode><PriorBillingCodes><PriorBillingCode>WR454</PriorBillingCode></PriorBillingCodes><Name>SALVATION Strut</Name><Description>SALVATION External Fixation Strut</Description><Size>60mm - 230mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112160</SubGroupID><ARTGs><ARTG>198486</ARTG></ARTGs><MinimumBenefit>836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY793</BillingCode><Name>MAXFRAME Distraction Osteogenesis External Fixation System</Name><Description>Circular frame struts</Description><Size>XX Short - Long</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112160</SubGroupID><Suffix>3D</Suffix><ARTGs><ARTG>326183</ARTG></ARTGs><MinimumBenefit>1235</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT026</BillingCode><Name>Frame It Struts</Name><Description>Complex 3D Strut</Description><Size>Standard</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112160</SubGroupID><Suffix>3D</Suffix><ARTGs><ARTG>282764</ARTG></ARTGs><MinimumBenefit>1235</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ172</BillingCode><Name>Orthex Struts</Name><Description>Struts, Telescoping, Quick Lock</Description><Size>70-295mm, small, medium, large</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112160</SubGroupID><Suffix>3D</Suffix><ARTGs><ARTG>341661</ARTG></ARTGs><MinimumBenefit>1235</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR096</BillingCode><Name>HOFFMANN LRF - TELESCOPIC STRUT</Name><Description>TELESCOPIC STRUT</Description><Size>LENGTHS - 100-277MM</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112160</SubGroupID><ARTGs><ARTG>197935</ARTG><ARTG>258035</ARTG></ARTGs><MinimumBenefit>836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK032</BillingCode><Name>3D Rapid Adjust Strut</Name><Description>The rapid adjust strut is made of two metal casings encapsulating a threaded rod. It has the ability to correct acutely or gradually. The rapid adjust strut ends have 45 degree locking angulation with 360 degree rotation. The rapid adjust struts have unique ball and claw universal lockable joint at both ends of the strut. Two rapid adjust struts are sufficient for fracture reduction and initial stabilisation, whereas three rapid adjust struts are necessary for walking and weight bearing. Loosening of the ball claw joints allows for verification of the amplitude of angular correction and horizontal translation, magnitude of rotational correction and stability of fixation in coronal, sagittal and horizontal planes.</Description><Size>Short 70 - 104mm range  Medium 98 - 188mm range  Long 163 - 300mm range</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112160</SubGroupID><Suffix>3D</Suffix><ARTGs><ARTG>177324</ARTG><ARTG>207662</ARTG></ARTGs><MinimumBenefit>1235</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN244</BillingCode><Name>MAXFRAME Distraction Osteogenesis External Fixation System</Name><Description>ASSURE-STRUT™ Quick Adjust Strut - integral locking system, self-adjustment knob</Description><Size>XShort - Long</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112160</SubGroupID><Suffix>3D</Suffix><ARTGs><ARTG>326183</ARTG></ARTGs><MinimumBenefit>1235</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW481</BillingCode><Name>HOFFMANN LRF - THREADED TELESCOPIC ROD</Name><Description>THREADED TELESCOPIC ROD</Description><Size>DIAMETER - 6MM LENGTHS  - 30-400MM</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112160</SubGroupID><ARTGs><ARTG>197935</ARTG></ARTGs><MinimumBenefit>836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW480</BillingCode><Name>HOFFMANN LRF - STATIC STRUT</Name><Description>STATIC STRUT</Description><Size>LENGTHS - 20 -60MM</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112160</SubGroupID><ARTGs><ARTG>197935</ARTG></ARTGs><MinimumBenefit>836</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW633</BillingCode><Name>Hoffmann LRF System</Name><Description>Hexapod Strut</Description><Size>XS, S, M, L</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112160</SubGroupID><Suffix>3D</Suffix><ARTGs><ARTG>258035</ARTG></ARTGs><MinimumBenefit>1235</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK033</BillingCode><Name>3D Telescopic Strut</Name><Description>Struts consist of two telescopic aluminium tubes, outer tube and an inner tube, which can be locked together at various lengths using the side locking bolt and clamp washer. The inner tube is attached to a spring-loaded, black knurled adjustment knob. The adjustment knob mates with the threaded rod in a manner such that the rod translates relative to the inner tube when the knob is rotated. This will provide gradual changes of overall strut length in 0.5mm increments. A reference arrow with plus sign located on the base of the adjustment knob indicates the direction of turning to perform strut elongation - distraction. Each strut has two special joints and one at the base of the outer tube and the other at the end of the threaded rod. Each joint has a mounting stud, which can be inserted into the mounting holes on the ring tabs and held in place by the locking screw. The rapid adjustment of the strut length is achieved by untightening the side locking bolt, sliding the inner tube relative to the outer tube to the desired length. The rapid adjustment is indicated by the inner tube scale in 1mm increments relative to the orange line mark on the outer tube. The gradual adjustment is achieved by pulling and rotating the adjustment knob resulting in a noticeable detect click every 0.5mm of adjustment. Gradual adjustment is indicated by the scale relative to the green line mark.</Description><Size>Struts are available in four sizes - ultrashort, short, medium and long providing adjustment range from 45mm to 318mm.  Ultrashort strut  45 - 101mm range  Short strut 92 - 122mm range  Medium strut 114 - 184mm range  Long strut 158 - 318mm range</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112160</SubGroupID><Suffix>3D</Suffix><ARTGs><ARTG>177324</ARTG><ARTG>207662</ARTG></ARTGs><MinimumBenefit>1235</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY427</BillingCode><Name>MAXFRAME Distraction Osteogenesis External Fixation System</Name><Description>Foot Rings, Foot Plates Short/Long, Footplate Support Kit - single unit with Left/Right Supports</Description><Size>Rings/Plates 100mm-210mm, Supports One Size - Left &amp; Right</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112161</SubGroupID><ARTGs><ARTG>155806</ARTG><ARTG>289708</ARTG></ARTGs><MinimumBenefit>1872</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN957</BillingCode><Name>Smith &amp; Nephew External Fixation (Llizarov, Taylor Spatial Frame, Jet-X, Compass)</Name><Description>Foot Plate</Description><Size>Standard</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112161</SubGroupID><ARTGs><ARTG>97612</ARTG></ARTGs><MinimumBenefit>1872</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ167</BillingCode><Name>Orthex Foot Plate</Name><Description>Foot Plate</Description><Size>75-205mm, short</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112161</SubGroupID><ARTGs><ARTG>341661</ARTG></ARTGs><MinimumBenefit>1872</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT027</BillingCode><Name>Frame It Foot Plate</Name><Description>Foot plate</Description><Size>Diameter 80mm-220mm</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112161</SubGroupID><ARTGs><ARTG>282764</ARTG></ARTGs><MinimumBenefit>1872</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL236</BillingCode><Name>SMART TSF (Taylor Spatial Frame)</Name><Description>Foot Plate</Description><Size>155 - 180 mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112161</SubGroupID><ARTGs><ARTG>384817</ARTG></ARTGs><MinimumBenefit>1872</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK031</BillingCode><Name>Orthofix Circular Frame Foot Plate</Name><Description>The Orthofix circular frame is a surgeon designed, user-friendly ring fixation system for trauma applications, limb lengthening and deformity correction. It is based on the science, methodology and principles of Prof Ilizarov. The circular frame is simple, offering preassembled functional components that are easy to connect and operate. The frame is stable with anti-rotational feature on connection elements that prevents any undesirable movement. Its unique wire and half pin fixation elements provide efficient bone segment stabilisation. A biomechanically superior metal-plastic interface is stable both during and between adjustments. The system is versatile, consisting of rings, half-rings, foot plates, 5/8 rings and arches. Full control of bone segments accomplished with Orthofix circular frame allows precise movement of segments without compromising stability.</Description><Size>100mm - 220mm foot plates</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112161</SubGroupID><ARTGs><ARTG>229624</ARTG><ARTG>177324</ARTG></ARTGs><MinimumBenefit>1872</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW475</BillingCode><Name>HOFFMAN LRF</Name><Description>FOOT RING PLATE/ARCH</Description><Size>DIAMETER - 100-210MM</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112161</SubGroupID><ARTGs><ARTG>112434</ARTG><ARTG>197935</ARTG></ARTGs><MinimumBenefit>1872</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW844</BillingCode><PriorBillingCodes><PriorBillingCode>WR306</PriorBillingCode></PriorBillingCodes><Name>SALVATION Limb Salvage Foot Plates</Name><Description>Foot Plates</Description><Size>120mm - 180mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112161</SubGroupID><ARTGs><ARTG>198486</ARTG></ARTGs><MinimumBenefit>1872</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK042</BillingCode><Name>TrueLok Ring Fixation System - Spacers, Washers, Nuts, Bolts</Name><Description>Nuts, Spacers, Washers and Bolts.</Description><Size>Length 12 - 30mm, 10mm Hex Heads, Thickness 2 - 4mm.</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112162</SubGroupID><ARTGs><ARTG>177324</ARTG></ARTGs><MinimumBenefit>36</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW849</BillingCode><PriorBillingCodes><PriorBillingCode>WR311</PriorBillingCode></PriorBillingCodes><Name>SALVATION Limb Salvage Circular Frame Nuts and Spacers</Name><Description>Circular Frame Nuts and Spacers</Description><Size>1mm - 120mm, 1 hole to 4 hole, Standard - Large</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112162</SubGroupID><ARTGs><ARTG>198486</ARTG></ARTGs><MinimumBenefit>36</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW477</BillingCode><Name>HOFFMANNLRF - NUTS, WASHERS , SPACERS</Name><Description>NUTS, WASHERS , SPACERS</Description><Size>SHORT, LONG, M6,M8,1-7MM</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112162</SubGroupID><ARTGs><ARTG>197935</ARTG><ARTG>258035</ARTG></ARTGs><MinimumBenefit>36</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY419</BillingCode><Name>MAXFRAME Distraction Osteogenesis External Fixation System</Name><Description>Nuts, Washers &amp; Spacers, Bolts</Description><Size>Various</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112162</SubGroupID><ARTGs><ARTG>289708</ARTG><ARTG>305577</ARTG><ARTG>326183</ARTG></ARTGs><MinimumBenefit>36</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY228</BillingCode><Name>MAXFRAME Distraction Osteogenesis External Fixation System</Name><Description>Connecting Plate / Spacer</Description><Size>1 - 5 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112162</SubGroupID><ARTGs><ARTG>155806</ARTG></ARTGs><MinimumBenefit>36</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL023</BillingCode><Name>Modular Rail System</Name><Description>Rail Accessories</Description><Size>Various</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112162</SubGroupID><ARTGs><ARTG>97612</ARTG></ARTGs><MinimumBenefit>36</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL237</BillingCode><Name>SMART TSF (Taylor Spatial Frame)</Name><Description>Bolts, Washers</Description><Size>Standard</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112162</SubGroupID><ARTGs><ARTG>218416</ARTG><ARTG>384817</ARTG></ARTGs><MinimumBenefit>36</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN958</BillingCode><Name>Smith &amp; Nephew External Fixation (Llizarov, Taylor Spatial Frame, Jet-X, Compass)</Name><Description>Circular Frame, Nuts &amp; Spacer</Description><Size>standard</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112162</SubGroupID><ARTGs><ARTG>107550</ARTG><ARTG>118355</ARTG><ARTG>108966</ARTG><ARTG>109591</ARTG><ARTG>164373</ARTG><ARTG>97612</ARTG><ARTG>141018</ARTG><ARTG>156686</ARTG></ARTGs><MinimumBenefit>36</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT028</BillingCode><Name>Frame It Nuts &amp; Bolts</Name><Description>Nuts, Bolts and spacers</Description><Size>standard</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112162</SubGroupID><ARTGs><ARTG>282764</ARTG></ARTGs><MinimumBenefit>36</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ160</BillingCode><Name>Orthex Threaded Sockets</Name><Description>Nut, Threaded</Description><Size>18-60mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112162</SubGroupID><ARTGs><ARTG>341661</ARTG></ARTGs><MinimumBenefit>36</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ161</BillingCode><Name>Orthex Frame Components</Name><Description>Circular Frame Components  </Description><Size>Standard</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112162</SubGroupID><ARTGs><ARTG>341661</ARTG></ARTGs><MinimumBenefit>36</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK003</BillingCode><Name>Orthofix External Fixation System Elbow Fixator</Name><Description>Anodised aluminium and stainless steel</Description><Size>One size only</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>117273</ARTG><ARTG>118320</ARTG><ARTG>123604</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK004</BillingCode><Name>Orthofix External Fixation System Hybrid Fixator</Name><Description>Anodised aluminium and stainless steel</Description><Size>One size only</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>117273</ARTG><ARTG>118320</ARTG><ARTG>123604</ARTG><ARTG>177324</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST951</BillingCode><Name>Monotube External Fixation System</Name><Description>Anodized metal alloy, pin clamp yellow, blue, red</Description><Size>15, 20, 25mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>112434</ARTG><ARTG>16241</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST967</BillingCode><Name>TenXor External Fixation System</Name><Description>Anodized metal alloy, wire post, pin post</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>16241</ARTG><ARTG>112434</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST966</BillingCode><Name>TenXor External Fixation System</Name><Description>Anodized metal alloy, ring clamp</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>16241</ARTG><ARTG>112434</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK390</BillingCode><Name>Hoffman II External Fixation System</Name><Description>Hoffman II MRI</Description><Size>Compression/Dystraction Tube, Dynamisation Tube</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>16241</ARTG><ARTG>112434</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY663</BillingCode><Name>Orthopaedic External Fixator Systems</Name><Description>Medium Frame; Rod, Threaded, Adjustable Clamps RL MRI</Description><Size>5-11.0mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>155806</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL022</BillingCode><Name>Modular Rail System</Name><Description>Angle Clamps</Description><Size>Various</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>97612</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL020</BillingCode><Name>Modular Rail System</Name><Description>Caps, clamps (upper, lower &amp; stacked) &amp; hinges, clamp connectors</Description><Size>Various</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>97612</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN959</BillingCode><Name>Smith &amp; Nephew External Fixation (Llizarov, Taylor Spatial Frame, Jet-X, Compass)</Name><Description>Coupling device, 3 dimensional</Description><Size>Standard</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>156686</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN964</BillingCode><Name>Smith &amp; Nephew External Fixation (Llizarov, Taylor Spatial Frame, Jet-X, Compass)</Name><Description>Articulating Hinge, 3 Dimensional</Description><Size>Standard</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>156686</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK005</BillingCode><Name>Orthofix External Fixation System Knee Fixator</Name><Description>Anodised aluminium and stainless steel</Description><Size>One size only</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>117273</ARTG><ARTG>118320</ARTG><ARTG>123604</ARTG><ARTG>177324</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK050</BillingCode><Name>TrueLok Wire, Pin Fixators</Name><Description>Wire, Pin Fixators.</Description><Size>4mm to 8mm.</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>177324</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY744</BillingCode><Name>MAXFRAME Distraction Osteogenesis External Fixation System</Name><Description>Distractors and lengthening apparatus</Description><Size>20mm-250mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>155806</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW847</BillingCode><PriorBillingCodes><PriorBillingCode>WR309</PriorBillingCode></PriorBillingCodes><Name>SALVATION Limb Salvage Wire Fixaters</Name><Description>Wire Fixaters</Description><Size>2mm - 40mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>198486</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK487</BillingCode><Name>Hoffmann Xpress - 5 Pin Clamp Posts</Name><Description>Hoffmann Xpress External Fixation Device - adapted to fit needs of medically trained staff of such occupations as the Armed Forces</Description><Size>2 categories, a 1 post clamp and a 2 post clamp</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>112434</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST950</BillingCode><Name>Monotube External Fixation System</Name><Description>Anodized metal alloy, dynamic tube red</Description><Size>25mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>16241</ARTG><ARTG>112434</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK375</BillingCode><Name>Hoffman II External Fixation System</Name><Description>Hoffman II MRI Coupling</Description><Size>Pin to Rod, Rod to Rod, Tube to Rod, Pin Clamp Assembly</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>112434</ARTG><ARTG>16241</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW516</BillingCode><Name>HOFFMANN3 EXTERNAL FIXATION SYSTEM</Name><Description>ROD COUPLER</Description><Size>0-120 DEGREES</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>112434</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW448</BillingCode><Name>Hoffmann3 External Fixation system - Posts</Name><Description>Hoffmann3 posts</Description><Size>straight, 30 deg, 90 deg</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>112434</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST972</BillingCode><Name>TenXor External Fixation System</Name><Description>Anodized metal alloy,with sliding clamp and spacer</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>112434</ARTG><ARTG>16241</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW449</BillingCode><Name>Hoffmann3 External Fixation System</Name><Description>Rod &amp; Pin-Rod couplings</Description><Size>Coupling, 5/8/11mm rods - 4/5/6mm pins</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>112434</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST954</BillingCode><Name>Monotube External Fixation System</Name><Description>Anodized metal alloy, tube to tube clamp yellow, blue, red, yellow/blue, blue/red</Description><Size>15, 20, 25mm, 15/20mm, 20/25mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>16241</ARTG><ARTG>112434</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST971</BillingCode><Name>TenXor External Fixation System</Name><Description>Anodized metal alloy, with sliding clamp</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>112434</ARTG><ARTG>16241</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST952</BillingCode><Name>Monotube External Fixation System</Name><Description>Anodized metal alloy, single pin clamp yellow, blue, red</Description><Size>15, 20, 25mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>112434</ARTG><ARTG>16241</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK485</BillingCode><Name>Hoffmann Xpress - Universal Pin Clamp</Name><Description>Hoffmann Xpress External Fixation Device - Adapted to fit the needs of medically trained staff of such occupations as the Armed Forces</Description><Size>One size to fit the Rod to Rod</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><ARTGs><ARTG>112434</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK206</BillingCode><Name>Hoffmann II External Fixation System</Name><Description>Hoffmann II Micro - Couplings </Description><Size>Couplings, Rod to rod, Pin to Rod and Multipin</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><Suffix>Mini</Suffix><ARTGs><ARTG>16241</ARTG><ARTG>112434</ARTG></ARTGs><MinimumBenefit>613</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST935</BillingCode><Name>Hoffman II External Fixation System</Name><Description>Anodised metal alloy, rod to rod coupling</Description><Size>8/8mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><Suffix>Small</Suffix><ARTGs><ARTG>16241</ARTG><ARTG>112434</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST936</BillingCode><Name>Hoffman II External Fixation System</Name><Description>Anodised metal alloy, pin to rod coupling</Description><Size>8/4, 5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><Suffix>Small</Suffix><ARTGs><ARTG>16241</ARTG><ARTG>112434</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY745</BillingCode><Name>Orthopaedic External Fixator Systems</Name><Description>Distractors and lengthening apparatus</Description><Size>≥ 160mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112163</SubGroupID><Suffix>CDD</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>622</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY193</BillingCode><Name>Orthopaedic External Fixator Systems</Name><Description>Rod / Bar</Description><Size>2.0mm - 15mm (diameter)</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112164</SubGroupID><Suffix>Small</Suffix><ARTGs><ARTG>289708</ARTG><ARTG>155806</ARTG><ARTG>326183</ARTG></ARTGs><MinimumBenefit>137</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY224</BillingCode><Name>MAXFRAME, Distraction Osteogenesis &amp; External Fixation System</Name><Description>External fixator clamp components, angled piece</Description><Size>Oblique, 1.0 - 3.0mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112164</SubGroupID><Suffix>Small</Suffix><ARTGs><ARTG>289708</ARTG></ARTGs><MinimumBenefit>137</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI964</BillingCode><Name>XtraFix External Fixation System</Name><Description>Connecting rods</Description><Size>6mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112164</SubGroupID><Suffix>Small</Suffix><ARTGs><ARTG>270757</ARTG></ARTGs><MinimumBenefit>137</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL255</BillingCode><Name>MAVERICK Mini</Name><Description>Bars/ Rods</Description><Size>6mm x 75-300 mm and 6mm offset</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112164</SubGroupID><Suffix>Small</Suffix><ARTGs><ARTG>401572</ARTG></ARTGs><MinimumBenefit>137</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST964</BillingCode><Name>Monotube External Fixation System</Name><Description>Carbon tube red 015, RL</Description><Size>150, 200, 250, 300mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112164</SubGroupID><Suffix>Standard</Suffix><ARTGs><ARTG>16241</ARTG><ARTG>112434</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK393</BillingCode><Name>Hoffman II External Fixation System</Name><Description>Hoffmann II MRI Connecting Rods, RL </Description><Size>8mm Connecting rod (100mm - 500mm), 5mm Connecting rod (100mm - 500mm), Semi Circular Curve Rod</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112164</SubGroupID><Suffix>Standard</Suffix><ARTGs><ARTG>16241</ARTG><ARTG>112434</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST963</BillingCode><Name>Monotube External Fixation System</Name><Description>Carbon tube blue 015, RL</Description><Size>150, 200, 250, 300mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112164</SubGroupID><Suffix>Standard</Suffix><ARTGs><ARTG>16241</ARTG><ARTG>112434</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK486</BillingCode><Name>Hoffmann Xpress External Fixation Device</Name><Description>Hoffmann Xpress - Connnecting Tube, RL, MRI</Description><Size>15 mm diameter / 150 to 440 mm in length</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112164</SubGroupID><Suffix>Standard</Suffix><ARTGs><ARTG>112434</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW852</BillingCode><PriorBillingCodes><PriorBillingCode>WR314</PriorBillingCode></PriorBillingCodes><Name>SALVATION Limb Salvage Rods</Name><Description>Rods</Description><Size>60mm - 400mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112164</SubGroupID><Suffix>Standard</Suffix><ARTGs><ARTG>198486</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW446</BillingCode><Name>Hoffmann3 External Fixation system - MRI Curved and straight rod/coupler - carbon fibre</Name><Description>MRI curved and straight rod/coupler - carbon fibre</Description><Size>Diameter - 11mm, lengths 100-650mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112164</SubGroupID><Suffix>Standard</Suffix><ARTGs><ARTG>112434</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI965</BillingCode><Name>XtraFix External Fixation System</Name><Description>Connecting rods</Description><Size>11mm, large</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112164</SubGroupID><Suffix>Standard</Suffix><ARTGs><ARTG>270757</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY196</BillingCode><Name>Orthopaedic External Fixator Systems</Name><Description>Rod/Bar</Description><Size>8 - 11 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112164</SubGroupID><Suffix>Standard</Suffix><ARTGs><ARTG>155806</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY421</BillingCode><Name>MAXFRAME Distraction Osteogenesis External Fixation System</Name><Description>Threaded Rod</Description><Size>60- 400mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112164</SubGroupID><Suffix>Standard</Suffix><ARTGs><ARTG>155806</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN961</BillingCode><Name>Smith &amp; Nephew External Fixation (Llizarov, Taylor Spatial Frame, Jet-X, Compass)</Name><Description>Rods, telescopic</Description><Size>standard</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112164</SubGroupID><Suffix>Standard</Suffix><ARTGs><ARTG>97612</ARTG><ARTG>156686</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL248</BillingCode><Name>MAVERICK External Fixation</Name><Description>Bars/ Rods</Description><Size>100 – 600 mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112164</SubGroupID><Suffix>Standard</Suffix><ARTGs><ARTG>401572</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN960</BillingCode><Name>Smith &amp; Nephew External Fixation (Llizarov, Taylor Spatial Frame, Jet-X, Compass)</Name><Description>Rods</Description><Size>Standard</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112164</SubGroupID><Suffix>Standard</Suffix><ARTGs><ARTG>156686</ARTG><ARTG>97612</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY667</BillingCode><Name>Orthopaedic External Fixator Systems</Name><Description>Curved and straight rod, RL, MRI Carbon Fibre</Description><Size>8.0-11.0mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112164</SubGroupID><Suffix>Standard</Suffix><ARTGs><ARTG>155806</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK041</BillingCode><Name>TrueLok/TL-HEX/EVO Threaded rods</Name><Description>Threaded rods.</Description><Size>60mm - 400mm.</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112164</SubGroupID><Suffix>Standard</Suffix><ARTGs><ARTG>177324</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT029</BillingCode><Name>Frame It Rods</Name><Description>Threaded Rods</Description><Size>6mm Diameter
Lengths from 80mm-200mm</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112164</SubGroupID><Suffix>Standard</Suffix><ARTGs><ARTG>282764</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ168</BillingCode><Name>Orthex Threaded Rods</Name><Description>Threaded Rods</Description><Size>60-450mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112164</SubGroupID><Suffix>Standard</Suffix><ARTGs><ARTG>341661</ARTG></ARTGs><MinimumBenefit>143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST962</BillingCode><Name>Monotube External Fixation System</Name><Description>Carbon tube yellow 015, RL</Description><Size>15mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112164</SubGroupID><Suffix>Small</Suffix><ARTGs><ARTG>112434</ARTG><ARTG>16241</ARTG></ARTGs><MinimumBenefit>137</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ169</BillingCode><Name>Orthex Threaded Rods</Name><Description>Threaded Rods</Description><Size>30-120mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112164</SubGroupID><Suffix>Mini</Suffix><ARTGs><ARTG>341661</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK212</BillingCode><Name>Hoffmann II External Fixation System</Name><Description>Hoffman II Micro - Stainless Steel Rods</Description><Size>3mm x (30-180mm)</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112164</SubGroupID><Suffix>Mini</Suffix><ARTGs><ARTG>112434</ARTG><ARTG>16241</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK211</BillingCode><Name>Hoffmann II External Fixation System</Name><Description>Hoffmann II Micro - Carbon Fibre Rods, RL</Description><Size>3mm (30-150mm)</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112164</SubGroupID><Suffix>Mini</Suffix><ARTGs><ARTG>112434</ARTG><ARTG>16241</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK008</BillingCode><Name>Osteotite screw</Name><Description>HA coated screw used for fixation of an external frame</Description><Size>Shaft Dia 3.0 - 6.0mm, Thread Dia 6.0 - 2.0mm, Total Length 40 - 260mm, Thread Length 15 - 90mm</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112165</SubGroupID><ARTGs><ARTG>117274</ARTG></ARTGs><MinimumBenefit>134</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL256</BillingCode><Name>MAVERICK Mini</Name><Description>Pins</Description><Size>3-4mm x 80-120 mm x 15-30mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112165</SubGroupID><ARTGs><ARTG>401572</ARTG></ARTGs><MinimumBenefit>134</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL010</BillingCode><Name>Smith &amp; Nephew Ex-Fix</Name><Description>Frame Component - pins</Description><Size>All sizes</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112165</SubGroupID><ARTGs><ARTG>131082</ARTG><ARTG>118355</ARTG><ARTG>109512</ARTG><ARTG>157919</ARTG><ARTG>99767</ARTG></ARTGs><MinimumBenefit>134</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY051</BillingCode><Name>AO/ASIF Pins</Name><Description>Seldrill, Schanz Screws, Steinmann Pins, Stainless Steel, Titanium Alloy</Description><Size>3mm - 6mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112165</SubGroupID><ARTGs><ARTG>133927</ARTG><ARTG>297881</ARTG><ARTG>157068</ARTG></ARTGs><MinimumBenefit>134</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL249</BillingCode><Name>MAVERICK and JET-X External Fixation</Name><Description>Pins</Description><Size>30 – 275 mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112165</SubGroupID><ARTGs><ARTG>112731</ARTG><ARTG>401572</ARTG></ARTGs><MinimumBenefit>134</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL233</BillingCode><Name>SMART TSF (Taylor Spatial Frame)</Name><Description>Frame Component - Pins</Description><Size>150-200mm length</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112165</SubGroupID><ARTGs><ARTG>99767</ARTG></ARTGs><MinimumBenefit>134</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT020</BillingCode><Name>Frame IT - Pins</Name><Description>Fixation Pins used in conjunction with the external fixation frame to adjust the placement of frame to best suit individual patient</Description><Size>6mm</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112165</SubGroupID><ARTGs><ARTG>282833</ARTG></ARTGs><MinimumBenefit>134</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ189</BillingCode><Name>Pins</Name><Description>Pin, Half Pin,Transfixation, Large Bone, Small Bone, HA Coated</Description><Size>75-350mm length  2-6mm thickness</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112165</SubGroupID><ARTGs><ARTG>345470</ARTG></ARTGs><MinimumBenefit>134</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK007</BillingCode><Name>Screw</Name><Description>Frame Component - Pins</Description><Size>Shaft Dia 3.0 - 6.0mm
Thread Dia 6.0 - 2.00mm
Total Length 40 - 260mm
Thread Length 15 - 100mm</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112165</SubGroupID><ARTGs><ARTG>117274</ARTG></ARTGs><MinimumBenefit>134</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM334</BillingCode><Name>Axis Pin</Name><Description>Axis Pin</Description><Size>2.5mm x 30mm-70mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112165</SubGroupID><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>134</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM198</BillingCode><Name>MiniFlo pins</Name><Description>Bone pins(screws)for finger mini fixator system</Description><Size>Thread diameter: 1.6,&amp;2.0, 2.5mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112165</SubGroupID><ARTGs><ARTG>222614</ARTG></ARTGs><MinimumBenefit>134</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST884</BillingCode><Name>Apex Pins</Name><Description>Stainless Steel Orthopaedic Pins</Description><Size>2 - 6mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112165</SubGroupID><ARTGs><ARTG>139621</ARTG><ARTG>16241</ARTG></ARTGs><MinimumBenefit>134</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK483</BillingCode><Name>HA Apex Pins</Name><Description>HA coated bone screw</Description><Size>4-6mm diameters, various lengths.</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112165</SubGroupID><ARTGs><ARTG>139621</ARTG></ARTGs><MinimumBenefit>134</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI968</BillingCode><Name>XtraFix External Fixation System</Name><Description>Pins</Description><Size>2.5-6</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112165</SubGroupID><ARTGs><ARTG>272132</ARTG></ARTGs><MinimumBenefit>134</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW851</BillingCode><PriorBillingCodes><PriorBillingCode>WR313</PriorBillingCode></PriorBillingCodes><Name>SALVATION Limb Salvage Pins</Name><Description>Pins</Description><Size>1.8mm - 6mm diameter, 25mm - 180mm length</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112165</SubGroupID><ARTGs><ARTG>198486</ARTG></ARTGs><MinimumBenefit>134</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL234</BillingCode><Name>SMART TSF (Taylor Spatial Frame)</Name><Description>Pin Clamp Assembly – Conversion Clamp</Description><Size>Standard</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112166</SubGroupID><ARTGs><ARTG>218416</ARTG></ARTGs><MinimumBenefit>933</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI966</BillingCode><Name>XtraFix External Fixation System</Name><Description>Pin clamp assembly</Description><Size>large</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112166</SubGroupID><ARTGs><ARTG>270757</ARTG></ARTGs><MinimumBenefit>933</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY200</BillingCode><Name>Orthopaedic External Fixator Systems</Name><Description>External fixator clamps, transverse clamp</Description><Size>1.25 - 6.0mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112166</SubGroupID><ARTGs><ARTG>155806</ARTG></ARTGs><MinimumBenefit>933</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN963</BillingCode><Name>Smith &amp; Nephew External Fixation (Llizarov, Taylor Spatial Frame, Jet-X, Compass)</Name><Description>Pin Clamp Assembly, 3 Dimensional</Description><Size>Standard</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112166</SubGroupID><ARTGs><ARTG>156686</ARTG><ARTG>97612</ARTG></ARTGs><MinimumBenefit>933</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY418</BillingCode><Name>MAXFRAME Distraction Osteogenesis External Fixation System</Name><Description>Bolt-connecting, clamp, eye, wire offset, wire slotted, MRI safe.</Description><Size>One size</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112166</SubGroupID><ARTGs><ARTG>155806</ARTG></ARTGs><MinimumBenefit>933</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN962</BillingCode><Name>Smith &amp; Nephew External Fixation (Llizarov, Taylor Spatial Frame, Jet-X, Compass)</Name><Description>Pin Clamp Assembly</Description><Size>Standard</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112166</SubGroupID><ARTGs><ARTG>156686</ARTG><ARTG>97612</ARTG></ARTGs><MinimumBenefit>933</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST892</BillingCode><Name>Hoffmann II Compact External Fixation System</Name><Description>Pin clamp assembly with no post</Description><Size>One Size Only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112166</SubGroupID><Suffix>Small</Suffix><ARTGs><ARTG>112434</ARTG><ARTG>16241</ARTG></ARTGs><MinimumBenefit>552</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK373</BillingCode><Name>Hoffman II External Fixation system</Name><Description>Hoffman II MRI, Pin Clamp Assembly, MRI</Description><Size>Pelvic Clamp</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112166</SubGroupID><ARTGs><ARTG>16241</ARTG><ARTG>112434</ARTG></ARTGs><MinimumBenefit>933</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI967</BillingCode><Name>XtraFix External Fixation System</Name><Description>Clamp, 3D</Description><Size>Large</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112166</SubGroupID><Suffix>3D</Suffix><ARTGs><ARTG>270757</ARTG></ARTGs><MinimumBenefit>2900</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW447</BillingCode><Name>Hoffmann3 External Fixation System - Pin Clamp</Name><Description>Pin clamp Assembly</Description><Size>5 hole with/without posts</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112166</SubGroupID><ARTGs><ARTG>112434</ARTG></ARTGs><MinimumBenefit>933</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW479</BillingCode><Name>HOFFMANN LRF - POSTS</Name><Description>POSTS</Description><Size>LENGTHS - 44-88MM</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112167</SubGroupID><ARTGs><ARTG>197935</ARTG></ARTGs><MinimumBenefit>89</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK374</BillingCode><Name>Hoffman II External Fixation System</Name><Description>Hoffman II MRI</Description><Size>Posts 8mm and 5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112167</SubGroupID><ARTGs><ARTG>16241</ARTG><ARTG>112434</ARTG></ARTGs><MinimumBenefit>89</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST937</BillingCode><Name>Hoffman II External Fixation System</Name><Description>Anodised metal alloy, 30 deg angled post, stainless steel</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112167</SubGroupID><Suffix>Small</Suffix><ARTGs><ARTG>112434</ARTG><ARTG>16241</ARTG></ARTGs><MinimumBenefit>79</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW963</BillingCode><PriorBillingCodes><PriorBillingCode>WR453</PriorBillingCode></PriorBillingCodes><Name>SALVATION L Bracket</Name><Description>L Bracket</Description><Size>1-6 hole. Short and tall</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112167</SubGroupID><ARTGs><ARTG>198486</ARTG></ARTGs><MinimumBenefit>89</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL250</BillingCode><Name>MAVERICK External Fixation</Name><Description>Straight, 30°, and 90° Posts</Description><Size>Straight, 30°, and 90°</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112167</SubGroupID><ARTGs><ARTG>401572</ARTG></ARTGs><MinimumBenefit>89</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY420</BillingCode><Name>MAXFRAME Distraction Osteogenesis External Fixation System</Name><Description>Wire Post MRI Safe</Description><Size>Short, Tall, Long and 1 to 5 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112167</SubGroupID><ARTGs><ARTG>383992</ARTG><ARTG>289708</ARTG></ARTGs><MinimumBenefit>89</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW848</BillingCode><PriorBillingCodes><PriorBillingCode>WR310</PriorBillingCode></PriorBillingCodes><Name>SALVATION Limb Salvage Posts</Name><Description>Posts</Description><Size>1 - 6 hole, short and tall</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112167</SubGroupID><ARTGs><ARTG>198486</ARTG></ARTGs><MinimumBenefit>89</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST938</BillingCode><Name>Hoffman II External Fixation System</Name><Description>Anodised metal alloy, straight post, stainless steel</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112167</SubGroupID><Suffix>Small</Suffix><ARTGs><ARTG>16241</ARTG><ARTG>112434</ARTG></ARTGs><MinimumBenefit>79</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW853</BillingCode><PriorBillingCodes><PriorBillingCode>WR315</PriorBillingCode></PriorBillingCodes><Name>SALVATION Limb Salvage Hinges</Name><Description>Hinges</Description><Size>Universal and In-line.</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112168</SubGroupID><Suffix>Mini</Suffix><ARTGs><ARTG>198486</ARTG></ARTGs><MinimumBenefit>2337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST888</BillingCode><Name>Howmedica Dynamic Joint Distractor</Name><Description>Complete Y Body Frame - Stainless Steel</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112168</SubGroupID><Suffix>CDD</Suffix><ARTGs><ARTG>16241</ARTG><ARTG>112434</ARTG></ARTGs><MinimumBenefit>3866</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ173</BillingCode><Name>Orthex Articulating Hinge</Name><Description>Universal, Single plane, 90 degree Hinges</Description><Size>standard</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112168</SubGroupID><ARTGs><ARTG>341661</ARTG></ARTGs><MinimumBenefit>428</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY428</BillingCode><Name>MAXFRAME, Distraction Osteogenesis &amp; External Fixation System</Name><Description>Hinge</Description><Size>One Size</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112168</SubGroupID><ARTGs><ARTG>155806</ARTG></ARTGs><MinimumBenefit>428</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK040</BillingCode><Name>TrueLok Ring Fixation System - Hinges</Name><Description>Universal and inline hinges.</Description><Size>Standard.</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112168</SubGroupID><ARTGs><ARTG>177324</ARTG></ARTGs><MinimumBenefit>428</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH557</BillingCode><Name>IOS  Fixator Kit</Name><Description>Complete kit of fixator, 6x bone pins, 6 x set screws, 6 x collets, drill bit.</Description><Size>long, short</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112169</SubGroupID><ARTGs><ARTG>266632</ARTG></ARTGs><MinimumBenefit>3042</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK006</BillingCode><Name>Orthopaedic External Fixation System - Radiolucent Wrist Fixator</Name><Description>Complete System Sterile</Description><Size>One size only</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112170</SubGroupID><ARTGs><ARTG>197444</ARTG></ARTGs><MinimumBenefit>4969</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK396</BillingCode><Name>Hoffmann II Compact Wrist Sterile Pre-Packs, RL</Name><Description>Bridging &amp; Non-bridging</Description><Size>Sterile Wrist Kit</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112170</SubGroupID><ARTGs><ARTG>112434</ARTG></ARTGs><MinimumBenefit>4969</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN965</BillingCode><Name>Jet X Distal Radius Kit</Name><Description>Complete Frame, 3 Dimensional &amp; Compression/Distraction Device</Description><Size>Small</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112170</SubGroupID><ARTGs><ARTG>97612</ARTG></ARTGs><MinimumBenefit>4969</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW489</BillingCode><Name>HOFFMANN3 external fixation system</Name><Description>Sterile field kit</Description><Size>Standard kit A</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112170</SubGroupID><ARTGs><ARTG>112434</ARTG></ARTGs><MinimumBenefit>4969</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA062</BillingCode><Name>FastFrame External Fixation System</Name><Description>Distal radius - fully assembled, sterile</Description><Size>Length: 150mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112170</SubGroupID><ARTGs><ARTG>315769</ARTG></ARTGs><MinimumBenefit>4969</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK378</BillingCode><Name>Hoffman II External Fixation System</Name><Description>Hoffman Pre-pack Pelvic kit</Description><Size>Sterile Pelvic Kit</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112171</SubGroupID><ARTGs><ARTG>112434</ARTG></ARTGs><MinimumBenefit>5397</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN946</BillingCode><Name>Jet X Bar Ankle spanning kit</Name><Description>Complete Frames, 3 Dimensional &amp; Compression/Distraction</Description><Size>Standard</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112171</SubGroupID><ARTGs><ARTG>112731</ARTG><ARTG>97612</ARTG></ARTGs><MinimumBenefit>5397</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK047</BillingCode><Name>Orthofix and CalcFix Plus Calcaneal External Fixator Sterile Kit</Name><Description>The Kits contain the Calcaneal Fixator, T-Wrench, Driver, Screws and Kirschner wire.</Description><Size>One size.</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112171</SubGroupID><ARTGs><ARTG>257368</ARTG></ARTGs><MinimumBenefit>5397</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK012</BillingCode><Name>Orthofix Limb Reconstruction System</Name><Description>Orthofix Limb Reconstruction System</Description><Size>Adult and paediatric - Short, Standard and Long</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112171</SubGroupID><ARTGs><ARTG>197364</ARTG></ARTGs><MinimumBenefit>5397</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK010</BillingCode><Name>Orthopaedic External Fixation System - Xcaliber External Fixator</Name><Description>Articulated Ankle Fixator</Description><Size>One size only</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112171</SubGroupID><ARTGs><ARTG>197444</ARTG></ARTGs><MinimumBenefit>5397</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW962</BillingCode><PriorBillingCodes><PriorBillingCode>WR452</PriorBillingCode></PriorBillingCodes><Name>SALVATION Frame Assembly</Name><Description>Salvation External Frame Assembly</Description><Size>200mm -  220mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112171</SubGroupID><ARTGs><ARTG>198486</ARTG></ARTGs><MinimumBenefit>5397</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK364</BillingCode><Name>Hoffman II External Fixation System</Name><Description>Hoffman II Sterile Pre-pack kit, RL</Description><Size>Standard Tibia</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112171</SubGroupID><ARTGs><ARTG>112434</ARTG></ARTGs><MinimumBenefit>5397</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW961</BillingCode><PriorBillingCodes><PriorBillingCode>WR451</PriorBillingCode></PriorBillingCodes><Name>SALVATION Frame Assembly</Name><Description>Salvation External Frames Assembly</Description><Size>160mm - 180mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112171</SubGroupID><ARTGs><ARTG>198486</ARTG></ARTGs><MinimumBenefit>5397</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW842</BillingCode><PriorBillingCodes><PriorBillingCode>WR304</PriorBillingCode></PriorBillingCodes><Name>SALVATION Limb Salvage Pre-Assembled Frame Assemblies</Name><Description>Pre - Assembled Frame</Description><Size>120mm - 180mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112171</SubGroupID><ARTGs><ARTG>198486</ARTG></ARTGs><MinimumBenefit>5397</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW490</BillingCode><Name>HOFFMANN3 external fixation system</Name><Description>Sterile field kit</Description><Size>Standard kit B</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112171</SubGroupID><ARTGs><ARTG>112434</ARTG></ARTGs><MinimumBenefit>5397</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK365</BillingCode><Name>Hoffman II External Fixation System</Name><Description>Hoffmann II Ankle Sterile Pre-Pack kit, RL</Description><Size>Standard Large Ankle Kit</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112171</SubGroupID><ARTGs><ARTG>112434</ARTG></ARTGs><MinimumBenefit>5397</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW843</BillingCode><PriorBillingCodes><PriorBillingCode>WR305</PriorBillingCode></PriorBillingCodes><Name>SALVATION Limb Salvage Frame Assemblies</Name><Description>Frame Assemblies</Description><Size>160mm - 200mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112171</SubGroupID><ARTGs><ARTG>198486</ARTG></ARTGs><MinimumBenefit>5397</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK568</BillingCode><Name>Hoffmann II MRI System</Name><Description>Anodized metal alloy, dynamic tube, MRI</Description><Size>15/20mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112173</SubGroupID><Suffix>CDD</Suffix><ARTGs><ARTG>112434</ARTG></ARTGs><MinimumBenefit>2410</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK044</BillingCode><Name>LRS</Name><Description>Rails and Compression Distraction Unit.</Description><Size>100mm to 400mm.</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112173</SubGroupID><Suffix>CDD</Suffix><ARTGs><ARTG>123604</ARTG><ARTG>197638</ARTG><ARTG>172152</ARTG></ARTGs><MinimumBenefit>2410</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST948</BillingCode><Name>Monotube External Fixation System</Name><Description>Anodized metal alloy, dynamic tube yellow</Description><Size>15mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112173</SubGroupID><Suffix>Small, CDD</Suffix><ARTGs><ARTG>16241</ARTG><ARTG>112434</ARTG></ARTGs><MinimumBenefit>990</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ165</BillingCode><Name>Monoplanar Body</Name><Description>Body</Description><Size>100 - 400 mm  </Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112173</SubGroupID><ARTGs><ARTG>341661</ARTG></ARTGs><MinimumBenefit>657</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL018</BillingCode><Name>Modular Rail System</Name><Description>Rail</Description><Size>Standard; small; small short</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112173</SubGroupID><ARTGs><ARTG>97612</ARTG></ARTGs><MinimumBenefit>657</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK567</BillingCode><Name>Monotube External Fixation System</Name><Description>Anodized metal alloy, dynamic tube blue</Description><Size>20mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112173</SubGroupID><Suffix>CDD</Suffix><ARTGs><ARTG>112434</ARTG></ARTGs><MinimumBenefit>2410</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN950</BillingCode><Name>Smith &amp; Nephew External Fixation (Ilizarov, Taylor Spatial Frame, Jet-X, Compass)</Name><Description>Monoplanar Clamp, compression distraction device</Description><Size>Standard</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112173</SubGroupID><Suffix>CDD</Suffix><ARTGs><ARTG>97612</ARTG></ARTGs><MinimumBenefit>2410</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW482</BillingCode><Name>HOFFMANN LRF - WIRE BOLT COUPLINGS</Name><Description>WIRE BOLT COUPLING</Description><Size>SHORT, MEDIUM, LONG</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112174</SubGroupID><ARTGs><ARTG>197935</ARTG></ARTGs><MinimumBenefit>225</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN951</BillingCode><Name>Smith &amp; Nephew External Fixation (Ilizarov, Taylor Spatial Frame, Jet-X, Compass)</Name><Description>Monoplanar adaptor</Description><Size>standard</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112174</SubGroupID><ARTGs><ARTG>97612</ARTG></ARTGs><MinimumBenefit>225</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN954</BillingCode><Name>Smith &amp; Nephew External Fixation (Llizarov, Taylor Spatial Frame, Jet-X, Compass)</Name><Description>Circular Coupling device</Description><Size>standard</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112174</SubGroupID><ARTGs><ARTG>108966</ARTG><ARTG>156686</ARTG><ARTG>97612</ARTG></ARTGs><MinimumBenefit>225</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW474</BillingCode><Name>HOFFMANN LRF</Name><Description>Coupling</Description><Size>SHORT , LONG</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112174</SubGroupID><ARTGs><ARTG>112434</ARTG><ARTG>197935</ARTG><ARTG>258035</ARTG></ARTGs><MinimumBenefit>225</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VK049</BillingCode><Name>TrueLok</Name><Description>Coupling devices.</Description><Size>Standard.</Size><SupplierCode>40048</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112174</SubGroupID><ARTGs><ARTG>177324</ARTG></ARTGs><MinimumBenefit>225</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL240</BillingCode><Name>SMART TSF (Taylor Spatial Frame)</Name><Description>Circular Coupling Device</Description><Size>Standard</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112174</SubGroupID><ARTGs><ARTG>384817</ARTG></ARTGs><MinimumBenefit>225</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT025</BillingCode><Name>Frame It Coupling</Name><Description>Coupling devices; Posts, Basic Struts, Plates, Hinges and Extenders</Description><Size>Ranging from 1-12 holes</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112174</SubGroupID><ARTGs><ARTG>282764</ARTG></ARTGs><MinimumBenefit>225</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY662</BillingCode><Name>Orthopaedic External Fixator Systems</Name><Description>Hybrid Ring Clamps; Combination, Rod, Rod/Wire, Adjustable, Tube/Tube RL MRI</Description><Size>11.0mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108803</GroupID><SubGroupID>112174</SubGroupID><ARTGs><ARTG>155806</ARTG></ARTGs><MinimumBenefit>225</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HC035</BillingCode><Name>NEOBONE GEL</Name><Description>Synthetic Bone Graft Putty</Description><Size>0.5 - 5ml</Size><SupplierCode>40349</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>351642</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC009</BillingCode><Name>uDesis Gel 1cc-5cc</Name><Description>uDesis  is a synthetic, highly crystalline beta-tricalcium phosphate bone substitute.</Description><Size>1cc, 2.5cc, 5cc</Size><SupplierCode>40100</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>353248</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU168</BillingCode><Name>In'Oss</Name><Description>Synthetic Bone Graft Putty Hydroxyapatite/Beta Calcium Phosphate (HA/beta-TCP) and Hydroxpropylmethylcellulose hydrogel carrier (HPMC).</Description><Size>0.5 ÷ 5ml</Size><SupplierCode>40166</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>303932</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH766</BillingCode><Name>Reosrba Synthetic bone</Name><Description>Injectable Bone Substitute – Putty</Description><Size>0.5-5mL</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>400447</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VG001</BillingCode><Name>CERAMENT BVF</Name><Description>Bone substitute with hydroxyapatite and iohexal</Description><Size>5ml</Size><SupplierCode>40249</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>372270</ARTG></ARTGs><MinimumBenefit>1026</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY073</BillingCode><PriorBillingCodes><PriorBillingCode>DR002</PriorBillingCode></PriorBillingCodes><Name>BioSphere Putty</Name><Description>Bone Graft Substitue - Bioactive Glass Putty</Description><Size>1cc, 2.5cc, 5cc</Size><SupplierCode>40470</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>297474</ARTG></ARTGs><MinimumBenefit>1026</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY001</BillingCode><PriorBillingCodes><PriorBillingCode>EV038</PriorBillingCode></PriorBillingCodes><Name>GlassBONE Injectable Putty</Name><Description>Injectable putty for bone grafting</Description><Size>0.1cc to 5cc</Size><SupplierCode>40470</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>341771</ARTG></ARTGs><MinimumBenefit>1026</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ178</BillingCode><Name>GlassBONE Granules</Name><Description>Bioglass granules for bone grafting</Description><Size>0.5-5cc</Size><SupplierCode>40470</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>433832</ARTG></ARTGs><MinimumBenefit>1026</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN344</BillingCode><Name>FIBERGRAFT</Name><Description>Bioactive Glass (BG) Bone Graft Morsels</Description><Size>2cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>387006</ARTG></ARTGs><MinimumBenefit>1026</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN341</BillingCode><Name>FIBERGRAFT</Name><Description>Bioactive Glass Bone Graft - BG Putty and BG Putty GPS</Description><Size>1-4cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>387410</ARTG><ARTG>387411</ARTG></ARTGs><MinimumBenefit>1026</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MV003</BillingCode><Name>4Bone Synthetic Bone Graft</Name><Description>HA/βTCP synthetic bone graft</Description><Size>0.5cc, 1cc, 2cc</Size><SupplierCode>40146</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>147636</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QG001</BillingCode><Name>Nanogel</Name><Description>Injectable Synthetic Bone Substitute Paste In A Syringe</Description><Size>0.5ml  1.0ml  2.5ml  5.0ml</Size><SupplierCode>39928</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>325849</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB184</BillingCode><Name>SIGNIFY Bioactive</Name><Description>Osteostimulative and osteoconductive bioactive bone void filler</Description><Size>2cc and 5cc</Size><SupplierCode>40358</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>317427</ARTG><ARTG>317449</ARTG><ARTG>317260</ARTG></ARTGs><MinimumBenefit>1026</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MV001</BillingCode><Name>BondBone</Name><Description>Biphasic Calcium Sulfate</Description><Size>0.5cc, 1cc</Size><SupplierCode>40146</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>189584</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH560</BillingCode><Name>JectOS</Name><Description>Injectable synthetic bone graft substitute</Description><Size>5cc</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>141918</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ026</BillingCode><PriorBillingCodes><PriorBillingCode>SV051</PriorBillingCode></PriorBillingCodes><Name>GelOS™</Name><Description>Gel based Synthetic bone substitute</Description><Size>1cc, 2.5cc, 5cc</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>233982</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB362</BillingCode><Name>Nanogel</Name><Description>Synthetic, Biomimetic Bone Substitute Material</Description><Size>Syringe 0.5ml, 1.0ml, 2.5ml, 5.0ml</Size><SupplierCode>40020</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>282244</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH768</BillingCode><Name>Reosrba Synthetic bone</Name><Description>60/40 HA/TCP bone graft substitute</Description><Size>2cc, 5cc Granules</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>400446</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW789</BillingCode><PriorBillingCodes><PriorBillingCode>WR005</PriorBillingCode></PriorBillingCodes><Name>ProDense / Osteoset</Name><Description>Composite Bone Void Filler - Pellets</Description><Size>2cc, 5cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>172033</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ005</BillingCode><Name>ReproBone</Name><Description>TCP/HA Synthetic Bone Graft Granules</Description><Size>0.5-5cc</Size><SupplierCode>40099</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>231295</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW673</BillingCode><PriorBillingCodes><PriorBillingCode>SR061</PriorBillingCode><PriorBillingCode>SK480</PriorBillingCode></PriorBillingCodes><Name>HydroSet Injectable Calcium Phosphate Cement</Name><Description>Injectable, rapid set, calcium phosphate bone substitute kit</Description><Size>0-5cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>138334</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER651</BillingCode><PriorBillingCodes><PriorBillingCode>ER153</PriorBillingCode><PriorBillingCode>ER155</PriorBillingCode></PriorBillingCodes><Name>SIGNUS KAINOS</Name><Description>Bioactive Bone Graft Substitute Granules </Description><Size>2 or 5 cc</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>122272</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW568</BillingCode><Name>Stryker DirectInject</Name><Description>DirectInject bone cement</Description><Size>3cc
5cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>CDS</Suffix><ARTGs><ARTG>278932</ARTG></ARTGs><MinimumBenefit>1188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV016</BillingCode><Name>ProDense 2.0</Name><Description>Injectable Bone Graft Substitute</Description><Size>2cc, 5cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>CDS</Suffix><ARTGs><ARTG>172032</ARTG></ARTGs><MinimumBenefit>1188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW790</BillingCode><PriorBillingCodes><PriorBillingCode>WR002</PriorBillingCode></PriorBillingCodes><Name>ProDense / Osteoset XR</Name><Description>Composite Injectable Bone Void Filler</Description><Size>2cc-5cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>CDS</Suffix><ARTGs><ARTG>172032</ARTG></ARTGs><MinimumBenefit>1188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM091</BillingCode><Name>Injectable Calcium Phosphate Synthetic Bone Substitute</Name><Description>Calcium Phosphate Bone Substitute</Description><Size>5cc</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>CDS</Suffix><ARTGs><ARTG>115698</ARTG></ARTGs><MinimumBenefit>1188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW690</BillingCode><PriorBillingCodes><PriorBillingCode>WR017</PriorBillingCode></PriorBillingCodes><Name>Osteoset Bone Void Filler</Name><Description>Calcium Sulphate</Description><Size>3mm Syringe 1.25cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>CDS</Suffix><ARTGs><ARTG>171900</ARTG></ARTGs><MinimumBenefit>1188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM239</BillingCode><Name>Exabone HA/TCP Wedges, Blocks, Discs</Name><Description>HA/TCP Bone Substitute</Description><Size>Wedges: 15-35mm width x 20-15mm length x 6-14mm height 1 X 4-10mm height 2
Blocks: 4-20mm length x 10-30mm width x 10-45mm height
Discs: 5-20mm diameter x 5-20mm height</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>232997</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ009</BillingCode><Name>ReproBone novo</Name><Description>HA Synthetic Bone Graft Paste</Description><Size>0.5-5ml</Size><SupplierCode>40099</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>217839</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI193</BillingCode><Name>Bone Graft Substitute</Name><Description>Triosite Granules (2 - 3mm grain size) - HATCP</Description><Size>5g Tube</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>143036</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW689</BillingCode><PriorBillingCodes><PriorBillingCode>WR016</PriorBillingCode></PriorBillingCodes><Name>Osteoset Bone Void Filler</Name><Description>Calcium Sulphate</Description><Size>3mm &amp; 4.8mm Pellets 5cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>171899</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK184</BillingCode><Name>VITOSS - Synthetic cancellous bone void filler</Name><Description>Beta-tricalcium phosphate</Description><Size>1.2cc dowel</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>140557</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IJ029</BillingCode><PriorBillingCodes><PriorBillingCode>CR297</PriorBillingCode></PriorBillingCodes><Name>NanoBone - Granules</Name><Description>Nanocrystalline HA in a porous silica matrix, synthetic bone graft substitute granules</Description><Size>0.6ml, 1.2ml, 2.4ml, 5ml</Size><SupplierCode>40241</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>281303</ARTG></ARTGs><MinimumBenefit>1026</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU272</BillingCode><PriorBillingCodes><PriorBillingCode>DE476</PriorBillingCode></PriorBillingCodes><Name>Quickset</Name><Description>Injectable Macroporous Calcium Phospahte</Description><Size>5cc</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>267632</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM207</BillingCode><Name>BonAlive Putty</Name><Description>Bone Graft Substitute - Bioactive Glass Putty</Description><Size>1cc, 2.5cc, 5cc</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>231484</ARTG></ARTGs><MinimumBenefit>1026</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH562</BillingCode><Name>i-FACTOR Putty Peptide Enhanced Bone Graft</Name><Description>P-15, ABM, Osteoinductive, Osteoconductive bone graft substitute</Description><Size>0 - 5.0mL</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>169831</ARTG></ARTGs><MinimumBenefit>1026</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX315</BillingCode><Name>ACTIFUSE SHAPE 2.6mL–BONE MATRIX IMPLANT ARTIFICIAL</Name><Description>A silicate substituted synthetic bone graft</Description><Size>2.6mL</Size><SupplierCode>39947</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>203922</ARTG></ARTGs><MinimumBenefit>1026</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX351</BillingCode><Name>INDUCTIGRAFT</Name><Description>Silicate Substituted Calcium Phosphate Bone Graft   Substitute, 82.5% Porosity</Description><Size>0-5ML  </Size><SupplierCode>39947</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>402036</ARTG></ARTGs><MinimumBenefit>1026</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX313</BillingCode><Name>Actifuse ABX Easyfill Putty</Name><Description>Actifuse ABX Easyfill Putty - A silicate substituted synthetic bone graft</Description><Size>5ml</Size><SupplierCode>39947</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>188736</ARTG></ARTGs><MinimumBenefit>1026</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW692</BillingCode><PriorBillingCodes><PriorBillingCode>WR019</PriorBillingCode></PriorBillingCodes><Name>Osteoset MIIG X3</Name><Description>Injectable Calcium Sulphate Bone Void Filler, Includes Syringe</Description><Size>5cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>CDS</Suffix><ARTGs><ARTG>172285</ARTG></ARTGs><MinimumBenefit>1188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN232</BillingCode><Name>Chronos</Name><Description>Bone Graft Substitute</Description><Size>0-5cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>CDS</Suffix><ARTGs><ARTG>153247</ARTG><ARTG>159907</ARTG></ARTGs><MinimumBenefit>1188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX310</BillingCode><Name>Actifuse ABX Easyfill</Name><Description>Actifuse ABX Easyfill - A silicate substituted synthetic bone graft</Description><Size>1.5mL to 4mL</Size><SupplierCode>39947</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>188736</ARTG></ARTGs><MinimumBenefit>1026</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI192</BillingCode><Name>Bone Graft Substitute</Name><Description>Triosite Granules (0.5 - 1.0 mm grain sizes)- HATCP</Description><Size>1 g Tube</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>143036</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IJ028</BillingCode><PriorBillingCodes><PriorBillingCode>CR298</PriorBillingCode></PriorBillingCodes><Name>NanoBone - Putty</Name><Description>Nanocrystalline HA in a porous silica matrix, synthetic bone graft substitute putty</Description><Size>0.5ml, 1.0ml, 2.5ml, 5ml</Size><SupplierCode>40241</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>292263</ARTG></ARTGs><MinimumBenefit>1026</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM215</BillingCode><Name>BonAlive Granules</Name><Description>Bone Graft Substitute - Bioactive Glass Granules</Description><Size>Range (1-5cc)
0.5-08mm (small) 1cc
0.5-08mm (small) 2.5cc
0.5-0.8mm (small) 5cc
1.0-2.0mm (medium) 5cc
2.0-3.15mm (large) 5cc</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>176953</ARTG></ARTGs><MinimumBenefit>1026</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ093</BillingCode><PriorBillingCodes><PriorBillingCode>SQ188</PriorBillingCode></PriorBillingCodes><Name>MagnetOS Granules</Name><Description>Granule size 0.15-4mm</Description><Size>0.5cc, 1cc, 2cc, 5cc</Size><SupplierCode>40483</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>343493</ARTG></ARTGs><MinimumBenefit>1026</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE655</BillingCode><Name>NovaBone BioGlass</Name><Description>Bioactive synthetic bone graft - calcium phospo-silicate</Description><Size>0.25 - 5cc</Size><SupplierCode>39975</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>320170</ARTG><ARTG>302472</ARTG><ARTG>302473</ARTG></ARTGs><MinimumBenefit>1026</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ096</BillingCode><PriorBillingCodes><PriorBillingCode>SQ185</PriorBillingCode></PriorBillingCodes><Name>MagnetOS Putty</Name><Description>Granule size 0.25-2mm</Description><Size>0.5cc, 1cc, 2cc, 2.5cc, 5cc</Size><SupplierCode>40483</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>345090</ARTG></ARTGs><MinimumBenefit>1026</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OK004</BillingCode><Name>NanoBone - Block</Name><Description>Nanocrystalline HA in a porous silica matrix, synthetic bone graft substitute block</Description><Size>0. 75ml (5x10x15 mm3)</Size><SupplierCode>40176</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>281252</ARTG></ARTGs><MinimumBenefit>1026</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OK003</BillingCode><Name>NanoBone - Granulate</Name><Description>Nanocrystalline HA in a porous silica matrix, synthetic bone graft substitute granulate</Description><Size>0.6ml, 1.2ml, 2.4ml, 5ml</Size><SupplierCode>40176</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>281251</ARTG></ARTGs><MinimumBenefit>1026</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OK005</BillingCode><Name>NanoBone - Putty</Name><Description>QD and SBX Putty</Description><Size>0.25ml, 0.5ml, 1.0ml, 2.5ml, 5ml</Size><SupplierCode>40176</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>314924</ARTG></ARTGs><MinimumBenefit>1026</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX314</BillingCode><Name>ACTIFUSE SHAPE 1.6mL–BONE MATRIX IMPLANT ARTIFICIAL</Name><Description>A silicate substituted synthetic bone graft</Description><Size>1.6mL</Size><SupplierCode>39947</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>203922</ARTG></ARTGs><MinimumBenefit>1026</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW856</BillingCode><PriorBillingCodes><PriorBillingCode>WR323</PriorBillingCode></PriorBillingCodes><Name>Augment Bone Graft - rhPDGF-BB component</Name><Description>rhPDGF-BB solution (0.3mg/ml)</Description><Size>1.5cc (0.45mg)</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>191454</ARTG></ARTGs><Note>The Prostheses List benefit is limited to reimbursement for the use of the device as an alternative to autograft in hindfoot and ankle fusion procedures that require supplemental graft material, including tibiotalar, tibiocalcaneal, talonavicular and calcaneocuboid fusions, or any other procedure if stated in the Intended Purpose in the Australian Register of Therapeutic Goods (ARTG) entry 191454.</Note><MinimumBenefit>1026</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW857</BillingCode><PriorBillingCodes><PriorBillingCode>WR325</PriorBillingCode></PriorBillingCodes><Name>Augment Bone Graft - β-TCP component</Name><Description>β-TCP granules</Description><Size>1.5 cc, 3cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>191454</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ056</BillingCode><Name>ReproBone fusion</Name><Description>HA paste with HA/TCP granules</Description><Size>1cc
2.5cc
5cc</Size><SupplierCode>40099</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>297896</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER107</BillingCode><Name>GeneX</Name><Description>GeneX putty</Description><Size>2.5cc</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>155298</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM235</BillingCode><Name>HA/TCP Granules</Name><Description>HA/TCP Bone graft substitute Granules</Description><Size>2.5cc, 5cc</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>232997</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER655</BillingCode><Name>Biocomposites Stimulan kit 5 cc</Name><Description>Calcium Sulfate synthetic bone void filler kit   </Description><Size>5cc</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>391242</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA074</BillingCode><PriorBillingCodes><PriorBillingCode>ZI194</PriorBillingCode><PriorBillingCode>ZI195</PriorBillingCode><PriorBillingCode>ZI196</PriorBillingCode><PriorBillingCode>ZI198</PriorBillingCode></PriorBillingCodes><Name>Bone Graft Substitute</Name><Description>Triosite block and wedges</Description><Size>10-20mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>143036</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER106</BillingCode><Name>GeneX</Name><Description>GeneX putty</Description><Size>5cc</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>155298</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW691</BillingCode><PriorBillingCodes><PriorBillingCode>WR018</PriorBillingCode></PriorBillingCodes><Name>Osteoset Bone Void Filler</Name><Description>Calcium Sulphate</Description><Size>4.8mm Syringe 5cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>171900</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER652</BillingCode><Name>Biocomposites Stimulan Rapid Cure 5 cc</Name><Description>Calcium Sulfate synthetic rapid setting bone void filler kit.  </Description><Size>5cc</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>391243</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT021</BillingCode><Name>Integrant Bone Graft Granules</Name><Description>Osteo Conductive Bone Substitute, that promotes bone growth</Description><Size>0.5cc - 5.0cc</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>282832</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW687</BillingCode><PriorBillingCodes><PriorBillingCode>WR014</PriorBillingCode></PriorBillingCodes><Name>OSTEOSET - BVT KIT (STANDARD CURE, FAST CURE)</Name><Description>Mini Bead Kit</Description><Size>5cc Standard/Fast Cure</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>173514</ARTG><ARTG>173515</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN233</BillingCode><Name>Chronos</Name><Description>Bone Graft Substitute</Description><Size>0-5cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>153247</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC855</BillingCode><Name>Nanostim</Name><Description>Synthetic Bone Paste</Description><Size>5cc</Size><SupplierCode>40151</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>158926</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV075</BillingCode><Name>AttraX bone graft substitute</Name><Description>1cc Cylinder (Putty)
2cc Cylinder (Putty)
2.5cc Cylinder (Putty)
5cc (2x2.5cc) Strip (Putty)</Description><Size>1cc, 2cc 2.5cc, 5cc</Size><SupplierCode>40129</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>180974</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM240</BillingCode><Name>Exabone Paste</Name><Description>Preloaded Paste in Syringe</Description><Size>0.5cc, 1cc, 2cc, 2.5cc, 5cc</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>232998</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF005</BillingCode><Name>Osteoflo</Name><Description>Biphasic Calcium Phosphate; Hydrated Biphasic Calcium Phosphate (Putty)</Description><Size>1ml, 2ml, 5ml</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>185876</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC854</BillingCode><Name>Nanostim</Name><Description>Synthetic Bone Paste</Description><Size>2cc</Size><SupplierCode>40151</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>158926</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC415</BillingCode><Name>BCP</Name><Description>Biphasic Calcium Phosphate Reabsorbable Graft Supplement</Description><Size>1-3cc</Size><SupplierCode>40151</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>144137</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC853</BillingCode><Name>Nanostim</Name><Description>Synthetic Bone Paste</Description><Size>1cc</Size><SupplierCode>40151</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>158926</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC594</BillingCode><Name>Mastergraft</Name><Description>Calcium Phosphate Ceramic Granules</Description><Size>5cc Vial</Size><SupplierCode>40151</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>96971</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY331</BillingCode><Name>Norian®</Name><Description>Fast Set Putty</Description><Size>3cc-5cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>207130</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF060</BillingCode><Name>Osteoflo G</Name><Description>Biphasic Calcium Phosphate</Description><Size>1cc,2cc, 5cc Granules</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>273800</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER104</BillingCode><Name>GeneX</Name><Description>GeneX/GeneX DS paste</Description><Size>2.5 and 5cc</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>158711</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK191</BillingCode><Name>VITOSS - Synthetic Cancellous bone void filler</Name><Description>Beta-tricalcium phosphate</Description><Size>5cc morsels</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>140557</ARTG><ARTG>77710</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ004</BillingCode><Name>In'Oss</Name><Description>Synthetic Bone Graft Putty 
Hydroxyapatite/Beta Calcium Phosphate (HA/beta-TCP) and Hydroxpropylmethylcellulose hydrogel carrier (HPMC)</Description><Size>0.5 - 5ml</Size><SupplierCode>40099</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112213</SubGroupID><ARTGs><ARTG>203574</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU271</BillingCode><PriorBillingCodes><PriorBillingCode>DE477</PriorBillingCode></PriorBillingCodes><Name>Quickset</Name><Description>Injectable Macropourous Calcium Phosphate</Description><Size>8cc</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>267632</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ177</BillingCode><Name>GlassBONE Granules</Name><Description>Bioglass granules for bone graft</Description><Size>6cc-10cc</Size><SupplierCode>40470</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>433832</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UK002</BillingCode><PriorBillingCodes><PriorBillingCode>ER291</PriorBillingCode></PriorBillingCodes><Name>Tecres CAL-CEMEX Bone Void Filler</Name><Description>CAL-CEMEX Bone Void Filler with delivery system</Description><Size>10 gram</Size><SupplierCode>40267</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>219764</ARTG><ARTG>223957</ARTG><ARTG>220245</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UK001</BillingCode><PriorBillingCodes><PriorBillingCode>ER290</PriorBillingCode></PriorBillingCodes><Name>Tecres CAL-CEMEX bone void filler</Name><Description>CAL-CEMEX bone void filler with optional mixing device</Description><Size>10 grams</Size><SupplierCode>40267</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>219764</ARTG><ARTG>223957</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC856</BillingCode><Name>Nanostim</Name><Description>Synthetic Bone Paste</Description><Size>10cc</Size><SupplierCode>40151</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>158926</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW686</BillingCode><PriorBillingCodes><PriorBillingCode>WR012</PriorBillingCode></PriorBillingCodes><Name>Osteoset</Name><Description>Calcium Sulphate</Description><Size>4.8mm pellets 10cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>171899</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ006</BillingCode><Name>ReproBone</Name><Description>TCP/HA Synthetic Bone Graft Granules</Description><Size>6-10cc</Size><SupplierCode>40099</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>231295</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER105</BillingCode><Name>GeneX</Name><Description>GeneX putty</Description><Size>10cc</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>155298</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM241</BillingCode><Name>Exabone Paste</Name><Description>Preloaded Paste in Syringe</Description><Size>10cc</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>232998</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK188</BillingCode><Name>VITOSS - Synthetic cancellous bone void filler</Name><Description>Beta-tricalcium phosphate</Description><Size>10cc morsels and 10cc dowels</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>140557</ARTG><ARTG>77710</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW683</BillingCode><PriorBillingCodes><PriorBillingCode>WR006</PriorBillingCode></PriorBillingCodes><Name>ProDense / Osteroset XR</Name><Description>Composite Bone Void Filler - Pellets</Description><Size>10cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>172033</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM236</BillingCode><Name>HA/TCP Granules</Name><Description>HA/TCP Bone graft substitute Granules</Description><Size>10cc</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>232997</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER656</BillingCode><Name>Biocomposites Stimulan kit 10 cc</Name><Description>Calcium Sulfate synthetic bone void filler kit  </Description><Size>10 cc</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>391242</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MV002</BillingCode><Name>4Bone Synthetic Bone Graft</Name><Description>HA/βTCP synthetic bone graft</Description><Size>6cc</Size><SupplierCode>40146</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>147636</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV076</BillingCode><Name>AttraX bone graft substitute (&gt;5cc&lt;=10cc)</Name><Description>6cc (2x3cc) Blocks (Putty)
10cc (2x5cc) Strip (Putty)</Description><Size>6cc, 10cc</Size><SupplierCode>40129</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>180974</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ027</BillingCode><PriorBillingCodes><PriorBillingCode>SV052</PriorBillingCode></PriorBillingCodes><Name>GelOS™</Name><Description>Gel based Synthetic bone substitute</Description><Size>10cc</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>233982</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH769</BillingCode><Name>Reosrba Synthetic bone</Name><Description>Injectable Bone Substitute – Granules / Syringe</Description><Size>10cc Granules</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>400446</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC595</BillingCode><Name>Mastergraft</Name><Description>Calcium Phosphate Ceramic Granules</Description><Size>10cc Vial</Size><SupplierCode>40151</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>96971</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER653</BillingCode><Name>Biocomposites Stimulan Rapid Cure 10 cc</Name><Description>Calcium Sulfate synthetic rapid setting bone void filler kit.  </Description><Size>10 cc</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>391243</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR054</BillingCode><Name>HydroSet Injectable Calcium Phosphate</Name><Description>Injectable, rapid set, calcium phosphate bone substitute kit</Description><Size>10cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>138334</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER103</BillingCode><Name>GeneX</Name><Description>GeneX paste</Description><Size>10cc</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>158711</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER157</BillingCode><Name>Kainos</Name><Description>Granules</Description><Size>1x10cm3</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>122272</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV017</BillingCode><Name>ProDense 2.0</Name><Description>Injectable Bone Graft Substitute </Description><Size>7cc, 10cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><Suffix>CDS</Suffix><ARTGs><ARTG>172032</ARTG></ARTGs><MinimumBenefit>1449</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK189</BillingCode><Name>CORTOSS - Synthetic cortical bone void filler</Name><Description>-</Description><Size>10cc CORTOSS kit</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><Suffix>CDS</Suffix><ARTGs><ARTG>140547</ARTG></ARTGs><MinimumBenefit>1449</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OK006</BillingCode><PriorBillingCodes><PriorBillingCode>GO291</PriorBillingCode></PriorBillingCodes><Name>NanoBone - Putty</Name><Description>QD and SBX Putty</Description><Size>10ml</Size><SupplierCode>40176</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>314924</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN231</BillingCode><Name>Chronos</Name><Description>Bone Graft Substitute</Description><Size>5 - 10cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><Suffix>CDS</Suffix><ARTGs><ARTG>153247</ARTG></ARTGs><MinimumBenefit>1449</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY332</BillingCode><Name>Norian®</Name><Description>Fast Set Putty</Description><Size>10cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>207130</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY002</BillingCode><Name>Chronos</Name><Description>Bone Graft Substitute</Description><Size>5 - 10cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>153247</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF061</BillingCode><Name>Osteoflo G</Name><Description>Biphasic Calcium Phosphate</Description><Size>6cc,10cc Granules</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>185876</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH767</BillingCode><Name>Reosrba Synthetic bone</Name><Description>Injectable Bone Substitute – Putty</Description><Size>10mL</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>400447</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ010</BillingCode><Name>ReproBone novo</Name><Description>HA Synthetic Bone Graft Paste</Description><Size>6-10ml</Size><SupplierCode>40099</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><ARTGs><ARTG>217839</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY074</BillingCode><PriorBillingCodes><PriorBillingCode>DR003</PriorBillingCode></PriorBillingCodes><Name>BioSphere Putty</Name><Description>Bone Graft Substrate - Bioactive Glass</Description><Size>6cc-10cc</Size><SupplierCode>40470</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>297474</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY002</BillingCode><PriorBillingCodes><PriorBillingCode>EV037</PriorBillingCode></PriorBillingCodes><Name>GlassBONE Injectable Putty</Name><Description>Injectable putty for bone grafting</Description><Size>10cc</Size><SupplierCode>40470</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>341771</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VG002</BillingCode><Name>CERAMENT BVF</Name><Description>Bone substitute with hydroxyapatite and iohexal</Description><Size>10ml</Size><SupplierCode>40249</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>372270</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN345</BillingCode><Name>FIBERGRAFT</Name><Description>Bioactive Glass (BG) Bone Graft Morsels</Description><Size>6cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>387006</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB183</BillingCode><Name>SIGNIFY Bioactive</Name><Description>Osteostimulative and osteoconductive bioactive bone void filler</Description><Size>10cc</Size><SupplierCode>40358</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>317260</ARTG><ARTG>317427</ARTG><ARTG>317449</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN342</BillingCode><Name>FIBERGRAFT</Name><Description>Bioactive Glass Bone Graft - BG Putty and BG Putty GPS</Description><Size>6cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>387410</ARTG><ARTG>387411</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IJ027</BillingCode><PriorBillingCodes><PriorBillingCode>CR299</PriorBillingCode></PriorBillingCodes><Name>NanoBone - Putty</Name><Description>Nanocrystalline HA in a porous silica matrix, synthetic bone graft substitute putty</Description><Size>10ml</Size><SupplierCode>40241</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>292263</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM216</BillingCode><Name>BonAlive Granules</Name><Description>Bone Graft Substitute - Bioactive Glass Granules</Description><Size>(5.1-10cc)
13140 - 0.5-0.8mm small granules, 10cc syringe
13340 - 1.0-2.0mm medium granules, 10cc syringe
13440 - 2.0-3.15mm large granules, 10cc syringe</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>176953</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM208</BillingCode><Name>BonAlive Putty</Name><Description>Bone Graft Substitute - Bioactive Glass Putty</Description><Size>10cc</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>231484</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH566</BillingCode><Name>i-FACTOR Putty Peptide Enhanced Bone Graft</Name><Description>P-15, ABM, Osteoinductive, Osteoconductive bone graft substitute</Description><Size>5.0ml - 10ml</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>169831</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX309</BillingCode><Name>Actifuse ABX MIS</Name><Description>Actifuse ABX MIS, Applicator and Cartridge, 7.5ml</Description><Size>7.5ml</Size><SupplierCode>39947</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>193684</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX350</BillingCode><Name>INDUCTIGRAFT</Name><Description>Silicate Substituted Calcium Phosphate Bone Graft   Substitute, 82.5% Porosity</Description><Size>10ML</Size><SupplierCode>39947</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>402036</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX312</BillingCode><Name>Actifuse ABX Easyfill Putty</Name><Description>Actifuse ABX Easyfill Putty - A silicate substituted synthetic bone graft</Description><Size>10ml</Size><SupplierCode>39947</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>188736</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX308</BillingCode><Name>Actifuse ABX MIS</Name><Description>Actifuse ABX MIS, Refill Cartridge, 7.5ml</Description><Size>7.5ml</Size><SupplierCode>39947</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>193684</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX317</BillingCode><Name>ACTIFUSE SHAPE 8.0mL –BONE MATRIX IMPLANT ARTIFICIAL</Name><Description>A silicate substituted synthetic bone graft</Description><Size>8.0mL</Size><SupplierCode>39947</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>203922</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW993</BillingCode><PriorBillingCodes><PriorBillingCode>WR003</PriorBillingCode></PriorBillingCodes><Name>ProDense / Osteoset XR</Name><Description>Composite Injectable Bone Void Filler</Description><Size>10cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><Suffix>CDS</Suffix><ARTGs><ARTG>172032</ARTG></ARTGs><MinimumBenefit>1449</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ094</BillingCode><PriorBillingCodes><PriorBillingCode>SQ183</PriorBillingCode></PriorBillingCodes><Name>MagnetOS Granules</Name><Description>Granule size 0.15-4mm</Description><Size>10cc</Size><SupplierCode>40483</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>343493</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE656</BillingCode><Name>NovaBone BioGlass</Name><Description>Bioactive synthetic bone graft - calcium phospho-silicate</Description><Size>8cc-10cc</Size><SupplierCode>39975</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>302473</ARTG><ARTG>302474</ARTG><ARTG>302472</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ097</BillingCode><PriorBillingCodes><PriorBillingCode>SQ186</PriorBillingCode></PriorBillingCodes><Name>MagnetOS Putty</Name><Description>Granule size 0.25-2mm</Description><Size>10cc</Size><SupplierCode>40483</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>345090</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW573</BillingCode><Name>Stryker DirectInject</Name><Description>DirectInject bone cement</Description><Size>10cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112214</SubGroupID><Suffix>CDS</Suffix><ARTGs><ARTG>278932</ARTG></ARTGs><MinimumBenefit>1449</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM237</BillingCode><Name>HA/TCP Granules</Name><Description>HA/TCP Bone graft substitute Granules</Description><Size>15cc, 20cc</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><ARTGs><ARTG>232997</ARTG></ARTGs><MinimumBenefit>1425</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER654</BillingCode><Name>Biocomposites Stimulan Rapid Cure 20 cc</Name><Description>  Calcium Sulfate synthetic rapid setting bone void filler kit  </Description><Size>20 cc</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><ARTGs><ARTG>391243</ARTG></ARTGs><MinimumBenefit>1425</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK185</BillingCode><Name>VITOSS - Synthetic cancellous bone void filler</Name><Description>Beta-tricalcium phosphate</Description><Size>15cc morsels</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><ARTGs><ARTG>140557</ARTG><ARTG>77710</ARTG></ARTGs><MinimumBenefit>1425</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ007</BillingCode><Name>ReproBone</Name><Description>TCP/HA Synthetic Bone Graft Granules</Description><Size>11-20cc</Size><SupplierCode>40099</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><ARTGs><ARTG>231295</ARTG></ARTGs><MinimumBenefit>1425</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH770</BillingCode><Name>Reosrba Synthetic bone</Name><Description>Injectable Bone Substitute – Granules / Syringe</Description><Size>16 &amp; 20cc</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><ARTGs><ARTG>400446</ARTG></ARTGs><MinimumBenefit>1425</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PJ028</BillingCode><PriorBillingCodes><PriorBillingCode>SV059</PriorBillingCode></PriorBillingCodes><Name>GelOS</Name><Description>Gel based synthetic bone substitute</Description><Size>15cc</Size><SupplierCode>40094</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><ARTGs><ARTG>233982</ARTG></ARTGs><MinimumBenefit>1425</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ011</BillingCode><Name>ReproBone novo</Name><Description>HA Synthetic Bone Graft Paste</Description><Size>11-20ml</Size><SupplierCode>40099</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><ARTGs><ARTG>217839</ARTG></ARTGs><MinimumBenefit>1425</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC596</BillingCode><Name>Mastergraft</Name><Description>Calcium Phosphate Ceramic Granules</Description><Size>15cc Vial</Size><SupplierCode>40151</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><ARTGs><ARTG>96971</ARTG></ARTGs><MinimumBenefit>1425</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW688</BillingCode><PriorBillingCodes><PriorBillingCode>WR015</PriorBillingCode></PriorBillingCodes><Name>Osteoset Pellets - Bone Graft Substitute</Name><Description>Calcium Sulphate</Description><Size>4.8mm Pellets 20cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><ARTGs><ARTG>171899</ARTG></ARTGs><MinimumBenefit>1425</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM242</BillingCode><Name>Exabone Paste</Name><Description>Preloaded Paste in Syringe</Description><Size>15cc</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><ARTGs><ARTG>232998</ARTG></ARTGs><MinimumBenefit>1425</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK481</BillingCode><Name>HydroSet injectable Calcium Phosphate Cement</Name><Description>Injectable, rapid set, calcium phosphate bone substitute kit</Description><Size>15cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><ARTGs><ARTG>138334</ARTG></ARTGs><MinimumBenefit>1425</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW684</BillingCode><PriorBillingCodes><PriorBillingCode>WR007</PriorBillingCode></PriorBillingCodes><Name>ProDense / Osteoset XR</Name><Description>Composite Bone Void Filler - Pellets</Description><Size>20cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><ARTGs><ARTG>172033</ARTG></ARTGs><MinimumBenefit>1425</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU249</BillingCode><PriorBillingCodes><PriorBillingCode>DE478</PriorBillingCode></PriorBillingCodes><Name>Quickset</Name><Description>Injectable Macroporous Calcium Phosphate</Description><Size>16cc</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><Suffix>CDS</Suffix><ARTGs><ARTG>267632</ARTG></ARTGs><MinimumBenefit>2043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV015</BillingCode><Name>ProDense 2.0</Name><Description>Injectable Bone Graft Substitute </Description><Size>12cc, 15cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><Suffix>CDS</Suffix><ARTGs><ARTG>172032</ARTG></ARTGs><MinimumBenefit>2043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ176</BillingCode><Name>GlassBONE Granules</Name><Description>Bioglass granules for bone grafting</Description><Size>10cc-20cc</Size><SupplierCode>40470</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>433832</ARTG></ARTGs><MinimumBenefit>4370</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW693</BillingCode><PriorBillingCodes><PriorBillingCode>WR020</PriorBillingCode></PriorBillingCodes><Name>Osteoset MIIG X3</Name><Description>Injectable Calcium Sulphate Bone Void Filler, Includes Syringe</Description><Size>15cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><Suffix>CDS</Suffix><ARTGs><ARTG>172285</ARTG></ARTGs><MinimumBenefit>2043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW800</BillingCode><PriorBillingCodes><PriorBillingCode>WR215</PriorBillingCode></PriorBillingCodes><Name>Pro-Dense core Decompression Kit</Name><Description>Composite Injectable Bone Void Filler plus instrumentation kit for core decompression</Description><Size>15cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><Suffix>CDS</Suffix><ARTGs><ARTG>172105</ARTG></ARTGs><MinimumBenefit>2043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW682</BillingCode><PriorBillingCodes><PriorBillingCode>WR004</PriorBillingCode></PriorBillingCodes><Name>ProDense/Osteoset XR</Name><Description>Composite Injectable Bone Void Filler</Description><Size>20cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><Suffix>CDS</Suffix><ARTGs><ARTG>172032</ARTG></ARTGs><MinimumBenefit>2043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE657</BillingCode><Name>NovaBone BioGlass</Name><Description>Bioactive synthetic bone graft - calcium phospho-silicate</Description><Size>15cc - 20cc</Size><SupplierCode>39975</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>302475</ARTG></ARTGs><MinimumBenefit>4370</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX311</BillingCode><Name>ACTIFUSE ABX Putty</Name><Description>Actifuse AVX Putty - A silicated substituted synthetic bone graft.</Description><Size>20ml</Size><SupplierCode>39947</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>188736</ARTG></ARTGs><MinimumBenefit>4370</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX349</BillingCode><Name>INDUCTIGRAFT</Name><Description>Silicate Substituted Calcium Phosphate Bone Graft Substitute, 82.5%  Porosity</Description><Size>20ML</Size><SupplierCode>39947</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>402036</ARTG></ARTGs><MinimumBenefit>4370</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX318</BillingCode><Name>ACTIFUSE SHAPE15.8mL –BONE MATRIX IMPLANT ARTIFICIAL</Name><Description>A silicate substituted synthetic bone graft</Description><Size>15.8mL</Size><SupplierCode>39947</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>203922</ARTG></ARTGs><MinimumBenefit>4370</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ098</BillingCode><PriorBillingCodes><PriorBillingCode>SQ187</PriorBillingCode></PriorBillingCodes><Name>MagnetOS Putty</Name><Description>Granule size 1-2mm</Description><Size>20cc</Size><SupplierCode>40483</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>345090</ARTG></ARTGs><MinimumBenefit>4370</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ095</BillingCode><PriorBillingCodes><PriorBillingCode>SQ184</PriorBillingCode></PriorBillingCodes><Name>MagnetOS Granules</Name><Description>Granule size 0.25-4mm</Description><Size>15cc, 20cc</Size><SupplierCode>40483</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>343493</ARTG></ARTGs><MinimumBenefit>4370</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VG003</BillingCode><Name>CERAMENT BVF</Name><Description>Bone substitute with hydroxyapatite and iohexal</Description><Size>18ml</Size><SupplierCode>40249</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>372270</ARTG></ARTGs><MinimumBenefit>4370</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN343</BillingCode><Name>FIBERGRAFT</Name><Description>Bioactive Glass Bone Graft - BG Putty and BG Putty GPS</Description><Size>11cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>387411</ARTG><ARTG>387410</ARTG></ARTGs><MinimumBenefit>4370</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN346</BillingCode><Name>FIBERGRAFT</Name><Description>Bioactive Glass (BG) Bone Graft Morsels</Description><Size>11cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112215</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>387006</ARTG></ARTGs><MinimumBenefit>4370</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH567</BillingCode><Name>i-Factor Flex &amp; Flex FR Peptide Enhanced Bone Graft – 25mm</Name><Description>P-15, ABM, Osteoinductive, Osteoconductive bone graft substitute</Description><Size>50mm x 25mm x 4mm, 100mm x 25mm x 4mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112216</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>231653</ARTG><ARTG>176753</ARTG></ARTGs><MinimumBenefit>5700</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH564</BillingCode><Name>i-Factor Flex &amp; Flex FR Peptide Enhanced Bone Graft – 25mm</Name><Description>P-15, ABM, Osteoinductive, Osteoconductive bone graft substitute</Description><Size>25mm x 25mm x 4mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112216</SubGroupID><Suffix>AUG</Suffix><ARTGs><ARTG>231653</ARTG><ARTG>176753</ARTG></ARTGs><MinimumBenefit>5700</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HC029</BillingCode><Name>Bone substitute</Name><Description>Synethetic Resorbable Bone Graft</Description><Size>H;4-20mm</Size><SupplierCode>40349</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112216</SubGroupID><ARTGs><ARTG>283972</ARTG></ARTGs><MinimumBenefit>1482</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH771</BillingCode><Name>Reosrba Synthetic bone</Name><Description>60/40 HA/TCP bone graft substitute</Description><Size>30cc Granules</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112216</SubGroupID><ARTGs><ARTG>400446</ARTG></ARTGs><MinimumBenefit>1482</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST021</BillingCode><Name>Stryker Bone Substitute</Name><Description>Bonesave, Calcium Phosphate</Description><Size>40gms, sizes 2 - 4 and  4-6mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112216</SubGroupID><ARTGs><ARTG>143522</ARTG></ARTGs><MinimumBenefit>1482</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC597</BillingCode><Name>Mastergraft</Name><Description>Calcium Phosphate Ceramic Granules</Description><Size>30cc Vial</Size><SupplierCode>40151</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112216</SubGroupID><ARTGs><ARTG>96971</ARTG></ARTGs><MinimumBenefit>1482</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF062</BillingCode><Name>Osteoflo G</Name><Description>Biphasic Calcium Phosphate</Description><Size>30cc Granules</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112216</SubGroupID><ARTGs><ARTG>185876</ARTG></ARTGs><MinimumBenefit>1482</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ008</BillingCode><Name>ReproBone</Name><Description>TCP/HA Synthetic Bone Graft Granules</Description><Size>21-30cc</Size><SupplierCode>40099</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112216</SubGroupID><ARTGs><ARTG>231295</ARTG></ARTGs><MinimumBenefit>1482</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW685</BillingCode><PriorBillingCodes><PriorBillingCode>WR011</PriorBillingCode></PriorBillingCodes><Name>Osteoset BVF Kit</Name><Description>Kit contains calcium sulfate, diluent, mould, spatula and mixing bowl</Description><Size>25cc only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112216</SubGroupID><ARTGs><ARTG>173514</ARTG><ARTG>173515</ARTG></ARTGs><MinimumBenefit>1482</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM238</BillingCode><Name>HA/TCP Granules</Name><Description>HA/TCP Bone graft substitute Granules</Description><Size>25cc, 30cc</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112216</SubGroupID><ARTGs><ARTG>232997</ARTG></ARTGs><MinimumBenefit>1482</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK187</BillingCode><Name>VITOSS - Synthetic cancellous bone void filler</Name><Description>Beta-tricalcium phosphate</Description><Size>30cc morsels and 30cc dowels</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112216</SubGroupID><ARTGs><ARTG>140557</ARTG><ARTG>77710</ARTG></ARTGs><MinimumBenefit>1482</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GI004</BillingCode><Name>Bio-Oss</Name><Description>This bone block consists of anorganic bovine bone matrix sterilised by gamma-irradiation.  Bio-Oss is a natural bone mineral for filling of bone defects in maxillofacial surgery, implantology, and periodontology.</Description><Size>approx 1.4-1.6g, 2cc</Size><SupplierCode>40366</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112218</SubGroupID><ARTGs><ARTG>229987</ARTG></ARTGs><MinimumBenefit>503</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GI003</BillingCode><Name>Bio-Oss Bone Natural Bone Mineral</Name><Description>Derived from bovine bone</Description><Size>Granule size 1 - 2mm, 1.0gm (3cc)  Granule size 0.25 - 1mm, 2.0gm (4cc)</Size><SupplierCode>40366</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112218</SubGroupID><ARTGs><ARTG>229987</ARTG></ARTGs><MinimumBenefit>503</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GI005</BillingCode><Name>Bio-Oss</Name><Description>Natural bone mineral derived from bovine bone</Description><Size>1 to 2mm; 2.0g (6cc)</Size><SupplierCode>40366</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112219</SubGroupID><ARTGs><ARTG>229987</ARTG></ARTGs><MinimumBenefit>1330</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC660</BillingCode><Name>Mastergraft</Name><Description>Matrix</Description><Size>5cc</Size><SupplierCode>40151</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112221</SubGroupID><ARTGs><ARTG>283420</ARTG></ARTGs><MinimumBenefit>808</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW664</BillingCode><Name>VITOSS Foam - Compression Resistant Synthetic Cancellous Bone Void Filler</Name><Description>Highly porous bone graft material made from beta-tricalcium phosphate (β-TCP) and Type I bovine collagen</Description><Size>0-5cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112221</SubGroupID><ARTGs><ARTG>322495</ARTG></ARTGs><MinimumBenefit>808</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI142</BillingCode><Name>Mastergraft</Name><Description>Mastergraft Putty</Description><Size>&gt;0cc-5cc</Size><SupplierCode>40151</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112221</SubGroupID><ARTGs><ARTG>215319</ARTG></ARTGs><MinimumBenefit>808</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GI016</BillingCode><Name>Bio-Oss Collagen</Name><Description>The product consists of Bio-Oss granules, embedded in 10% porcine collagen.  The collagen component is resorbed within a few weeks.  The properties of the Bio-Oss granules remain unchanged. Facilitates handling. </Description><Size>1 preformed block of cancellous-bone granulate and collagen, block size 250mg</Size><SupplierCode>40366</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112221</SubGroupID><ARTGs><ARTG>229994</ARTG></ARTGs><MinimumBenefit>808</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI022</BillingCode><Name>nanOss Bioactive Bone Void Filler, 1-5cc</Name><Description>Granular bone graft material comprised of porous hydroxyapatite and porcine gelatin based carrier. Granules supplied in jar (1cc, 2cc, &amp;5cc) or in a prefilled mixing chamber with delivery accessories (5cc) packaging variant.</Description><Size>1cc, 2cc, &amp; 5cc</Size><SupplierCode>40088</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112221</SubGroupID><ARTGs><ARTG>279230</ARTG></ARTGs><MinimumBenefit>808</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GI017</BillingCode><Name>Bio-Oss Collagen</Name><Description>The product consists of Bio-Oss granules, embedded in 10% porcine collagen.  The collagen component is resorbed within a few weeks.  The properties of the Bio-Oss granules remain unchanged. Facilitates handling. </Description><Size>1 preformed block of cancellous-bone granulate and collagen, block size 100mg</Size><SupplierCode>40366</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112221</SubGroupID><ARTGs><ARTG>229994</ARTG></ARTGs><MinimumBenefit>808</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW858</BillingCode><PriorBillingCodes><PriorBillingCode>WR326</PriorBillingCode></PriorBillingCodes><Name>Augment Injectable Bone Graft – β-TCP/bovine Type I collagen matrix</Name><Description>β-TCP/bovine Type I collagen matrix</Description><Size>1.5cc  3cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112221</SubGroupID><ARTGs><ARTG>231499</ARTG></ARTGs><MinimumBenefit>808</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GI015</BillingCode><Name>Bio-Oss Collagen</Name><Description>The product consists of Bio-Oss granules, embedded in 10% porcine collagen.  The collagen component is resorbed within a few weeks.  The properties of the Bio-Oss granules remain unchanged. Facilitates handling. </Description><Size>1 preformed block of cancellous-bone granulate and collagen, block sizes 500mg</Size><SupplierCode>40366</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112221</SubGroupID><ARTGs><ARTG>229994</ARTG></ARTGs><MinimumBenefit>808</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI143</BillingCode><Name>Mastergraft</Name><Description>Mastergraft Putty</Description><Size>&gt;5cc-10cc</Size><SupplierCode>40151</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112222</SubGroupID><ARTGs><ARTG>215319</ARTG></ARTGs><MinimumBenefit>1889</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW665</BillingCode><Name>VITOSS Foam - Compression Resistant Synthetic Cancellous Bone Void Filler</Name><Description>Highly porous bone graft material made from beta-tricalcium phosphate (β-TCP) and Type I bovine collagen.</Description><Size>&gt;5cc - 10cc</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112222</SubGroupID><ARTGs><ARTG>322495</ARTG></ARTGs><MinimumBenefit>1889</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC663</BillingCode><Name>Mastergraft</Name><Description>Matrix</Description><Size>10cc</Size><SupplierCode>40151</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112222</SubGroupID><ARTGs><ARTG>283420</ARTG></ARTGs><MinimumBenefit>1889</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI023</BillingCode><Name>nanOss Bioactive Bone Void Filler, 10cc</Name><Description>Granular bone graft material comprised of porous hydroxyapatite and porcine gelatin based carrier. Granules supplied in jar (10cc) or in a prefilled mixing chamber with delivery accessories (10cc) packaging variant.</Description><Size>10cc</Size><SupplierCode>40088</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112222</SubGroupID><ARTGs><ARTG>279230</ARTG></ARTGs><MinimumBenefit>1889</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI024</BillingCode><Name>nanOss Bioactive Bone Void Filler, 20cc</Name><Description>Granular bone graft material comprised of porous hydroxyapatite and porcine gelatin based
carrier</Description><Size>20cc</Size><SupplierCode>40088</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112223</SubGroupID><ARTGs><ARTG>279230</ARTG></ARTGs><MinimumBenefit>2143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK469</BillingCode><Name>VITOSS Foam - Compression Resistant Synthetic Cancellous Bone Void Filler</Name><Description>Highly porous bone graft material made from beta-tricalcium phosphate (β-TCP) and Type I bovine collagen.</Description><Size>20cc Foam strip (25x100x8)</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112223</SubGroupID><ARTGs><ARTG>142666</ARTG></ARTGs><MinimumBenefit>2143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI144</BillingCode><Name>Mastergraft</Name><Description>Mastergraft Strip</Description><Size>&gt;10cc-20cc</Size><SupplierCode>40151</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112223</SubGroupID><ARTGs><ARTG>215317</ARTG></ARTGs><MinimumBenefit>2143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC662</BillingCode><Name>Mastergraft</Name><Description>Matrix</Description><Size>20cc</Size><SupplierCode>40151</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112223</SubGroupID><ARTGs><ARTG>283420</ARTG></ARTGs><MinimumBenefit>2143</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK475</BillingCode><Name>VITOSS Foam - Compression Resistant Synthetic Cancellous Bone Void Filler.</Name><Description>Highly porous bone graft material made from beta-tricalcium phosphate (β-TCP) and Type I bovine collagen.</Description><Size>Sheet (Wide Strip) 75x100x4mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112224</SubGroupID><ARTGs><ARTG>142666</ARTG></ARTGs><MinimumBenefit>2850</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI145</BillingCode><Name>Mastergraft</Name><Description>Mastergraft Strip</Description><Size>&gt;20cc</Size><SupplierCode>40151</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108806</GroupID><SubGroupID>112224</SubGroupID><ARTGs><ARTG>215317</ARTG></ARTGs><MinimumBenefit>2850</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW538</BillingCode><Name>Simplex HV  </Name><Description>Simplex HV is a fast-setting acrylic resin for use in bone surgery. Mixing the two separate sterile components produces a ductile bone cement which, after hardening, fixes the implant and transfers stresses produced during movement evenly to the bone. Simplex HV cement powder also contains insoluble zirconium dioxide as an X-ray contrast medium. Simplex HV does not emit a signal and does not pose a safety risk in a magnetic resonance environment.</Description><Size>There is only one size. Powder Component 40g, Liquid Component 20ml</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112273</SubGroupID><ARTGs><ARTG>220884</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW589</BillingCode><Name>VertePlex</Name><Description>PMMA Cement</Description><Size>20 gram</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112273</SubGroupID><ARTGs><ARTG>289085</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK458</BillingCode><Name>Simplex P Speed Set Bone Cement</Name><Description>PMMA Bone Cement</Description><Size>40g pack</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112273</SubGroupID><ARTGs><ARTG>131533</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER389</BillingCode><Name>Signus Introx Bone Cement System-Cement, low viscosity</Name><Description>Signus Introx cement is a radiopaque bone cement for Percutaneous Vertebral Augmentation (PVA) procedures</Description><Size>20 grams</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112273</SubGroupID><ARTGs><ARTG>287169</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW590</BillingCode><Name>VertePlex HV</Name><Description>High Viscosity PMMA Cement</Description><Size>20 gram</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112273</SubGroupID><ARTGs><ARTG>289085</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW322</BillingCode><Name>Surgical Simplex P Radiopaque Bone Cement</Name><Description>Polymethyl Methacrylate, Styrene Copolymer, Barium Sulfate</Description><Size>40 grams</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112273</SubGroupID><ARTGs><ARTG>141277</ARTG><ARTG>141278</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HK005</BillingCode><Name>Palacos or Palamed bone cement</Name><Description>Single mix PMMA</Description><Size>40g</Size><SupplierCode>40346</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112273</SubGroupID><ARTGs><ARTG>152109</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ932</BillingCode><Name>SmartSet</Name><Description>PMMA bone cement</Description><Size>20 to 40g</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112273</SubGroupID><ARTGs><ARTG>96550</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH526</BillingCode><Name>G21 Bone Cement</Name><Description>Bone Cement - std and low viscosity</Description><Size>20-60g</Size><SupplierCode>40113</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112273</SubGroupID><ARTGs><ARTG>235604</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DR043</BillingCode><Name>Osteofix</Name><Description>PMMA Bone Cement (High and Low Viscosity)</Description><Size>One Size (19.2g, 10ml Vial)</Size><SupplierCode>40180</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112273</SubGroupID><ARTGs><ARTG>333240</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB165</BillingCode><Name>Fortress and Fortress-Plus Bone Cement</Name><Description>Bone Cement</Description><Size>20g</Size><SupplierCode>40358</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112273</SubGroupID><ARTGs><ARTG>274306</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP107</BillingCode><Name>CMW Bone Cement</Name><Description>CMW Bone Cement Various  without Antibiotic</Description><Size>20, 40 grams</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112273</SubGroupID><ARTGs><ARTG>96550</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC202</BillingCode><PriorBillingCodes><PriorBillingCode>OH526</PriorBillingCode></PriorBillingCodes><Name>G21 Bone Cement</Name><Description>Bone Cement - std and low viscosity</Description><Size>20-60g</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112273</SubGroupID><ARTGs><ARTG>329063</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB164</BillingCode><Name>AFFIRM Vertebral Compression Fracture System - Access Pack</Name><Description>Bone Cement and Delivery System</Description><Size>20g</Size><SupplierCode>40358</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112273</SubGroupID><ARTGs><ARTG>192479</ARTG><ARTG>274306</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC984</BillingCode><Name>CD HORIZON Fenestrated Screw Cement</Name><Description>Fenestrated screw cement - High viscosity, radiopaque, PMMA bone cement</Description><Size>20g powder, 9g vial</Size><SupplierCode>40151</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112273</SubGroupID><ARTGs><ARTG>284119</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UK006</BillingCode><PriorBillingCodes><PriorBillingCode>ER302</PriorBillingCode></PriorBillingCodes><Name>Cemex-genta bone cement</Name><Description>1 mix Methylmethacrylate/ Polymethylmethacrylate with gentamiacin</Description><Size>1 mix 40g powder and 13.3g liquid</Size><SupplierCode>40267</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112274</SubGroupID><ARTGs><ARTG>209861</ARTG><ARTG>209860</ARTG></ARTGs><MinimumBenefit>161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP108</BillingCode><Name>CMW Antibiotic Bone Cement </Name><Description>CMW Bone Cement Various with Antibiotic</Description><Size>20, 40 grams</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112274</SubGroupID><ARTGs><ARTG>150888</ARTG><ARTG>150886</ARTG><ARTG>150887</ARTG></ARTGs><MinimumBenefit>161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HK011</BillingCode><Name>Copal G + V</Name><Description>Specialised cement with gentamicin and vancomycin for use in septic revisions</Description><Size>40g</Size><SupplierCode>40346</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112274</SubGroupID><ARTGs><ARTG>228234</ARTG></ARTGs><MinimumBenefit>161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL164</BillingCode><Name>RALLY</Name><Description>Bone Cement, Polymethylmethacrylate, Gentamicin- Med &amp; High viscosity</Description><Size>40g</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112274</SubGroupID><ARTGs><ARTG>323860</ARTG><ARTG>323815</ARTG></ARTGs><MinimumBenefit>161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ933</BillingCode><Name>SmartSet</Name><Description>Bone cement with antibiotic</Description><Size>40g</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112274</SubGroupID><ARTGs><ARTG>150929</ARTG><ARTG>119257</ARTG></ARTGs><MinimumBenefit>161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HK012</BillingCode><Name>PALACOS® fast R+G</Name><Description>Fast setting, high viscosity, radiopaque bone cement with gentamicin</Description><Size>40g</Size><SupplierCode>40346</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112274</SubGroupID><ARTGs><ARTG>248254</ARTG></ARTGs><MinimumBenefit>161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW320</BillingCode><Name>Antibiotic Simplex Bone Cement with Tobramycin</Name><Description>Polymethyl Methacrylate, Styrene Copolymer, Barium Sulfate</Description><Size>40 grams</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112274</SubGroupID><ARTGs><ARTG>158560</ARTG></ARTGs><MinimumBenefit>161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA019</BillingCode><PriorBillingCodes><PriorBillingCode>BI243</PriorBillingCode><PriorBillingCode>BI844</PriorBillingCode><PriorBillingCode>BI845</PriorBillingCode></PriorBillingCodes><Name>Refobacin Plus Bone Cemen</Name><Description>Bone Cement, Methyl methacrylate, Gentamicin</Description><Size>20-80gm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112274</SubGroupID><ARTGs><ARTG>168753</ARTG></ARTGs><MinimumBenefit>161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HK013</BillingCode><Name>Palacos or Palmed Bone Cement with Gentamicin</Name><Description>Single mix PMMA with Gentamicin</Description><Size>20,40 gms</Size><SupplierCode>40346</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112274</SubGroupID><ARTGs><ARTG>133411</ARTG></ARTGs><MinimumBenefit>161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HK008</BillingCode><Name>Copal G+C</Name><Description>High-viscosity, radiopaque bone cement with gentamicin and clindamycin</Description><Size>40g</Size><SupplierCode>40346</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112274</SubGroupID><ARTGs><ARTG>176198</ARTG></ARTGs><MinimumBenefit>161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW569</BillingCode><Name>Simplex HV with Gentamicin</Name><Description>High viscosity bone cement with antibiotic (Gentamicin)</Description><Size>One unit contains: Powder Component 40.8g, Liquid Component 20ml</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112274</SubGroupID><ARTGs><ARTG>276417</ARTG></ARTGs><MinimumBenefit>161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ316</BillingCode><Name>Refobacin Bone Cement R</Name><Description>Bone Cement with Gentamicin  </Description><Size>20-40g</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112274</SubGroupID><ARTGs><ARTG>450208</ARTG></ARTGs><ChangeExplanation>New listing</ChangeExplanation><MinimumBenefit>161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Insert</ActionFlag><CycleStartDate>2024-08-08</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER390</BillingCode><Name>Signus Introx Bone Cement-Cement plus mixer/delivery system</Name><Description>Signus Introx low viscosity bone cement plus preparation/delivery kit for mixing and delivering the bone cement.</Description><Size>20 grams</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112275</SubGroupID><ARTGs><ARTG>287168</ARTG></ARTGs><MinimumBenefit>437</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW785</BillingCode><Name>AutoPlex Mixer and Delivery System with VertaPlex HV</Name><Description>High Viscosity PMMA Cement with Mixer and Delivery System - Intended to be used for pedicle screw augmentation and vertebroplasty only. </Description><Size>20 gram</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112275</SubGroupID><ARTGs><ARTG>288933</ARTG></ARTGs><Note>No PL benefit will be payable if the device is used for kyphoplasty surgery, as there is no evidence presented and no MBS item available for this procedure.</Note><MinimumBenefit>437</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC201</BillingCode><PriorBillingCodes><PriorBillingCode>OH525</PriorBillingCode></PriorBillingCodes><Name>G21 Bone Cement + Delivery System</Name><Description>Bone Cement – low &amp; std viscosity</Description><Size>20-60g</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112275</SubGroupID><ARTGs><ARTG>329063</ARTG></ARTGs><MinimumBenefit>437</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ736</BillingCode><Name>Confidence Spinal cement system</Name><Description>Spinal Bone Cement PMMA and Percutaneous Administration Kit</Description><Size>11cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112275</SubGroupID><ARTGs><ARTG>211565</ARTG></ARTGs><MinimumBenefit>437</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY429</BillingCode><Name>Traumacem</Name><Description>Cement with mixing and delivery system</Description><Size>10-20gm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112275</SubGroupID><ARTGs><ARTG>177835</ARTG></ARTGs><MinimumBenefit>437</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DR044</BillingCode><Name>Osteofix + Delivery Systems</Name><Description>Cement + Complex Delivery System</Description><Size>All Sizes (Various Cannula Gauges/Lengths, Syringes and Connectors)</Size><SupplierCode>40180</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112275</SubGroupID><ARTGs><ARTG>333240</ARTG></ARTGs><MinimumBenefit>437</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BF031</BillingCode><Name>MixMax Bone Cement</Name><Description>MIXMAX is a Procedure pack for mixing bone cement. It is possible to connect an external vacuum pump or to mix cement in a vacuum state using a vacuum tube. Contains a methyl methacrylate monomer liquid component and a poly-methymethacrylate powder component that mixed in the system provided. High radiopaque cement includes 60% of ZrO2. Optimized viscosity for Vetebroplasty, short mixing and preparing time allows to inject the cement immediately.</Description><Size>20g</Size><SupplierCode>40171</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112275</SubGroupID><ARTGs><ARTG>404236</ARTG></ARTGs><Note>No PL benefit will be payable if the device is used for kyphoplasty surgery, as there is no evidence presented and no Medicare benefit payable for this procedure.</Note><MinimumBenefit>437</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KN004</BillingCode><Name>Invictus Spinal Cement System </Name><Description>Radio Opaque Bone Cement with Mixing and Injection System.  Poly Methylmethacrylate Styrene Copolymer </Description><Size>25.8gm powder, 9.2 gms monomer</Size><SupplierCode>40401</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112275</SubGroupID><ARTGs><ARTG>409679</ARTG></ARTGs><Note>No PL benefit will be payable if the device is used for kyphoplasty surgery, as there is no evidence presented and no Medicare benefit payable for this procedure.</Note><MinimumBenefit>437</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW591</BillingCode><Name>PCD Precision Cement Delivery System with VertePlex HV</Name><Description>High Viscosity PMMA Cement with Mixer and Delivery System</Description><Size>20 gram</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112275</SubGroupID><ARTGs><ARTG>288933</ARTG></ARTGs><MinimumBenefit>437</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER648</BillingCode><Name>SIGNUS INTROX HighV Cement</Name><Description>The INTROX® HighV cement is a radiopaque bone cement.</Description><Size>Powder 20 g; Liquid 8.6 g</Size><SupplierCode>40067</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112275</SubGroupID><ARTGs><ARTG>354819</ARTG></ARTGs><MinimumBenefit>437</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH525</BillingCode><Name>G21 Bone Cement + Delivery System</Name><Description>Bone Cement – low &amp; std viscosity</Description><Size>20-60g</Size><SupplierCode>40113</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112275</SubGroupID><ARTGs><ARTG>235604</ARTG></ARTGs><MinimumBenefit>437</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH503</BillingCode><Name>G-21 Radiopaque Bone cement for Vertebral Consolidation + V-Kit 06</Name><Description>Radiopaque Bone Cement for Vertebroplasty – high and low viscosity</Description><Size>10-20g</Size><SupplierCode>40113</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112275</SubGroupID><ARTGs><ARTG>235604</ARTG></ARTGs><MinimumBenefit>437</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH533</BillingCode><Name>High V+ Cement with Delivery Kit</Name><Description>PMMA Cement including Delivery Kit</Description><Size>20gm</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112275</SubGroupID><ARTGs><ARTG>239816</ARTG></ARTGs><MinimumBenefit>437</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF082</BillingCode><Name>Bone cement with vacuum mixing system</Name><Description>Bone cement with vacuum mixing system</Description><Size>40 to 100gm</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112276</SubGroupID><ARTGs><ARTG>244560</ARTG><ARTG>242598</ARTG></ARTGs><MinimumBenefit>437</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ324</BillingCode><Name>Optipac </Name><Description>Optipac Vacuum Mixing System with Refobacin R</Description><Size>40, 60, 80</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112276</SubGroupID><ARTGs><ARTG>450207</ARTG></ARTGs><ChangeExplanation>New listing</ChangeExplanation><MinimumBenefit>437</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Insert</ActionFlag><CycleStartDate>2024-08-08</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI937</BillingCode><Name>Optipac</Name><Description>Refobacin Plus, Prefilled Vaccum Mixing System, Gentamicin Sulphate, PMMA Cement</Description><Size>40-80 gram</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112276</SubGroupID><ARTGs><ARTG>168753</ARTG></ARTGs><MinimumBenefit>437</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UK007</BillingCode><PriorBillingCodes><PriorBillingCode>ER304</PriorBillingCode></PriorBillingCodes><Name>Cemex® System Genta</Name><Description>Bone Cement  with Gentamicin packaged in a complex delivery system</Description><Size>40, 60, 70 and 80 grams</Size><SupplierCode>40267</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112276</SubGroupID><ARTGs><ARTG>209862</ARTG><ARTG>201043</ARTG></ARTGs><MinimumBenefit>437</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HK014</BillingCode><PriorBillingCodes><PriorBillingCode>HK010</PriorBillingCode></PriorBillingCodes><Name>Palacos R+G Pro or Palacos MV+G Pro</Name><Description>Single Mix PMMA with Gentamicin and Complex Delivery System</Description><Size>55g, 75g</Size><SupplierCode>40346</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112276</SubGroupID><ARTGs><ARTG>309121</ARTG></ARTGs><MinimumBenefit>437</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL165</BillingCode><Name>RALLY All-in-One System</Name><Description>Bone cement pre-dosed with PMMA powder with gentamicin</Description><Size>70g</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112276</SubGroupID><ARTGs><ARTG>323816</ARTG><ARTG>323820</ARTG></ARTGs><MinimumBenefit>437</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW006</BillingCode><Name>Stryker Intramedullary/Bone Plugs</Name><Description>Bone Plugs</Description><Size>6 - 24mm
small,medium,large</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112277</SubGroupID><ARTGs><ARTG>289666</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UK024</BillingCode><Name>Cement Restrictors + inserter</Name><Description>Restrictors</Description><Size>12-18mm, 18-24mm</Size><SupplierCode>40267</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112277</SubGroupID><ARTGs><ARTG>325020</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW864</BillingCode><PriorBillingCodes><PriorBillingCode>WR333</PriorBillingCode></PriorBillingCodes><Name>Bone Plug</Name><Description>UHMWPE - Cement Plug</Description><Size>13mm and 24mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108809</GroupID><SubGroupID>112277</SubGroupID><ARTGs><ARTG>134451</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM333</BillingCode><Name>Internal joint articulating fixator Elbow</Name><Description>Internal joint articulating fixator Elbow</Description><Size>One size - adjustable</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107707</SubCategoryID><GroupID>108812</GroupID><SubGroupID>112286</SubGroupID><ARTGs><ARTG>278692</ARTG></ARTGs><MinimumBenefit>2416</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ079</BillingCode><PriorBillingCodes><PriorBillingCode>ER383</PriorBillingCode><PriorBillingCode>AE266</PriorBillingCode></PriorBillingCodes><Name>Hintermann Series H3™ Total Ankle Prosthesis-Talar Component</Name><Description>Hintermann Series H3™ Total Ankle Prosthesis-Talar component, left or right, primary or revision, CoCr, plasma sprayed titanium coating and a hydroxyapatite coating</Description><Size>0-6</Size><SupplierCode>40480</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108813</GroupID><SubGroupID>112287</SubGroupID><ARTGs><ARTG>289321</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW860</BillingCode><PriorBillingCodes><PriorBillingCode>WR328</PriorBillingCode></PriorBillingCodes><Name>INVISION Talar Component</Name><Description>Talar Dome</Description><Size>Size 1, 2, 3, 4, 5</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108813</GroupID><SubGroupID>112287</SubGroupID><ARTGs><ARTG>168052</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD075</BillingCode><PriorBillingCodes><PriorBillingCode>SK624</PriorBillingCode></PriorBillingCodes><Name> STAR Ankle Prosthesis</Name><Description>Talar Component, cemented</Description><Size>xx-Small - x- large</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108813</GroupID><SubGroupID>112287</SubGroupID><ARTGs><ARTG>237795</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD078</BillingCode><PriorBillingCodes><PriorBillingCode>SK627</PriorBillingCode></PriorBillingCodes><Name>STAR Ankle Prosthesis</Name><Description>Talar Component, cementless</Description><Size>xx- small - x-large</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108813</GroupID><SubGroupID>112287</SubGroupID><ARTGs><ARTG>237795</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA027</BillingCode><Name>TM Ankle</Name><Description>Talar Component</Description><Size>6 sizes of left and right</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108813</GroupID><SubGroupID>112287</SubGroupID><ARTGs><ARTG>202429</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW965</BillingCode><PriorBillingCodes><PriorBillingCode>WR456</PriorBillingCode></PriorBillingCodes><Name>INVISION Talar Component</Name><Description>Talar Dome</Description><Size>Size 1, 2, 3, 4, 5  - Standard and Thick (+3mm)</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108813</GroupID><SubGroupID>112287</SubGroupID><ARTGs><ARTG>168052</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW892</BillingCode><PriorBillingCodes><PriorBillingCode>WR365</PriorBillingCode></PriorBillingCodes><Name>Salto Talaris Ankle Prosthesis - Talar component</Name><Description>Talar compoment, CrCo + Ti</Description><Size>Sizes 0, 1, 2, 3, Left and Right</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108813</GroupID><SubGroupID>112287</SubGroupID><ARTGs><ARTG>198095</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW984</BillingCode><PriorBillingCodes><PriorBillingCode>WR321</PriorBillingCode></PriorBillingCodes><Name>INFINITY Total Ankle System: Talar Component</Name><Description>Talar dome</Description><Size>Sizes 1-5</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108813</GroupID><SubGroupID>112287</SubGroupID><ARTGs><ARTG>168052</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW883</BillingCode><PriorBillingCodes><PriorBillingCode>WR355</PriorBillingCode></PriorBillingCodes><Name>Salto Ankle Prostheses</Name><Description>Talar component mobile bearing CoCr, Ti, HA</Description><Size>Sizes 0,1,2,3 left and right</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108813</GroupID><SubGroupID>112287</SubGroupID><ARTGs><ARTG>198095</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW827</BillingCode><PriorBillingCodes><PriorBillingCode>WR273</PriorBillingCode></PriorBillingCodes><Name>INBONE® II Total Ankle System: Talar Component</Name><Description>Modular Talar Dome and Talar Stem</Description><Size>Sizes 1-6</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108813</GroupID><SubGroupID>112287</SubGroupID><ARTGs><ARTG>168052</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA030</BillingCode><Name>Vantage Total Ankle System - Talar component</Name><Description>Talar component, left and right, uncemented, plasma sprayed titanium coating</Description><Size>Left and Right, size 1-5</Size><SupplierCode>40074</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108813</GroupID><SubGroupID>112287</SubGroupID><ARTGs><ARTG>308700</ARTG></ARTGs><MinimumBenefit>2185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD076</BillingCode><PriorBillingCodes><PriorBillingCode>SK625</PriorBillingCode></PriorBillingCodes><Name> STAR Ankle Prosthesis</Name><Description>Tibial Component, cemented</Description><Size>xx-small - x-large</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108813</GroupID><SubGroupID>112288</SubGroupID><ARTGs><ARTG>237795</ARTG></ARTGs><MinimumBenefit>1900</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD079</BillingCode><PriorBillingCodes><PriorBillingCode>SK628</PriorBillingCode></PriorBillingCodes><Name> STAR Ankle Prosthesis</Name><Description>Tibial Component, cementless</Description><Size>xx-small - x-large</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108813</GroupID><SubGroupID>112288</SubGroupID><ARTGs><ARTG>237795</ARTG></ARTGs><MinimumBenefit>1900</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ080</BillingCode><PriorBillingCodes><PriorBillingCode>ER384</PriorBillingCode><PriorBillingCode>AE267</PriorBillingCode></PriorBillingCodes><Name>Hintermann Series H3™ Total Ankle Prosthesis-Tibial Component</Name><Description>Hintermann Series H3™ Total Ankle Prosthesis-Tibial Component, left or right, primary or revision, CoCr, plasma sprayed titanium coating and a hydroxyapatite coating</Description><Size>0-6, 8 or 12mm thickness (revision)</Size><SupplierCode>40480</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108813</GroupID><SubGroupID>112288</SubGroupID><ARTGs><ARTG>289424</ARTG></ARTGs><MinimumBenefit>1900</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW882</BillingCode><PriorBillingCodes><PriorBillingCode>WR354</PriorBillingCode></PriorBillingCodes><Name>Cheville Salto Ankle Prostheses</Name><Description>Tibial component mobile bearing CoCr, Ti, HA</Description><Size>Sizes 0,1,2,3 left and right</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108813</GroupID><SubGroupID>112288</SubGroupID><ARTGs><ARTG>134055</ARTG></ARTGs><MinimumBenefit>1900</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK629</BillingCode><Name>STAR Ankle Prosthesis</Name><Description>Revision Tibial Component, Cemented</Description><Size>Extra small - Extra large</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108813</GroupID><SubGroupID>112288</SubGroupID><ARTGs><ARTG>167057</ARTG></ARTGs><MinimumBenefit>1900</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA032</BillingCode><Name>Vantage Total Ankle System - Tibial Component</Name><Description>Tibial component, mobile bearing, CoCr, plasma sprayed titanium coating</Description><Size>Left and right, size 1-4</Size><SupplierCode>40074</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108813</GroupID><SubGroupID>112288</SubGroupID><ARTGs><ARTG>308700</ARTG></ARTGs><MinimumBenefit>1900</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW828</BillingCode><PriorBillingCodes><PriorBillingCode>WR274</PriorBillingCode></PriorBillingCodes><Name>INBONE® II Total Ankle System: Tibial Component</Name><Description>Modular Tibial Tray, Tibial Base Stem, Tibial Top Stem</Description><Size>Sizes 2-5</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108813</GroupID><SubGroupID>112289</SubGroupID><ARTGs><ARTG>168052</ARTG></ARTGs><MinimumBenefit>1638</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW983</BillingCode><PriorBillingCodes><PriorBillingCode>WR320</PriorBillingCode></PriorBillingCodes><Name>INFINITY Total Ankle System: Tibial Component</Name><Description>Tibial tray</Description><Size>Sizes 1-5 and 3 Long, 4 Long, 5 Long</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108813</GroupID><SubGroupID>112289</SubGroupID><ARTGs><ARTG>168052</ARTG></ARTGs><MinimumBenefit>1638</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA024</BillingCode><Name>TM Ankle</Name><Description>tibial base component</Description><Size>6 sizes</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108813</GroupID><SubGroupID>112289</SubGroupID><ARTGs><ARTG>202429</ARTG></ARTGs><MinimumBenefit>1638</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW893</BillingCode><PriorBillingCodes><PriorBillingCode>WR366</PriorBillingCode></PriorBillingCodes><Name>Salto Talaris Ankle Prosthesis - Tibial component</Name><Description>Tibial component, fixed bearing, CrCo + Ti</Description><Size>Sizes 0, 1,2,3</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108813</GroupID><SubGroupID>112289</SubGroupID><ARTGs><ARTG>134055</ARTG></ARTGs><MinimumBenefit>1638</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW859</BillingCode><PriorBillingCodes><PriorBillingCode>WR327</PriorBillingCode></PriorBillingCodes><Name>INVISION Tibial Component</Name><Description>Tibial Tray, Standard or Long</Description><Size>Sizes 2, 3, 4, 5; Standard or Long; +4mm; +8mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108813</GroupID><SubGroupID>112289</SubGroupID><ARTGs><ARTG>168052</ARTG></ARTGs><MinimumBenefit>1638</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW862</BillingCode><PriorBillingCodes><PriorBillingCode>WR330</PriorBillingCode></PriorBillingCodes><Name>INVISION Talar Plate</Name><Description>Talar Plate</Description><Size>Sizes 1 – 5, Left or right, standard or long, 3mm, 6mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108813</GroupID><SubGroupID>112290</SubGroupID><ARTGs><ARTG>168052</ARTG></ARTGs><MinimumBenefit>706</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW980</BillingCode><Name>INBONE II Total Ankle System: Tibial Stem Extender</Name><Description>Modular Tibial Segments</Description><Size>12mm, 14mm, 16mm, 18mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108813</GroupID><SubGroupID>112290</SubGroupID><ARTGs><ARTG>168052</ARTG></ARTGs><MinimumBenefit>706</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW861</BillingCode><PriorBillingCodes><PriorBillingCode>WR329</PriorBillingCode></PriorBillingCodes><Name>INVISION Talar Augment</Name><Description>Talar Augment</Description><Size>15, 20, 25, 30, 35mm Diameter; 6mm and 10mm Depth</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108813</GroupID><SubGroupID>112290</SubGroupID><ARTGs><ARTG>168052</ARTG></ARTGs><MinimumBenefit>706</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ126</BillingCode><PriorBillingCodes><PriorBillingCode>AE139</PriorBillingCode><PriorBillingCode>AE139</PriorBillingCode></PriorBillingCodes><Name>Hemi CAP Articular Resurfacing Great Toe System</Name><Description>Fixation Component</Description><Size>8mm x 16mm, 9.5mm x 18mm</Size><SupplierCode>40480</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108814</GroupID><SubGroupID>112294</SubGroupID><ARTGs><ARTG>123538</ARTG></ARTGs><MinimumBenefit>703</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ125</BillingCode><PriorBillingCodes><PriorBillingCode>AE138</PriorBillingCode><PriorBillingCode>AE138</PriorBillingCode></PriorBillingCodes><Name>Hemi CAP Articular Resurfacing Great Toe System</Name><Description>Articular Component</Description><Size>12mm (1-2mm x 1.5-3mm offset), 15mm (1.5-2.5mm x 2.5-4.5mm offset)</Size><SupplierCode>40480</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108814</GroupID><SubGroupID>112294</SubGroupID><ARTGs><ARTG>123538</ARTG></ARTGs><MinimumBenefit>703</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM363</BillingCode><PriorBillingCodes><PriorBillingCode>LH232</PriorBillingCode></PriorBillingCodes><Name>Toe Joint</Name><Description>Metallic Hemiarthroplasty resurfacing prosthesis for the Metatarsophalangeal Joint</Description><Size>8mm - 23 mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108814</GroupID><SubGroupID>112295</SubGroupID><ARTGs><ARTG>141544</ARTG></ARTGs><MinimumBenefit>1145</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW705</BillingCode><PriorBillingCodes><PriorBillingCode>WR044</PriorBillingCode></PriorBillingCodes><Name>WMT Orthopaedics Implants Hinge Toe and Hammertoe Implant</Name><Description>Silastic flexible hinge toe with/without grommets</Description><Size>0, 1, 2, 3, 4, 5, 6, 7</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108814</GroupID><SubGroupID>112296</SubGroupID><ARTGs><ARTG>131003</ARTG></ARTGs><MinimumBenefit>548</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ046</BillingCode><PriorBillingCodes><PriorBillingCode>LM373</PriorBillingCode></PriorBillingCodes><Name>Subtalar Implants</Name><Description>Subtalar Implants</Description><Size>All sizes</Size><SupplierCode>40003</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108817</GroupID><SubGroupID>112299</SubGroupID><ARTGs><ARTG>308018</ARTG></ARTGs><MinimumBenefit>1321</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB045</BillingCode><Name>Subtalar Implant</Name><Description>Conical tapered titanium implant to treat flat foot and stabilise subtalar joint</Description><Size>7 – 12mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108817</GroupID><SubGroupID>112299</SubGroupID><ARTGs><ARTG>223188</ARTG></ARTGs><MinimumBenefit>1321</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL189</BillingCode><PriorBillingCodes><PriorBillingCode>IG053</PriorBillingCode></PriorBillingCodes><Name>MBA Titanium Subtalar Implant</Name><Description>Implant for subtalar joint arthroereisis</Description><Size>6, 8, 9, 10, 12mm and guide pin 2mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108817</GroupID><SubGroupID>112299</SubGroupID><ARTGs><ARTG>177631</ARTG></ARTGs><MinimumBenefit>1321</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT017</BillingCode><Name>Arch It</Name><Description>Subtalar Arthroereisis Implant</Description><Size>8mm, 9mm, 10mm, 11mm &amp; 12mm</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108817</GroupID><SubGroupID>112299</SubGroupID><ARTGs><ARTG>266192</ARTG></ARTGs><MinimumBenefit>1321</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT035</BillingCode><Name>Fuse It Healing Screw</Name><Description>Fenestrated conical fusion cage - intended to be used in situations where an aid is required to help facilitate bone fusion and alignment generally following an osteotomy but also in the instance of large bone deformities and complex fusion procedures.</Description><Size>Diameters from 6mm-16mm, lengths from 10mm-30mm</Size><SupplierCode>40220</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108817</GroupID><SubGroupID>112299</SubGroupID><ARTGs><ARTG>308601</ARTG></ARTGs><MinimumBenefit>1321</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU103</BillingCode><PriorBillingCodes><PriorBillingCode>DE293</PriorBillingCode></PriorBillingCodes><Name>Prostop</Name><Description>Arthroereisis Subtalar implant</Description><Size>7x12mm 8x12mm 9x14mm 10x14mm 11x16mm 12x16mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108817</GroupID><SubGroupID>112299</SubGroupID><ARTGs><ARTG>350870</ARTG></ARTGs><MinimumBenefit>1321</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW681</BillingCode><PriorBillingCodes><PriorBillingCode>WR001</PriorBillingCode></PriorBillingCodes><Name>BioArch Subtalar Arthroereisis Implant</Name><Description>Conical, tapered, titanium implant with blunt thread design.</Description><Size>8, 9, 10, 11, 12mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108817</GroupID><SubGroupID>112299</SubGroupID><ARTGs><ARTG>164928</ARTG></ARTGs><MinimumBenefit>1321</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM100</BillingCode><Name>Hyprocure</Name><Description>Sinus Tarsi Implant</Description><Size>5-9mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108817</GroupID><SubGroupID>112299</SubGroupID><ARTGs><ARTG>291288</ARTG></ARTGs><MinimumBenefit>1321</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW912</BillingCode><PriorBillingCodes><PriorBillingCode>WR389</PriorBillingCode></PriorBillingCodes><Name>Futura Conical Subtalar Implant</Name><Description>The Conical Subtalar Implant (CSI) is designed to treat hyperpronated foot and to stabilize the subtalar joint. It is intended to block forward, downward and medial displacement of the talus, allowing for normal subtalar joint motion while simultaneously </Description><Size>7 - 12</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108817</GroupID><SubGroupID>112299</SubGroupID><ARTGs><ARTG>130055</ARTG></ARTGs><MinimumBenefit>1321</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF090</BillingCode><Name>R2 Subtalar Implant</Name><Description>R2 Subtalar Implant</Description><Size>Size 7/13mm to 12/18mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108817</GroupID><SubGroupID>112299</SubGroupID><ARTGs><ARTG>184460</ARTG></ARTGs><MinimumBenefit>1321</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW995</BillingCode><PriorBillingCodes><PriorBillingCode>WR322</PriorBillingCode></PriorBillingCodes><Name>INFINITY Total Ankle System: Poly Insert</Name><Description>UHMWPE poly insert, Standard or Plus</Description><Size>Sizes 1-5; 6-13mm thick</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108821</GroupID><SubGroupID>112314</SubGroupID><ARTGs><ARTG>168052</ARTG></ARTGs><MinimumBenefit>627</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW894</BillingCode><PriorBillingCodes><PriorBillingCode>WR367</PriorBillingCode></PriorBillingCodes><Name>Salto Talaris Ankle Prosthesis - Tibial insert</Name><Description>Tibial insert, fixed, UHMWPE</Description><Size>Sizes 0,1,2,3, Left and Right, each size available in the following thicknesses, 8mm, 9mm,10mm,11mm, 13mm,15mm, 17mm, 19mm, 21mm.  Sizes 00, Left and Right, available in the following thicknesses, 8mm,9mm,10mm,11mm.</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108821</GroupID><SubGroupID>112314</SubGroupID><ARTGs><ARTG>134055</ARTG><ARTG>198095</ARTG></ARTGs><MinimumBenefit>627</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA022</BillingCode><Name>TM Ankle</Name><Description>Tibial Polyethylene Insert</Description><Size>6 sizes of the polyethylene insert with standard, +2 mm and +4 mm offsets</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108821</GroupID><SubGroupID>112314</SubGroupID><ARTGs><ARTG>202429</ARTG></ARTGs><MinimumBenefit>627</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW996</BillingCode><PriorBillingCodes><PriorBillingCode>WR272</PriorBillingCode></PriorBillingCodes><Name>INBONE® Total Ankle System: Poly Insert</Name><Description>Poly Insert, Standard or Plus</Description><Size>Sizes 1-6, 6-20mm thick</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108821</GroupID><SubGroupID>112314</SubGroupID><ARTGs><ARTG>168052</ARTG></ARTGs><MinimumBenefit>627</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA031</BillingCode><Name>Vantage Total Ankle System - Tibial Insert</Name><Description>Inlay, Mobile Bearing, UHMWPE</Description><Size>Left and Right, size 1-5, thickness 6mm - 12mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108821</GroupID><SubGroupID>112315</SubGroupID><ARTGs><ARTG>308700</ARTG></ARTGs><MinimumBenefit>591</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD077</BillingCode><PriorBillingCodes><PriorBillingCode>SK626</PriorBillingCode></PriorBillingCodes><Name> STAR Ankle Prosthesis</Name><Description>UHMWPE Sliding Core</Description><Size>6- 14mm</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108821</GroupID><SubGroupID>112315</SubGroupID><ARTGs><ARTG>237795</ARTG></ARTGs><MinimumBenefit>591</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ078</BillingCode><PriorBillingCodes><PriorBillingCode>ER385</PriorBillingCode><PriorBillingCode>AE265</PriorBillingCode></PriorBillingCodes><Name>Hintermann Series H3™ Total Ankle Prosthesis-Inlay</Name><Description>Hintermann Series H3™ Total Ankle Prosthesis-Inlay, UHMW Polyethylene</Description><Size>0-6, thickness 5-9 mm</Size><SupplierCode>40480</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108821</GroupID><SubGroupID>112315</SubGroupID><ARTGs><ARTG>289319</ARTG></ARTGs><MinimumBenefit>591</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW884</BillingCode><PriorBillingCodes><PriorBillingCode>WR356</PriorBillingCode></PriorBillingCodes><Name>Cheville Salto Ankle Prostheses</Name><Description>Mobile insert UHMWPE</Description><Size>Sizes 0,1,2,3. Each size has thickness 4,5,6 &amp; 7mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107708</SubCategoryID><GroupID>108821</GroupID><SubGroupID>112315</SubGroupID><ARTGs><ARTG>198095</ARTG></ARTGs><MinimumBenefit>591</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK596</BillingCode><Name>Total Wrist Implant System</Name><Description>Carpal Component</Description><Size>Small, Medium, Large</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112327</SubGroupID><ARTGs><ARTG>237794</ARTG></ARTGs><MinimumBenefit>1710</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL211</BillingCode><PriorBillingCodes><PriorBillingCode>IG110</PriorBillingCode></PriorBillingCodes><Name>Universal2 Carpal Component</Name><Description>Carpal plate (titanium) with fixed central peg and porous coating</Description><Size>xs, small, med, large</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112327</SubGroupID><ARTGs><ARTG>177632</ARTG></ARTGs><MinimumBenefit>1710</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO416</BillingCode><Name>Motec Wrist Joint Prosthesis</Name><Description>Metacarpal Threaded Implant</Description><Size>45-70mm lengths in 5mm increments, both in Small and Large sizes</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112327</SubGroupID><ARTGs><ARTG>194619</ARTG></ARTGs><MinimumBenefit>1710</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK592</BillingCode><Name>Total Wrist Implant System</Name><Description>Left and Right Radial Components</Description><Size>Small, Medium, Large</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112328</SubGroupID><ARTGs><ARTG>237794</ARTG></ARTGs><MinimumBenefit>3111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM347</BillingCode><Name>KinematX Wrist Arthroplasty System</Name><Description>Modular Wrist Arthroplasty</Description><Size>1, 2, 3</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112328</SubGroupID><ARTGs><ARTG>242002</ARTG></ARTGs><MinimumBenefit>3111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO417</BillingCode><Name>Motec Wrist Joint Prosthesis</Name><Description>Radius Threaded Implant</Description><Size>Radius threaded Implant, lengths 32-70mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112328</SubGroupID><ARTGs><ARTG>194619</ARTG></ARTGs><MinimumBenefit>3111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL213</BillingCode><PriorBillingCodes><PriorBillingCode>IG112</PriorBillingCode></PriorBillingCodes><Name>Universal2 Radial Component</Name><Description>Radial Implant (cobalt chrome) with integral stem and porous coating</Description><Size>x-small - left &amp; right, small - left &amp; right, medium - left &amp; right, large - left &amp; right</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112328</SubGroupID><ARTGs><ARTG>177632</ARTG></ARTGs><MinimumBenefit>3111</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW702</BillingCode><PriorBillingCodes><PriorBillingCode>WR041</PriorBillingCode></PriorBillingCodes><Name>Orthosphere</Name><Description>The Orthosphere is a spherical interpositional implant that may be used in both the carpometacarpal joint and tarsometatarsal joint as a spherical interpositional device.  It is used to replace the sympotmatic joint - either between the trapezium and firs</Description><Size>9mm - 14mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112329</SubGroupID><ARTGs><ARTG>130998</ARTG></ARTGs><MinimumBenefit>2043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW924</BillingCode><PriorBillingCodes><PriorBillingCode>WR404</PriorBillingCode></PriorBillingCodes><Name>BioProfile Pyrocarbon Carpal Implants</Name><Description>Low temperature Isotropic Pyrolytic Carbon Implants for carpal replacement/interposition, includes Proximal Scaphoid, Scapho/Trapezio/Trapezoid &amp; Trapezium</Description><Size>Small, Medium, Large &amp; Extra Large</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112329</SubGroupID><ARTGs><ARTG>94262</ARTG></ARTGs><MinimumBenefit>2043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM297</BillingCode><Name>Pyrocarbon Lunate</Name><Description>Pyrocarbon Lunate replacement</Description><Size>Mulitple</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112329</SubGroupID><ARTGs><ARTG>92524</ARTG></ARTGs><MinimumBenefit>2043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW923</BillingCode><PriorBillingCodes><PriorBillingCode>WR403</PriorBillingCode></PriorBillingCodes><Name>BioProfile Pyrocarbon Total Wrist Replacement (Capitate Resurfacing)</Name><Description>Low Temperature Isotropic Pyrolytic Carbon Implants for capitate resurfacing (reverse total wrist arthroplasty)</Description><Size>Medium, Large</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112329</SubGroupID><ARTGs><ARTG>94262</ARTG></ARTGs><MinimumBenefit>2043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK594</BillingCode><Name>Total Wrist Implant System</Name><Description>Carpal Ball</Description><Size>Small, Medium, Large</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112329</SubGroupID><ARTGs><ARTG>237794</ARTG></ARTGs><MinimumBenefit>2043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL212</BillingCode><PriorBillingCodes><PriorBillingCode>IG111</PriorBillingCode></PriorBillingCodes><Name>Universal2 Carpal Poly Component</Name><Description>Polyethylene carpal component to restore proper carpal height in Universal2 total wrist implant</Description><Size>xs-standard, xs +1, xs+2, small - standard, small +1, small +2, Med-standard, med+1, med+2; large-standard, large+1, large+2</Size><SupplierCode>40406</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112329</SubGroupID><ARTGs><ARTG>177632</ARTG></ARTGs><MinimumBenefit>2043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO418</BillingCode><Name>Motec Wrist Joint Prosthesis</Name><Description>Modular Radius Cups available with 15mm PEEK insert bearing and Cobalt Chromium Molybdenum coated with Ceramic Chromium Nitride 15mm &amp; 18mm. Modular Metacarpal Heads available with 4 neck lengths</Description><Size>Modular Radius Cup PEEK 15mm Ceramitised 15mm &amp; 17mm.  Modular Metacarpal Head 15mm short, med, long &amp; Extra long Neck - 18mm short medium &amp; long Neck</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112329</SubGroupID><ARTGs><ARTG>194619</ARTG></ARTGs><MinimumBenefit>2043</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM356</BillingCode><Name>Radio-Ulnar Joint Stem</Name><Description>Radio-Ulnar Joint Stem</Description><Size>Multiple Sizes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112330</SubGroupID><ARTGs><ARTG>178232</ARTG></ARTGs><MinimumBenefit>1064</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW926</BillingCode><PriorBillingCodes><PriorBillingCode>WR406</PriorBillingCode></PriorBillingCodes><Name>Eclypse Modular Pyrocarbon Ulnar Head</Name><Description>A modular titanium stem for ulnar head prostheses</Description><Size>6, 7.5, 9mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112330</SubGroupID><ARTGs><ARTG>121874</ARTG></ARTGs><MinimumBenefit>1064</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM148</BillingCode><Name>Ascension DRUJ Ulna Head, Implant System</Name><Description>Cobalt chromium stem with PyroCarbon or Cobalt Chromium Articular Surface</Description><Size>0, 1, 2, 3, 4</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112330</SubGroupID><ARTGs><ARTG>118638</ARTG></ARTGs><MinimumBenefit>1064</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT076</BillingCode><PriorBillingCodes><PriorBillingCode>OH502</PriorBillingCode></PriorBillingCodes><Name>Martin Ulna Head prosthesis</Name><Description>Ulnar Stem Titanium</Description><Size>Small, medium and large,2mm,4mm and 17mm collar</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112330</SubGroupID><ARTGs><ARTG>225176</ARTG></ARTGs><MinimumBenefit>1064</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM149</BillingCode><Name>Ascension DRUJ Ulna Head, Implant System</Name><Description>Cobalt chromium stem with PyroCarbon or Cobalt Chromium Articular Surface</Description><Size>0, 1, 2, 3, 4</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112331</SubGroupID><ARTGs><ARTG>118638</ARTG></ARTGs><MinimumBenefit>1064</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW925</BillingCode><PriorBillingCodes><PriorBillingCode>WR405</PriorBillingCode></PriorBillingCodes><Name>Eclypse Modular Pyrocarbon Ulnar Head</Name><Description>A modular pyrocarbon ulnar head prosthesis</Description><Size>14, 16, 18mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112331</SubGroupID><ARTGs><ARTG>121874</ARTG></ARTGs><MinimumBenefit>1064</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM357</BillingCode><Name>UHMWP Ball</Name><Description>UHMWP Ball</Description><Size>Multiple</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112331</SubGroupID><ARTGs><ARTG>178232</ARTG></ARTGs><MinimumBenefit>1064</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT077</BillingCode><PriorBillingCodes><PriorBillingCode>OH501</PriorBillingCode></PriorBillingCodes><Name>Martin Ulna Head prosthesis</Name><Description>UHP Cobalt Chrome Head</Description><Size>Small, medium and large</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112331</SubGroupID><ARTGs><ARTG>225176</ARTG></ARTGs><MinimumBenefit>1064</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT075</BillingCode><PriorBillingCodes><PriorBillingCode>OH500</PriorBillingCode></PriorBillingCodes><Name>Martin Ulna Head prosthesis</Name><Description>UHP Ceramic Head</Description><Size>Small, medium and large</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112331</SubGroupID><ARTGs><ARTG>225176</ARTG></ARTGs><MinimumBenefit>1064</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM366</BillingCode><Name>Distal Radio-Ulnar Joint Prosthesis</Name><Description>Distal Radio-Ulnar Joint Prosthesis</Description><Size>Multiple sizes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112332</SubGroupID><ARTGs><ARTG>178232</ARTG></ARTGs><MinimumBenefit>2333</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM245</BillingCode><Name>Universal Tendon Spacer</Name><Description>Tendon Spacer</Description><Size>1 size only</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112333</SubGroupID><ARTGs><ARTG>235820</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW710</BillingCode><PriorBillingCodes><PriorBillingCode>WR053</PriorBillingCode></PriorBillingCodes><Name>WMT Orthopaedic Implants Hand</Name><Description>Silastic tendon spacer</Description><Size>24in long, 3, 4, 5, 6mm wide</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108823</GroupID><SubGroupID>112333</SubGroupID><ARTGs><ARTG>141772</ARTG></ARTGs><MinimumBenefit>294</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK602</BillingCode><Name>Trapezio Metacarpal Prosthesis DLC</Name><Description>Cup, Polyethylene</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112339</SubGroupID><ARTGs><ARTG>252453</ARTG></ARTGs><MinimumBenefit>420</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK601</BillingCode><Name>Elektra Neck</Name><Description>Cobalt Chromium</Description><Size>Extra Short, Short, Medium, Long</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112339</SubGroupID><ARTGs><ARTG>167056</ARTG></ARTGs><MinimumBenefit>420</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK604</BillingCode><Name>Elektra Cup</Name><Description>Cobalt Chromium and Hydroxyapatite coating</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112339</SubGroupID><ARTGs><ARTG>167056</ARTG></ARTGs><MinimumBenefit>420</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM389</BillingCode><Name>Modular Thumb Head and Stem </Name><Description>Modular Thumb Head and Stem</Description><Size>Suitable for patient anatomy</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112341</SubGroupID><ARTGs><ARTG>329234</ARTG></ARTGs><MinimumBenefit>420</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK600</BillingCode><Name>Elektra Stem</Name><Description>Cobalt Chromium/Hydroxyapatite coated</Description><Size>6-8mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112341</SubGroupID><ARTGs><ARTG>167056</ARTG></ARTGs><MinimumBenefit>420</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW704</BillingCode><PriorBillingCodes><PriorBillingCode>WR043</PriorBillingCode></PriorBillingCodes><Name>Wright Swanson Titanium Carpal Scaphoid, Carpal Lunate, Basal Thumb Implant</Name><Description>The Swanson Basal Thumb implant is a one-piece intramedullary-stemmed implant designed to be used as an adjunct to resection arthroplasty of the trapeziometacarpal joint.  It acts as a spacer to preserve joint relationship and allow appropriate capsulolig</Description><Size>1 to 5 - length 19.3 to 26.3mm, width 9.5 to 13.6mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112341</SubGroupID><ARTGs><ARTG>131003</ARTG></ARTGs><MinimumBenefit>420</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM294</BillingCode><Name>Ascension MCP Finger Joint Replacement</Name><Description>PyroCarbon MCP Proximal Component</Description><Size>05P, 10P, 20P, 30P, 40P, 50P</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112343</SubGroupID><ARTGs><ARTG>94980</ARTG></ARTGs><MinimumBenefit>665</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD067</BillingCode><PriorBillingCodes><PriorBillingCode>HW565</PriorBillingCode></PriorBillingCodes><Name>SR Hand Implant System</Name><Description>SR Hand MCP Proximal, CoCr - Titanium Alloy, UHMWPE</Description><Size>XS/S/M/L/XL</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112343</SubGroupID><ARTGs><ARTG>237799</ARTG></ARTGs><MinimumBenefit>665</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK598</BillingCode><Name>MCP Finger Prosthesis "Ariadna"</Name><Description>Proximal part, Stainless Steel</Description><Size>1,2,or 3</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112343</SubGroupID><ARTGs><ARTG>167056</ARTG></ARTGs><MinimumBenefit>665</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM293</BillingCode><Name>Ascension MCP Finger Joint Replacement</Name><Description>PyroCarbon MCP Distal Component</Description><Size>05D, 10D, 20D, 30D, 40D, 50D</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112344</SubGroupID><ARTGs><ARTG>94980</ARTG></ARTGs><MinimumBenefit>665</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD068</BillingCode><PriorBillingCodes><PriorBillingCode>HW566</PriorBillingCode></PriorBillingCodes><Name>SR Hand Implant System</Name><Description>SR Hand MCP Distal CoCr - Titanium Alloy, UHMWPE</Description><Size>XS/S/M/L/XL</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112344</SubGroupID><ARTGs><ARTG>237799</ARTG></ARTGs><MinimumBenefit>665</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD073</BillingCode><PriorBillingCodes><PriorBillingCode>HW675</PriorBillingCode></PriorBillingCodes><Name>Tactys PIP - Proximal System</Name><Description>Proximal Surface and Stem</Description><Size>XS, S, M &amp; L</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112345</SubGroupID><ARTGs><ARTG>237793</ARTG></ARTGs><MinimumBenefit>760</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD071</BillingCode><PriorBillingCodes><PriorBillingCode>SK597</PriorBillingCode></PriorBillingCodes><Name>PIP Finger Prosthesis</Name><Description>Proximal part PIP joint</Description><Size>0-5</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112345</SubGroupID><ARTGs><ARTG>237793</ARTG></ARTGs><MinimumBenefit>760</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT092</BillingCode><PriorBillingCodes><PriorBillingCode>OH655</PriorBillingCode></PriorBillingCodes><Name>Martin Endoprosthesis System CapFlex PIP</Name><Description>CapFlex PIP Proximal</Description><Size>S,M,L</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112345</SubGroupID><ARTGs><ARTG>266373</ARTG></ARTGs><MinimumBenefit>760</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MJ022</BillingCode><Name>PIPR Finger Joint</Name><Description>Proximal Interphalangeal Replacement Joint:
Proximal Component
CoCr, HA</Description><Size>Sizes 7 through to 11</Size><SupplierCode>40173</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112345</SubGroupID><ARTGs><ARTG>138339</ARTG><ARTG>192787</ARTG></ARTGs><MinimumBenefit>760</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM296</BillingCode><Name>Ascension PIP Finger Joint Replacement</Name><Description>PyroCarbon PIP Proximal Component.</Description><Size>10P, 20P, 30P, 40P</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112345</SubGroupID><ARTGs><ARTG>94980</ARTG></ARTGs><MinimumBenefit>760</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MJ023</BillingCode><Name>PIPR Finger Joint</Name><Description>Proximal Interphalangeal Replacement Joint:
Middle Component and Insert
CoCr, HA, UHMWPE</Description><Size>Sizes 7 through to 11</Size><SupplierCode>40173</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112346</SubGroupID><ARTGs><ARTG>138339</ARTG><ARTG>192787</ARTG></ARTGs><MinimumBenefit>760</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD072</BillingCode><PriorBillingCodes><PriorBillingCode>SK603</PriorBillingCode></PriorBillingCodes><Name>PIP Finger Prosthesis</Name><Description>Distal part PIP joint</Description><Size>0-5</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112346</SubGroupID><ARTGs><ARTG>237793</ARTG></ARTGs><MinimumBenefit>760</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD074</BillingCode><PriorBillingCodes><PriorBillingCode>HW676</PriorBillingCode></PriorBillingCodes><Name>Tactys PIP - Distal System </Name><Description>Distal Surface and Stem</Description><Size>XS, S, M &amp; L</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112346</SubGroupID><ARTGs><ARTG>237793</ARTG></ARTGs><MinimumBenefit>760</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK595</BillingCode><Name>MCP Finger Prosthesis "Ariadna"</Name><Description>Distal part, Stainless Steel</Description><Size>1,2 or3</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112346</SubGroupID><ARTGs><ARTG>167056</ARTG></ARTGs><MinimumBenefit>760</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM295</BillingCode><Name>Ascension PIP Finger Joint Replacement</Name><Description>PyroCarbon PIP Distal Component</Description><Size>10D, 20D, 30D, 40D</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112346</SubGroupID><ARTGs><ARTG>94980</ARTG></ARTGs><MinimumBenefit>760</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT093</BillingCode><PriorBillingCodes><PriorBillingCode>OH656</PriorBillingCode></PriorBillingCodes><Name>Martin Endoprosthesis System CapFlex PIP</Name><Description>CapFlex PIP Distal</Description><Size>S,M,L, Height: 2.1, 3.0 &amp; 4.4mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112346</SubGroupID><ARTGs><ARTG>266373</ARTG></ARTGs><MinimumBenefit>760</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM298</BillingCode><Name>Pyrocarbon carpal implants</Name><Description>Pyrocarbon carpal replacement implants</Description><Size>Multiple sizes</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112347</SubGroupID><ARTGs><ARTG>92524</ARTG></ARTGs><MinimumBenefit>665</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW933</BillingCode><PriorBillingCodes><PriorBillingCode>WR418</PriorBillingCode></PriorBillingCodes><Name>BIOProfile Pyrocarbon Carpometacarpal Implants</Name><Description>Low Temperature Isotropic Pyrolytic Carbon Implants for carpometacarpal resurfacing (arthroplasty)</Description><Size>Small, Medium, Large &amp; Extra Large</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112347</SubGroupID><ARTGs><ARTG>94262</ARTG></ARTGs><MinimumBenefit>665</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW703</BillingCode><PriorBillingCodes><PriorBillingCode>WR042</PriorBillingCode></PriorBillingCodes><Name>WMT Orthopaedic Implants Hand</Name><Description>The Swanson Trapezium Implant is a flexible, one-piece intramedullary-stemmed implant developed to restore function to thumbs disabled by degenerative arthritis or post-traumatic arthritis.</Description><Size>1, 2, 3, 4, 5</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112347</SubGroupID><ARTGs><ARTG>130998</ARTG></ARTGs><MinimumBenefit>665</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD069</BillingCode><PriorBillingCodes><PriorBillingCode>SK588</PriorBillingCode></PriorBillingCodes><Name>Sbi PIP Silicone Implant System</Name><Description>Silicone finger joint</Description><Size>Various</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112347</SubGroupID><Suffix>Total</Suffix><ARTGs><ARTG>237800</ARTG></ARTGs><MinimumBenefit>1330</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD070</BillingCode><PriorBillingCodes><PriorBillingCode>SK589</PriorBillingCode></PriorBillingCodes><Name>Sbi Silicone MCP Implant System</Name><Description>Silicon finger joint</Description><Size>Various</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112347</SubGroupID><Suffix>Total</Suffix><ARTGs><ARTG>237799</ARTG></ARTGs><MinimumBenefit>1330</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN187</BillingCode><Name>Neuflex Finger</Name><Description>Silicon Interpositional device</Description><Size>0-60</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112347</SubGroupID><Suffix>Total</Suffix><ARTGs><ARTG>97976</ARTG></ARTGs><MinimumBenefit>1330</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW706</BillingCode><PriorBillingCodes><PriorBillingCode>WR046</PriorBillingCode></PriorBillingCodes><Name>WMT Orthopaedic Implants Finger/Thumb</Name><Description>Silastic finger joint with/without Ti grommets 470 series</Description><Size>00, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112347</SubGroupID><Suffix>Total</Suffix><ARTGs><ARTG>131003</ARTG></ARTGs><MinimumBenefit>1330</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM053</BillingCode><Name>Osteotec Silicone PIP Joint Replacement</Name><Description>2 component hinged joint replacement for the proximal interphalangeal joint</Description><Size>5 - 50</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112347</SubGroupID><Suffix>Total</Suffix><ARTGs><ARTG>118424</ARTG></ARTGs><MinimumBenefit>1330</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM103</BillingCode><Name>Ascension Silicone Finger joint replacement</Name><Description>PIP moulded silicone finger joint</Description><Size>00-05</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112347</SubGroupID><Suffix>Total</Suffix><ARTGs><ARTG>92524</ARTG></ARTGs><MinimumBenefit>1330</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM102</BillingCode><Name>Ascension Silicone Finger joint replacement</Name><Description>MCP moulded silicone finger joint</Description><Size>Various</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108824</GroupID><SubGroupID>112347</SubGroupID><Suffix>Total</Suffix><ARTGs><ARTG>92524</ARTG></ARTGs><MinimumBenefit>1330</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI004</BillingCode><Name>Coonrad-Morrey Elbow</Name><Description>Humerus - Titanium</Description><Size>4, 6, 8 inch, Left &amp; Right</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112348</SubGroupID><ARTGs><ARTG>95733</ARTG></ARTGs><MinimumBenefit>4387</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW379</BillingCode><Name>Souter Strathclyde Elbow</Name><Description>Revision Humeral  - Custom, Long Stem</Description><Size>A, B, C, D</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112348</SubGroupID><ARTGs><ARTG>16236</ARTG><ARTG>166620</ARTG></ARTGs><MinimumBenefit>4387</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST818</BillingCode><Name>Osteonics Solar Elbow System - humeral assembly</Name><Description>Titanium alloy with polyethylene bushing</Description><Size>Standard, large</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112348</SubGroupID><ARTGs><ARTG>12875</ARTG><ARTG>166619</ARTG></ARTGs><MinimumBenefit>4387</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW985</BillingCode><Name>Latitude EV Humeral Stem</Name><Description>Cobalt-chromium humeral stem with Ti Plasma spray</Description><Size>Length - Standard, 150mm, 200mm  Size - Small (Left or Right), Medium (Left or Right), Large (Left or Right)</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112348</SubGroupID><ARTGs><ARTG>200974</ARTG></ARTGs><MinimumBenefit>4387</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA026</BillingCode><Name>Nexel Elbow</Name><Description>Humeral Component</Description><Size>Sizes 4-6 with multiple stem lengths</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112348</SubGroupID><ARTGs><ARTG>213309</ARTG></ARTGs><MinimumBenefit>4387</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST819</BillingCode><Name>Osteonics Solar Elbow System - long humeral assembly</Name><Description>Titanium alloy with polyethylene bushing</Description><Size>Standard, large</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112348</SubGroupID><ARTGs><ARTG>12875</ARTG><ARTG>166620</ARTG></ARTGs><MinimumBenefit>4387</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH338</BillingCode><Name>Comprehensive Segmental Revision System (SRS)</Name><Description>Comprehensive SRS Distal Humeral Body</Description><Size>50mm to 70mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112348</SubGroupID><ARTGs><ARTG>126999</ARTG></ARTGs><MinimumBenefit>4387</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW377</BillingCode><Name>Souter Strathclyde Elbow</Name><Description>Humeral - Long stem, left and right</Description><Size>Medium, Large</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112348</SubGroupID><ARTGs><ARTG>166620</ARTG><ARTG>16236</ARTG></ARTGs><MinimumBenefit>4387</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH663</BillingCode><PriorBillingCodes><PriorBillingCode>OO123</PriorBillingCode></PriorBillingCodes><Name>MUTARS Distal Humerus</Name><Description>MUTARS Distal Humerus</Description><Size>50mm, 30mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112348</SubGroupID><ARTGs><ARTG>284227</ARTG><ARTG>221739</ARTG></ARTGs><MinimumBenefit>4387</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM532</BillingCode><Name>Align Radial Head System</Name><Description>Titanium alloy stems with titanium plasma spray coating   </Description><Size>7 - 11mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112349</SubGroupID><ARTGs><ARTG>279801</ARTG></ARTGs><MinimumBenefit>1259</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW694</BillingCode><PriorBillingCodes><PriorBillingCode>WR022</PriorBillingCode></PriorBillingCodes><Name>Evolve Modular Radial Head</Name><Description>Cobalt chromium alloy, standard and plus stems</Description><Size>Stem 4.5 - 9.5mm Standard, +2 &amp; +4mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112349</SubGroupID><ARTGs><ARTG>118455</ARTG></ARTGs><MinimumBenefit>1259</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO271</BillingCode><Name>Acumed Total Radial Head</Name><Description>Stem</Description><Size>Standard Stems 6-10mm diameter 0-8mm neck height, Long Stems 6-12mm diameter</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112349</SubGroupID><ARTGs><ARTG>126428</ARTG></ARTGs><MinimumBenefit>1259</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW885</BillingCode><PriorBillingCodes><PriorBillingCode>WR357</PriorBillingCode></PriorBillingCodes><Name>RHS Radial Head System, Radial Stem</Name><Description>RHS Elbow prosthesis, Proximal Radial Stem, Press-fit Short Stems or Long Cemented Stems, Ti Co</Description><Size>Press-Fit Short Stems: 6 to 10mm , neck 13mm or 16mm. Cementeed Long Stems: 6.5 or 8mm, neck 19 or 22mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112349</SubGroupID><ARTGs><ARTG>94231</ARTG></ARTGs><MinimumBenefit>1259</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW888</BillingCode><PriorBillingCodes><PriorBillingCode>WR360</PriorBillingCode></PriorBillingCodes><Name>Latitude Elbow Prosthesis</Name><Description>Latitude Radial Stem component</Description><Size>Diam 6.5mm or 5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112349</SubGroupID><ARTGs><ARTG>200973</ARTG></ARTGs><MinimumBenefit>1259</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW928</BillingCode><PriorBillingCodes><PriorBillingCode>WR408</PriorBillingCode></PriorBillingCodes><Name>MoPyC-Modular Pyrocarbon Radial head Prosthesis</Name><Description>A modular titanium stem for radial head prosthesis</Description><Size>7mm, 8mm, 9mm, 10mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112349</SubGroupID><ARTGs><ARTG>94231</ARTG></ARTGs><MinimumBenefit>1259</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM104</BillingCode><Name>Ascension Radial Head</Name><Description>Proximal Radial Stem</Description><Size>01/02/03/04, standard &amp; long</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112349</SubGroupID><ARTGs><ARTG>112685</ARTG></ARTGs><MinimumBenefit>1259</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MO270</BillingCode><Name>Acumed Total Radial Head</Name><Description>Head</Description><Size>20-28mm</Size><SupplierCode>40163</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112350</SubGroupID><ARTGs><ARTG>126428</ARTG></ARTGs><MinimumBenefit>1267</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM531</BillingCode><Name>Align Radial Head </Name><Description>CoCr Radial Head with Lock Screw</Description><Size>18 - 26mm </Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112350</SubGroupID><ARTGs><ARTG>279801</ARTG></ARTGs><MinimumBenefit>1267</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW927</BillingCode><PriorBillingCodes><PriorBillingCode>WR407</PriorBillingCode></PriorBillingCodes><Name>MoPyC-Modular Pyrocarbon Radial head Prosthesis</Name><Description>A modular pyrocarbon radial head / neck prosthesis</Description><Size>18mm, 20mm, 22mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112350</SubGroupID><ARTGs><ARTG>94231</ARTG></ARTGs><MinimumBenefit>1267</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW887</BillingCode><PriorBillingCodes><PriorBillingCode>WR359</PriorBillingCode></PriorBillingCodes><Name>Latitude Elbow Prosthesis</Name><Description>Latitude Radial Head component</Description><Size>Small, Medium, Large, Large +</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112350</SubGroupID><ARTGs><ARTG>200973</ARTG></ARTGs><MinimumBenefit>1267</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW696</BillingCode><PriorBillingCodes><PriorBillingCode>WR025</PriorBillingCode></PriorBillingCodes><Name>Evolve Modular Radial Head</Name><Description>Cobalt chromium alloy head</Description><Size>Head 18-28mm Std, +2 and +4mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112350</SubGroupID><ARTGs><ARTG>118455</ARTG></ARTGs><MinimumBenefit>1267</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW695</BillingCode><PriorBillingCodes><PriorBillingCode>WR023</PriorBillingCode></PriorBillingCodes><Name>WMT Orthopaedic Implants Radial/Ulna Head</Name><Description>Radial head implant HP silastic</Description><Size>1, 1.5, 2, 2.5, 3</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112350</SubGroupID><ARTGs><ARTG>118455</ARTG></ARTGs><MinimumBenefit>1267</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW381</BillingCode><Name>Radial Head Prostheses</Name><Description>Radial Head - Small, Medium, Large</Description><Size>8 - 15mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112350</SubGroupID><ARTGs><ARTG>166613</ARTG></ARTGs><MinimumBenefit>1267</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM105</BillingCode><Name>Ascension Radial head</Name><Description>Proximal Radial Head</Description><Size>20/22/24mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112350</SubGroupID><ARTGs><ARTG>112685</ARTG></ARTGs><MinimumBenefit>1267</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW886</BillingCode><PriorBillingCodes><PriorBillingCode>WR358</PriorBillingCode></PriorBillingCodes><Name>RHS Radial Head System, Radial Head</Name><Description>RHS Elbow prosthesis, Radial Head, Ti Co</Description><Size>18mm to 24mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112350</SubGroupID><ARTGs><ARTG>94231</ARTG></ARTGs><MinimumBenefit>1267</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW380</BillingCode><Name>Souter Strathclyde Elbow</Name><Description>Revision Ulnar - Custom, Long stem</Description><Size>Small, Medium</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112351</SubGroupID><ARTGs><ARTG>16236</ARTG><ARTG>166619</ARTG></ARTGs><MinimumBenefit>3398</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI003</BillingCode><Name>Coonrad-Morrey Elbow</Name><Description>Ulna - Titanium</Description><Size>Petite, Left, Right</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112351</SubGroupID><ARTGs><ARTG>95731</ARTG></ARTGs><MinimumBenefit>3398</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW944</BillingCode><PriorBillingCodes><PriorBillingCode>WR433</PriorBillingCode></PriorBillingCodes><Name>Latitude EV Ulnar Stem</Name><Description>Chromium cobalt ulnar stem with Ti Plasma spray</Description><Size>Stem length: Short, Standard, 70mm, 125mm, 150mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112351</SubGroupID><ARTGs><ARTG>201352</ARTG></ARTGs><MinimumBenefit>3398</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH673</BillingCode><PriorBillingCodes><PriorBillingCode>OO134</PriorBillingCode></PriorBillingCodes><Name>MUTARS ulna anchorage</Name><Description>MUTARS ulna anchorage</Description><Size>left/right 70mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112351</SubGroupID><ARTGs><ARTG>221739</ARTG></ARTGs><MinimumBenefit>3398</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA028</BillingCode><Name>Nexel Elbow</Name><Description>Ulnar Component</Description><Size>75mm-115mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112351</SubGroupID><ARTGs><ARTG>213309</ARTG></ARTGs><MinimumBenefit>3398</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW866</BillingCode><PriorBillingCodes><PriorBillingCode>WR335</PriorBillingCode></PriorBillingCodes><Name>Tornier Latitude Total Elbow Prosthesis</Name><Description>Ulnar component, CoCr + UHMWPE</Description><Size>Small, Medium, Large</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112351</SubGroupID><ARTGs><ARTG>201352</ARTG></ARTGs><MinimumBenefit>3398</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW378</BillingCode><Name>Souter Strathclyde Elbow</Name><Description>Ulnar - Retentive, non retentive</Description><Size>50 - 90mm (Non), 70 - 90mm (Retentive)</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112351</SubGroupID><ARTGs><ARTG>16236</ARTG><ARTG>166619</ARTG></ARTGs><MinimumBenefit>3398</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH671</BillingCode><PriorBillingCodes><PriorBillingCode>OO132</PriorBillingCode></PriorBillingCodes><Name>MUTARS Proximal ulna</Name><Description>MUTARS Proximal ulna</Description><Size>60mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112351</SubGroupID><ARTGs><ARTG>284268</ARTG><ARTG>221739</ARTG></ARTGs><MinimumBenefit>3398</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH685</BillingCode><PriorBillingCodes><PriorBillingCode>OO177</PriorBillingCode></PriorBillingCodes><Name>MUTARS Ulna Anchorage</Name><Description>MUTARS Ulna Anchorage Component</Description><Size>Left/Right 70-100mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112351</SubGroupID><ARTGs><ARTG>221739</ARTG></ARTGs><MinimumBenefit>3398</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW938</BillingCode><PriorBillingCodes><PriorBillingCode>WR425</PriorBillingCode></PriorBillingCodes><Name>Latitude Elbow Prosthesis – Humeral Screw</Name><Description>Humeral Screw for revision surgery</Description><Size>Small, Medium and Large</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112353</SubGroupID><ARTGs><ARTG>200974</ARTG></ARTGs><MinimumBenefit>788</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW224</BillingCode><Name>Howmedica Modular Resection System</Name><Description>Humeral Axis -  Vitallium</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112353</SubGroupID><ARTGs><ARTG>242296</ARTG></ARTGs><MinimumBenefit>788</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH062</BillingCode><Name>Discovery Elbow System</Name><Description>2 x Condyle Bearings, 2 x screws, Poly articulation bearings</Description><Size>Std, Revision</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112356</SubGroupID><ARTGs><ARTG>126999</ARTG></ARTGs><MinimumBenefit>1368</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW881</BillingCode><PriorBillingCodes><PriorBillingCode>WR352</PriorBillingCode></PriorBillingCodes><Name>Latitude Elbow Prosthesis</Name><Description>Latitude Humeral Spool component, standard or anatomic, CoCr + PEEK</Description><Size>Standard spool: Small, Medium, Large, Large +, anterior, posterior or centered,   Anatomic Spool: Small, Medium, Large, Large +, Left and Right, Anterior Centred and Posterior Offset</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112356</SubGroupID><ARTGs><ARTG>200974</ARTG></ARTGs><MinimumBenefit>1368</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI005</BillingCode><Name>Coonrad-Morrey Elbow</Name><Description>Bushing -  Polyethylene, Titanium</Description><Size>1 &amp; 2</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112356</SubGroupID><ARTGs><ARTG>95733</ARTG></ARTGs><MinimumBenefit>1368</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW937</BillingCode><PriorBillingCodes><PriorBillingCode>WR424</PriorBillingCode></PriorBillingCodes><Name>Latitude Total Elbow Prosthesis – Ulnar Bushing</Name><Description>Ultra-high molecular weight polyethylene ulnar bushing</Description><Size>Small, Medium, Large – Right and Left</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112356</SubGroupID><ARTGs><ARTG>201352</ARTG></ARTGs><MinimumBenefit>1368</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA029</BillingCode><Name>Nexel Elbow</Name><Description>Accessories (1 Humeral Bearing, 2 Ulnar Bearings and 1 Axle Pin)</Description><Size>Various</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112356</SubGroupID><ARTGs><ARTG>213309</ARTG></ARTGs><MinimumBenefit>1368</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW199</BillingCode><Name>Howmedica Modular Resection System</Name><Description>Circlip -  Vitallium</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112357</SubGroupID><ARTGs><ARTG>261514</ARTG><ARTG>242296</ARTG></ARTGs><MinimumBenefit>70</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW223</BillingCode><Name>Howmedica Modular Resection System</Name><Description>Ulna Joint -  Vitallium</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108825</GroupID><SubGroupID>112359</SubGroupID><ARTGs><ARTG>128026</ARTG></ARTGs><MinimumBenefit>3594</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI884</BillingCode><Name>Comprehensive Fracture Stem</Name><Description>Fracture Stem Cobalt Chrome, Titanium</Description><Size>4,6,8,10,12,14mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112362</SubGroupID><ARTGs><ARTG>285717</ARTG><ARTG>218351</ARTG></ARTGs><MinimumBenefit>3771</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ969</BillingCode><Name>Global Shoulder System</Name><Description>Humeral Stem</Description><Size>6-16mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112362</SubGroupID><ARTGs><ARTG>137608</ARTG><ARTG>138093</ARTG><ARTG>138288</ARTG></ARTGs><MinimumBenefit>3771</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC044</BillingCode><Name>SMR Large Resection Stem</Name><Description>Resection Stem Large Ti6AI4V</Description><Size>7-10mm Dia x 50-80 Height</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112362</SubGroupID><ARTGs><ARTG>211984</ARTG></ARTGs><MinimumBenefit>3771</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA523</BillingCode><Name>Affinis Shoulder System</Name><Description>Stem Cemented - adjustable cone</Description><Size>6, 9, 12 and 15mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112362</SubGroupID><ARTGs><ARTG>215496</ARTG><ARTG>219396</ARTG></ARTGs><MinimumBenefit>3771</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EX055</BillingCode><Name>Equinoxe Humeral Stem, Fracture</Name><Description>The fracture stem is intended for cemented fixation only and is advised for 3 &amp; 4 part fractures of the proximal humerus</Description><Size>Fracture: left: 6.5mm - 12.5mm, right 6.5mm- 12.5mm Long stem fracture: left
6.5mmx200mm right 6.5mmx200mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112362</SubGroupID><ARTGs><ARTG>293562</ARTG><ARTG>293561</ARTG></ARTGs><MinimumBenefit>3771</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD005</BillingCode><Name>Turon Shoulder System - Humeral Stems</Name><Description>Turon Humeral Stem, Primary and Revision</Description><Size>6-16mm x 115mm and 6-16mm x 200mm</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112362</SubGroupID><ARTGs><ARTG>210938</ARTG><ARTG>215958</ARTG></ARTGs><MinimumBenefit>3771</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD059</BillingCode><Name>RSP Monoblock Humeral Stem Cemented</Name><Description>RSP Monoblock Humeral Stem cemented</Description><Size>6 x 101mm, 7 x 101mm, 8 x 101mm, 10 x 101mm, 12 x 101mm
6 x 175mm, 8 x 175mm,10 x 175mm, 12 x 175mm</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112362</SubGroupID><Suffix>Reverse</Suffix><ARTGs><ARTG>283578</ARTG><ARTG>283579</ARTG></ARTGs><MinimumBenefit>6301</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW874</BillingCode><PriorBillingCodes><PriorBillingCode>WR344</PriorBillingCode></PriorBillingCodes><Name>Aequalis Reversed fracture-standard</Name><Description>Monobloc Humeral Stem CoCr cemented</Description><Size>Length 130mm Dia 7 9 11 13 15</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112362</SubGroupID><Suffix>Reverse</Suffix><ARTGs><ARTG>211015</ARTG></ARTGs><MinimumBenefit>6301</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA528</BillingCode><Name>Affinis Inverse revision stem, cemented</Name><Description>Monoblock Revision Humeral Stem</Description><Size>6x180 to 12x230mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112362</SubGroupID><Suffix>Reverse</Suffix><ARTGs><ARTG>224955</ARTG></ARTGs><MinimumBenefit>6301</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ971</BillingCode><Name>DELTA Xtend</Name><Description>Monoblock Humeral Stem</Description><Size>8-14mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112362</SubGroupID><Suffix>Reverse</Suffix><ARTGs><ARTG>217441</ARTG></ARTGs><MinimumBenefit>6301</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA526</BillingCode><Name>Affinis Inverse Stem, cemented</Name><Description>Humeral component - cemented. Monoblock primary stem for reverse inlay</Description><Size>6,9,12,15mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112362</SubGroupID><Suffix>Reverse</Suffix><ARTGs><ARTG>215275</ARTG></ARTGs><MinimumBenefit>6301</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW875</BillingCode><PriorBillingCodes><PriorBillingCode>WR345</PriorBillingCode></PriorBillingCodes><Name>Aequalis Reversed Fracture Shoulder - Revision</Name><Description>Monobloc Humeral Stem CoCr and HA coated proximally</Description><Size>Length 170, 180 or 210mm Dia 7 9 11 13mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112362</SubGroupID><Suffix>Reverse</Suffix><ARTGs><ARTG>211015</ARTG></ARTGs><MinimumBenefit>6301</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW948</BillingCode><PriorBillingCodes><PriorBillingCode>WR437</PriorBillingCode></PriorBillingCodes><Name>Aequalis Ascend Flex PTC Humeral Stem</Name><Description>Convertible humeral stem with proximal PTC titanium plasma spray coating</Description><Size>Length: 66mm, 70mm, 74mm, 78mm, 82mm, 86mm, 88mm, 90mm, 93mm, 94mm, 98mm, 104mm, 109mm, 115mm, 120mm, 125mm, 130mm  Sizes: 1 to 9  Angulation: 127.5º, 132.5º, 137.5º</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112363</SubGroupID><ARTGs><ARTG>218732</ARTG></ARTGs><MinimumBenefit>3325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA543</BillingCode><Name>Affinis Shoulder System – Humeral Stem</Name><Description>Humeral stem and trunion, uncemented, Ti with Ti Plasma Spray and CaP coating</Description><Size>1-6</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112363</SubGroupID><ARTGs><ARTG>215479</ARTG></ARTGs><MinimumBenefit>3325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD066</BillingCode><Name>Altivate Reverse Humeral Stem</Name><Description>Altivate Reverse Humeral Stem</Description><Size>108, 175 &amp; 220mm Length</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112363</SubGroupID><Suffix>Reverse</Suffix><ARTGs><ARTG>297842</ARTG><ARTG>297843</ARTG></ARTGs><MinimumBenefit>6013</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN354</BillingCode><Name>GLOBAL ICON Stemless Shoulder System</Name><Description>Anchor Plate</Description><Size>40 to 56 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112363</SubGroupID><ARTGs><ARTG>395270</ARTG></ARTGs><MinimumBenefit>3325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU257</BillingCode><PriorBillingCodes><PriorBillingCode>DE173</PriorBillingCode></PriorBillingCodes><Name>Univers Fracture Prostheses</Name><Description>Shaft</Description><Size>8-13mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112363</SubGroupID><ARTGs><ARTG>308823</ARTG></ARTGs><MinimumBenefit>3325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU372</BillingCode><Name>Arthrex® UNIVERS™ II Humeral Stem</Name><Description>Uncoated Humeral Stem</Description><Size>6-15mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112363</SubGroupID><ARTGs><ARTG>308820</ARTG></ARTGs><MinimumBenefit>3325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD032</BillingCode><Name>Reverse Shoulder System</Name><Description>Humeral Stem, Ti</Description><Size>6mm to 12mm</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112363</SubGroupID><ARTGs><ARTG>210915</ARTG><ARTG>210917</ARTG></ARTGs><MinimumBenefit>3325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU371</BillingCode><Name>Arthrex® UNIVERS™ II Monoblock Stem</Name><Description>Uncoated Monoblock Stem</Description><Size>5mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112363</SubGroupID><ARTGs><ARTG>308819</ARTG></ARTGs><MinimumBenefit>3325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD060</BillingCode><Name>RSP Monoblock Humeral Stem Uncemented</Name><Description>RSP Monoblock Humeral Stem Uncemented</Description><Size>6 x 101mm, 7 x 101mm, 8 x 101mm, 10 x 101mm,12 x 101mm
6 x 175mm, 8 x 175mm, 10 x 175mm, 12 x 175mm</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112363</SubGroupID><Suffix>Reverse</Suffix><ARTGs><ARTG>283578</ARTG><ARTG>283579</ARTG></ARTGs><MinimumBenefit>6013</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ119</BillingCode><Name>Verso Shoulder System - Humeral Shell</Name><Description>Verso Shoulder Humeral Shell</Description><Size>Standard &amp; Stemmed</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112363</SubGroupID><Suffix>Reverse</Suffix><ARTGs><ARTG>284179</ARTG><ARTG>284180</ARTG></ARTGs><MinimumBenefit>6013</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW946</BillingCode><PriorBillingCodes><PriorBillingCode>WR435</PriorBillingCode></PriorBillingCodes><Name>Simpliciti - Nucleus</Name><Description>Uncemented humeral component, titanium, coated with a sintered titanium CP Ti bead coating</Description><Size>1,2,3</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112363</SubGroupID><ARTGs><ARTG>222657</ARTG></ARTGs><MinimumBenefit>3325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN374</BillingCode><Name>Global Shoulder System</Name><Description>Humeral Stem</Description><Size>6-16mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112363</SubGroupID><ARTGs><ARTG>223854</ARTG><ARTG>234875</ARTG><ARTG>234874</ARTG></ARTGs><MinimumBenefit>3325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA522</BillingCode><Name>Affinis Shoulder System</Name><Description>Stem Cementless - Titanium, adjustable cone</Description><Size>6, 7.5, 9, 10.5, 12, 13.5 and 15mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112363</SubGroupID><ARTGs><ARTG>219395</ARTG></ARTGs><MinimumBenefit>3325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW867</BillingCode><PriorBillingCodes><PriorBillingCode>WR337</PriorBillingCode></PriorBillingCodes><Name>Aequalis Fracture Shoulder HA Coated</Name><Description>Fracture shoulder humeral stem Cobalt Chrome, HA coated</Description><Size>Diam 6.5mm - 130mm and 170mm lengths, Diam 9mm - 130mm, 180mm and 210mm lengths. Diam 12mm - 130mm, 180mm and 210mm lengths</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112363</SubGroupID><ARTGs><ARTG>208886</ARTG></ARTGs><MinimumBenefit>3325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST674</BillingCode><Name>Osteonics Solar Shoulder Prostheses </Name><Description>Humeral stem polyethylene</Description><Size>3,5,7,9,11</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112363</SubGroupID><ARTGs><ARTG>128449</ARTG><ARTG>12875</ARTG></ARTGs><MinimumBenefit>3325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH047</BillingCode><Name>Comprehensive Shoulder System</Name><Description>Humeral Stems, standard, mini, micro and revision, porous coated, Ti</Description><Size>4mm to 20mm Diameter</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112363</SubGroupID><ARTGs><ARTG>262959</ARTG><ARTG>227906</ARTG><ARTG>218352</ARTG></ARTGs><MinimumBenefit>3325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA017</BillingCode><Name>Comprehensive Nano Humeral Component</Name><Description>stemless humeral component</Description><Size>30-40mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112363</SubGroupID><ARTGs><ARTG>220712</ARTG></ARTGs><MinimumBenefit>3325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA038</BillingCode><Name>Equinoxe Preserve Humeral Stem</Name><Description>Press fit humeral stem</Description><Size>6 - 14mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112363</SubGroupID><ARTGs><ARTG>409490</ARTG></ARTGs><MinimumBenefit>3325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI528</BillingCode><Name>Zimmer Trabecular Metal Reverse Shoulder System</Name><Description>Trabecular Metal Humeral Stem Titanium Alloy and Tantalum</Description><Size>8mm-18mm x 130mm-170mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112363</SubGroupID><Suffix>Reverse</Suffix><ARTGs><ARTG>228451</ARTG><ARTG>230880</ARTG></ARTGs><MinimumBenefit>6013</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA529</BillingCode><Name>Affinis Inverse Revision stem, uncemented</Name><Description>Monoblock Revision Humeral Stem</Description><Size>6 to 12 x180 to 230mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112363</SubGroupID><Suffix>Reverse</Suffix><ARTGs><ARTG>238292</ARTG></ARTGs><MinimumBenefit>6013</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA527</BillingCode><Name>Affinis Inverse Stem, uncemented</Name><Description>Monoblock Humeral Stem</Description><Size>6 to 15 mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112363</SubGroupID><Suffix>Reverse</Suffix><ARTGs><ARTG>215274</ARTG></ARTGs><MinimumBenefit>6013</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA007</BillingCode><Name>Equinoxe Humeral Stem, Primary, Press-Fit</Name><Description>Press-Fit Humeral Stem</Description><Size>7 – 19mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112363</SubGroupID><ARTGs><ARTG>244995</ARTG></ARTGs><MinimumBenefit>3325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD036</BillingCode><Name>Reverse Shoulder System</Name><Description>Humeral Socket Shell - Ti</Description><Size>Neutral, +4mm, +8mm offset</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112364</SubGroupID><ARTGs><ARTG>210937</ARTG></ARTGs><MinimumBenefit>2314</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH339</BillingCode><Name>Comprehensive Segmental Revision System (SRS)</Name><Description>Comprepehnsive SRS Proximal Body</Description><Size>42mm to 68mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112364</SubGroupID><ARTGs><ARTG>221713</ARTG></ARTGs><MinimumBenefit>2314</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH340</BillingCode><Name>Comprehensive Segmental Revision System (SRS)</Name><Description>Comprehensive SRS Tumour Body</Description><Size>51mm to 71mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112364</SubGroupID><ARTGs><ARTG>218350</ARTG></ARTGs><MinimumBenefit>2314</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW870</BillingCode><PriorBillingCodes><PriorBillingCode>WR340</PriorBillingCode></PriorBillingCodes><Name>Aequalis Reversed Shoulder -Metaphysis (Cemented or Cementless)</Name><Description>Cemented: CoCr and UMWHPE, Cementless: CoCr, HA Coated and UMWHPE</Description><Size>D.36mm &amp; 42mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112365</SubGroupID><ARTGs><ARTG>208524</ARTG><ARTG>208525</ARTG></ARTGs><MinimumBenefit>2451</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC188</BillingCode><Name>SMR Humeral Body with Locking Screw</Name><Description>Humeral Body Ti6aI4V - Finned - Trauma</Description><Size>Short/Medium/Long</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112365</SubGroupID><ARTGs><ARTG>234232</ARTG><ARTG>235005</ARTG></ARTGs><MinimumBenefit>2451</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN221</BillingCode><Name>Global Unite Shoulder System</Name><Description>Anatomic Proximal Body</Description><Size>6 to 16</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112365</SubGroupID><ARTGs><ARTG>231183</ARTG></ARTGs><MinimumBenefit>2451</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU193</BillingCode><Name>MSS - Medacta Shoulder System Reverse Metaphysis</Name><Description>Humeral Reverse and Eccentric Reverse Metaphysis</Description><Size>+0mm, +3mm, +9mm 0°, +/-20°, L and R</Size><SupplierCode>40166</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112365</SubGroupID><ARTGs><ARTG>400832</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Description, Size</ChangeExplanation><MinimumBenefit>2451</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN361</BillingCode><Name>Global Unite Reverse Fracture Epiphysis</Name><Description>Coated epiphysis, includes superior-lateral suture collar with suture holes. </Description><Size>Size 1. Centered, Left, and Right configurations</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112365</SubGroupID><ARTGs><ARTG>311439</ARTG></ARTGs><MinimumBenefit>2451</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ973</BillingCode><Name>Delta Shoulder System</Name><Description>Ephiphysis</Description><Size>1 – 2 in 26-42mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112365</SubGroupID><ARTGs><ARTG>143529</ARTG></ARTGs><MinimumBenefit>2451</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC189</BillingCode><Name>SMR Reverse Humeral Body with Locking Screw</Name><Description>SMR  Humeral Body -Reverse</Description><Size>Reverse Humeral body - short;  Reverse humeral body - finned;  Reverse humeral body - Standard HA Coated; 140° Reverse Humeral body - short; 140° Reverse humeral body - finned;  140°Reverse humeral body - Standard HA Coated</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112365</SubGroupID><Suffix>Reverse</Suffix><ARTGs><ARTG>225315</ARTG><ARTG>234748</ARTG><ARTG>234749</ARTG></ARTGs><MinimumBenefit>2451</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA481</BillingCode><Name>Affinis Shoulder System</Name><Description>Affinis Fracture Stem - metaphyseal, uncemented</Description><Size>15.5, Part 2- 18</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112365</SubGroupID><ARTGs><ARTG>219732</ARTG></ARTGs><MinimumBenefit>2451</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU258</BillingCode><PriorBillingCodes><PriorBillingCode>DE256</PriorBillingCode></PriorBillingCodes><Name>Eclipse Humeral Head Prosthesis</Name><Description>Eclipse Humeral Head Prosthesis Trunnion</Description><Size>41 - 53mm</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112365</SubGroupID><ARTGs><ARTG>308802</ARTG></ARTGs><MinimumBenefit>2451</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA035</BillingCode><Name>Equinoxe HRP Proximal Body</Name><Description>Anatomically shaped proximal bodies are designed to help restore the locations of the rotator cuff muscle insertions and increase deltoid wrapping to improve joint stability.</Description><Size>Extra-small, small, medium, large and extra-large</Size><SupplierCode>40074</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112365</SubGroupID><ARTGs><ARTG>396474</ARTG></ARTGs><MinimumBenefit>2451</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA536</BillingCode><Name>Affinis Fracture Inverse</Name><Description>Metaphyseal body with Ti plama spray plus CaPcoating- includes humeralcup with CoCr bearing surface</Description><Size>39 to 42</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112365</SubGroupID><ARTGs><ARTG>224971</ARTG></ARTGs><MinimumBenefit>2451</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK427</BillingCode><Name>Solar Reunion Humeral Fracture System</Name><Description>Solar Reunion Humeral Fracture System</Description><Size>Short &amp; Long</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112367</SubGroupID><ARTGs><ARTG>128450</ARTG></ARTGs><MinimumBenefit>3627</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC042</BillingCode><Name>SMR Shoulder System</Name><Description>Short and Revision Cemented Stem</Description><Size>Dia 12-20mm x length 80-210mm</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112368</SubGroupID><ARTGs><ARTG>218715</ARTG><ARTG>218783</ARTG></ARTGs><MinimumBenefit>3755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW889</BillingCode><PriorBillingCodes><PriorBillingCode>WR361</PriorBillingCode></PriorBillingCodes><Name>Aequalis Reversed Shoulder, Cemented Stem</Name><Description>Aequalis Reversed Shoulder prosthesis, Cemented Stem, CoCr</Description><Size>Diam 6.5mm to 15mm, Length 100 to 210mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112368</SubGroupID><ARTGs><ARTG>208476</ARTG></ARTGs><MinimumBenefit>3755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW967</BillingCode><PriorBillingCodes><PriorBillingCode>WR458</PriorBillingCode></PriorBillingCodes><Name>Aequalis Ascend Flex Cemented Humeral Stem</Name><Description>Convertible humeral stem for cemented used</Description><Size>Length: 66mm, 74mm, 82mm, 88mm, 90mm, 98mm, 109mm, 120mm.    Size: 2 to 8.     Angulation: 127.5º, 132.5º, 137.5º</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112368</SubGroupID><ARTGs><ARTG>218731</ARTG></ARTGs><MinimumBenefit>3755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA033</BillingCode><Name>Equinoxe HRP Distal Stem Modular</Name><Description>Distal stem, cemented, modular</Description><Size>6mm - 13mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112368</SubGroupID><ARTGs><ARTG>396476</ARTG></ARTGs><MinimumBenefit>3755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ161</BillingCode><Name>Global Unite Revision Stem</Name><Description>Long Humeral stem</Description><Size>6-12mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112368</SubGroupID><ARTGs><ARTG>220390</ARTG></ARTGs><MinimumBenefit>3755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EX051</BillingCode><Name>Equinoxe Humeral Long Stem</Name><Description>The long/revision stem is intended for cemented fixation only. The long/revision stem is advised when the distal bone quality is insufficient to adequately anchor the primary stems (typically as a result of mid-humeral fractures)</Description><Size>8x175mm, 8x215mm, 10x200mm, 12x200mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112368</SubGroupID><ARTGs><ARTG>264382</ARTG></ARTGs><MinimumBenefit>3755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA479</BillingCode><Name>Affinis Shoulder System</Name><Description>Affinis Fracture Stem - diaphyseal, cemented, short</Description><Size>6/125, 9/125, 12/125, 12/125, 9/200, 12/200</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112368</SubGroupID><ARTGs><ARTG>219731</ARTG></ARTGs><MinimumBenefit>3755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ162</BillingCode><Name>Global Unite Standard Stem</Name><Description>Standard humeral stem</Description><Size>6-16mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112368</SubGroupID><ARTGs><ARTG>220179</ARTG></ARTGs><MinimumBenefit>3755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH337</BillingCode><Name>Comprehensive Segmental Revision System</Name><Description>Comprehensive SRS Modular Stem</Description><Size>(4 to 18) mm dia x (75 to 200)mm length</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112368</SubGroupID><ARTGs><ARTG>266567</ARTG><ARTG>266559</ARTG></ARTGs><MinimumBenefit>3755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU192</BillingCode><Name>MSS - Medacta Shoulder System Diaphysis</Name><Description>Uncemented Humeral Diaphysis Ti + HA coated</Description><Size>from 6 to 16 STD and Short</Size><SupplierCode>40166</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112369</SubGroupID><ARTGs><ARTG>400830</ARTG></ARTGs><MinimumBenefit>2660</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC178</BillingCode><Name>SMR System - Finned &amp; Revision Humeral Stem</Name><Description>Finned Humeral Stem Ti6AI4V</Description><Size>Dia 11-26mm x Length 45 - 80mm, Dia 13-16mm x H 150 - 180mm</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112369</SubGroupID><ARTGs><ARTG>218726</ARTG><ARTG>274360</ARTG></ARTGs><MinimumBenefit>2660</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU259</BillingCode><PriorBillingCodes><PriorBillingCode>DE258</PriorBillingCode></PriorBillingCodes><Name>Eclipse Humeral Head Prosthesis</Name><Description>Eclipse Humeral Head Prosthesis Cage Screw</Description><Size>Small - X-Large</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112369</SubGroupID><ARTGs><ARTG>308799</ARTG></ARTGs><MinimumBenefit>2660</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC179</BillingCode><Name>SMR Resurfacing Humeral Stem</Name><Description>Resurfacing Humeral Stem Ti6AI4V - Uncemented</Description><Size>Dia 11-13mm x length 32-36mm</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112369</SubGroupID><ARTGs><ARTG>211983</ARTG></ARTGs><MinimumBenefit>2660</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW890</BillingCode><PriorBillingCodes><PriorBillingCode>WR362</PriorBillingCode></PriorBillingCodes><Name>Aequalis Reversed Shoulder, Cementless Stem</Name><Description>Aequalis Reversed Shoulder prosthetis, Cementless stem Ti, HA Coated</Description><Size>Diam 6.5mm to 154mm, Length 100mm to 210mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112369</SubGroupID><ARTGs><ARTG>208459</ARTG></ARTGs><MinimumBenefit>2660</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ160</BillingCode><Name>Delta Xtend Shoulder System</Name><Description>Modular humeral stem</Description><Size>10-16mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112369</SubGroupID><ARTGs><ARTG>307921</ARTG></ARTGs><MinimumBenefit>2660</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH341</BillingCode><Name>Comprehensive Segmental Revision System (SRS)</Name><Description>Comprehensive SRS Intercalary Segment</Description><Size>30-120mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112369</SubGroupID><ARTGs><ARTG>277258</ARTG></ARTGs><MinimumBenefit>2660</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EX058</BillingCode><Name>Equinoxe Humeral Head</Name><Description>The humeral head is used in hemi-shoulder and total-shoulder joint replacement procedures and for use in fractures of the proximal humerus and for use in total-shoulder joint replacement procedures in conjunction with an irreparable or nonfunctional rotator cuff. Multiple head heights for each diameter provides surgeon flexibility in patients with soft tissue challenges</Description><Size>38mm - 53mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112372</SubGroupID><ARTGs><ARTG>265513</ARTG></ARTGs><MinimumBenefit>1261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST672</BillingCode><Name>Osteonics Solar Shoulder Prostheses </Name><Description>Humeral head polyethylene</Description><Size>40-55mm by 12-34mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112372</SubGroupID><ARTGs><ARTG>128450</ARTG><ARTG>12875</ARTG></ARTGs><MinimumBenefit>1261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW945</BillingCode><PriorBillingCodes><PriorBillingCode>WR434</PriorBillingCode></PriorBillingCodes><Name>Simpliciti - Humeral Head</Name><Description>Anatomic humeral head, centred, CoCr</Description><Size>39 x 14, 41 x 15, 43 x 16, 46 x 17, 48 x 18, 50 x 16, 50 x 19, 52 x 19, 52 x 23</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112372</SubGroupID><ARTGs><ARTG>211853</ARTG></ARTGs><MinimumBenefit>1261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW863</BillingCode><PriorBillingCodes><PriorBillingCode>WR332</PriorBillingCode></PriorBillingCodes><Name>Aequalis Primary Shoulder Prostheses</Name><Description>Aequalis Primary Eccentric Humeral Head, CoCr</Description><Size>Diameter: 37, 39, 41, 43, 46, 48, 50, 52, 54mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112372</SubGroupID><ARTGs><ARTG>206492</ARTG></ARTGs><MinimumBenefit>1261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC180</BillingCode><Name>SMR Humeral Head</Name><Description>Humeral Head CoCrMo</Description><Size>Diameter (mm) 38 to 54  Offset 2 - 7 mm Eccentric  Shape Standard or Flattened</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112372</SubGroupID><ARTGs><ARTG>221715</ARTG></ARTGs><MinimumBenefit>1261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ965</BillingCode><Name>Global Shoulder System</Name><Description>Humeral heads</Description><Size>40–56mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112372</SubGroupID><ARTGs><ARTG>222178</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>1261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW949</BillingCode><PriorBillingCodes><PriorBillingCode>WR438</PriorBillingCode></PriorBillingCodes><Name>Aequalis Ascend Flex Humeral Head</Name><Description>Cobalt chrome humeral head</Description><Size>Diameter: 37mm, 39mm, 41mm, 43mm, 46mm, 48mm, 50mm, 52mm, 54mm  Height: 13.5mm, 14mm, 15mm, 16mm, 17mm, 18mm, 19mm, 23mm, 27mm  Offset: 1.5mm, 3.5mm, 4mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112372</SubGroupID><ARTGs><ARTG>218733</ARTG></ARTGs><MinimumBenefit>1261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP962</BillingCode><Name>Delta Shoulder system</Name><Description>DELTA Humeral Head INOX / ST.Steel / Nichtrostender St.</Description><Size>36 - 42 mm in +0-+4</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112372</SubGroupID><ARTGs><ARTG>225057</ARTG></ARTGs><MinimumBenefit>1261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW214</BillingCode><Name>Howmedica Modular Resection System</Name><Description>Humeral Head Fixed -  Vitallium</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112372</SubGroupID><ARTGs><ARTG>142278</ARTG></ARTGs><MinimumBenefit>1261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU261</BillingCode><Name>Eclipse Humeral Head Prosthesis</Name><Description>Eclipse Humeral Head Prosthesis Head</Description><Size>37/16 - 55/23</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112372</SubGroupID><ARTGs><ARTG>308800</ARTG></ARTGs><MinimumBenefit>1261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU370</BillingCode><Name>Arthrex® UNIVERS™ II Humeral Head</Name><Description>Humeral Head</Description><Size>40/17 - 56/24</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112372</SubGroupID><ARTGs><ARTG>308821</ARTG></ARTGs><MinimumBenefit>1261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU260</BillingCode><PriorBillingCodes><PriorBillingCode>DE174</PriorBillingCode></PriorBillingCodes><Name>Univers Fracture Prostheses</Name><Description>Metal head</Description><Size>43/15 - 51/22</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112372</SubGroupID><ARTGs><ARTG>308824</ARTG><ARTG>308825</ARTG></ARTGs><MinimumBenefit>1261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD003</BillingCode><Name>Turon Shoulder System - Humeral Head</Name><Description>Turon Standard Humeral Head, Standard and Offset</Description><Size>38-54mm x 14-26mm</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112372</SubGroupID><ARTGs><ARTG>215957</ARTG></ARTGs><MinimumBenefit>1261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH126</BillingCode><Name>Versadial Humeral Head</Name><Description>Humeral Head</Description><Size>Width (mm) 38-58  Diameter (mm) 38-64  Height (mm) 18-27</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112372</SubGroupID><ARTGs><ARTG>227907</ARTG></ARTGs><MinimumBenefit>1261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST673</BillingCode><Name>Osteonics Solar Shoulder Prostheses</Name><Description>Dual offset humeral head polyethylene</Description><Size>40,45,50mm Diameter by 15, 18, 21mm Thickness</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112372</SubGroupID><ARTGs><ARTG>128450</ARTG><ARTG>12875</ARTG></ARTGs><MinimumBenefit>1261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST027</BillingCode><Name>Solar Total Shoulder System</Name><Description>Dual Offset Humeral Heads</Description><Size>40-50mm diameter, 15-21mm thickness</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112372</SubGroupID><ARTGs><ARTG>12875</ARTG><ARTG>128450</ARTG></ARTGs><MinimumBenefit>1261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH349</BillingCode><Name>Comprehensive Segmental Revision System (SRS)</Name><Description>Comprehensive SRS Super EAS Head</Description><Size>Length (mm) 15-22,  Diameter (mm) 40-54</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112372</SubGroupID><ARTGs><ARTG>221710</ARTG></ARTGs><MinimumBenefit>1261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN353</BillingCode><Name>GLOBAL ICON Stemless Shoulder System</Name><Description>Humeral Head</Description><Size>40 to 56 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112372</SubGroupID><ARTGs><ARTG>395271</ARTG></ARTGs><MinimumBenefit>1261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA448</BillingCode><Name>Affinis Total Shoulder</Name><Description>Humeral Head - CoCr</Description><Size>Diameter 39, 41, 43, 45, 47, 49, 51, 53mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112372</SubGroupID><ARTGs><ARTG>220762</ARTG></ARTGs><MinimumBenefit>1261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ554</BillingCode><Name>DELTA Xtend</Name><Description>Delta Xtend CTA Head Extended Lip</Description><Size>48 + 52; 21, 26mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112372</SubGroupID><Suffix>EL</Suffix><ARTGs><ARTG>217443</ARTG></ARTGs><MinimumBenefit>3941</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC181</BillingCode><Name>SMR CTA Humeral Head</Name><Description>CTA Humeral Head CoCRMo</Description><Size>42 - 54mm</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112372</SubGroupID><Suffix>EL</Suffix><ARTGs><ARTG>211950</ARTG></ARTGs><MinimumBenefit>3941</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ970</BillingCode><Name>Global Shoulder System</Name><Description>CTA humeral head; Advantage, AP </Description><Size>Sizes 44-56mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112372</SubGroupID><Suffix>EL</Suffix><ARTGs><ARTG>275072</ARTG><ARTG>275073</ARTG></ARTGs><MinimumBenefit>3941</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA480</BillingCode><Name>Affinis Humeral Head</Name><Description>Affinis Humeral Head - Ceramic</Description><Size>39 to 53</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112372</SubGroupID><Suffix>Cer</Suffix><ARTGs><ARTG>215480</ARTG><ARTG>215501</ARTG></ARTGs><MinimumBenefit>1449</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC182</BillingCode><Name>SMR Resurfacing Humeral Head</Name><Description>Resurfacing Humeral Head CoCrMo + Poro+Ti+HA coated</Description><Size>42 - 54mm</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112373</SubGroupID><ARTGs><ARTG>211982</ARTG></ARTGs><MinimumBenefit>3040</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ787</BillingCode><Name>Global CAP Resurfacing Humeral Head Implant</Name><Description>Global CAP Conservative Anatomical Prosthesis (Shoulder Humeral Head Surface Replacement)</Description><Size>40-56mm Diameter</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112373</SubGroupID><ARTGs><ARTG>223855</ARTG></ARTGs><MinimumBenefit>3040</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW868</BillingCode><PriorBillingCodes><PriorBillingCode>WR338</PriorBillingCode></PriorBillingCodes><Name>Aequalis Resurfacing Shoulder</Name><Description>Resurfacing humeral head</Description><Size>12 head sizes from 37mm x 13.5mm to 54mm x 27mm, 3 stem lengths: 30, 35 and 40mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112373</SubGroupID><ARTGs><ARTG>207910</ARTG></ARTGs><MinimumBenefit>3040</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM078</BillingCode><Name>Ascension HRA - Humeral Resurfacing Arthroplasty</Name><Description>A anatomic semi constrained, monobody device intended for resurfacing of the humeral head.</Description><Size>40mm x 16mm to 56mm x21mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112373</SubGroupID><ARTGs><ARTG>149178</ARTG></ARTGs><MinimumBenefit>3040</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC183</BillingCode><Name>SMR Resurfacing CTA Humeral Head</Name><Description>CTA Resurfacing Humeral Head CoCrMo +Poro+Ti+Ha Coated</Description><Size>42 - 54mm</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112373</SubGroupID><Suffix>EL</Suffix><ARTGs><ARTG>211951</ARTG></ARTGs><MinimumBenefit>5220</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD035</BillingCode><Name>Reverse Shoulder System</Name><Description>Humeral Socket Insert - UHMWPE</Description><Size>32mm to 44mm</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112374</SubGroupID><ARTGs><ARTG>210914</ARTG><ARTG>210933</ARTG></ARTGs><MinimumBenefit>774</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD080</BillingCode><Name>Reverse Socket Insert e+</Name><Description>Socket Inserts e+ Poly</Description><Size>Size - 32mm, 36mm, 40mm, 44mm, Standard and Small, Thickness - Standard and +4</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112374</SubGroupID><ARTGs><ARTG>400333</ARTG></ARTGs><MinimumBenefit>774</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU194</BillingCode><Name>MSS - Medacta Shoulder System Reverse Liner</Name><Description>Humeral Reverse HC Liner</Description><Size>Diameter 32, 36, 39 and 42 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112374</SubGroupID><ARTGs><ARTG>400833</ARTG></ARTGs><MinimumBenefit>774</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC176</BillingCode><Name>SMR Reverse Liner (Cup) UHMWPE X-Lima</Name><Description>Reverse Liner UHMWPE X-Lima</Description><Size>36mm x +3/+6mm Standard &amp; Retentive</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112374</SubGroupID><ARTGs><ARTG>212774</ARTG></ARTGs><MinimumBenefit>774</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN170</BillingCode><Name>Delta Shoulder System</Name><Description>Humeral cup: Standard PE, High Mobility PE, Lateral, Retentive, </Description><Size>36 to 42</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112374</SubGroupID><ARTGs><ARTG>221374</ARTG><ARTG>212806</ARTG><ARTG>212807</ARTG><ARTG>217395</ARTG></ARTGs><MinimumBenefit>774</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW950</BillingCode><PriorBillingCodes><PriorBillingCode>WR439</PriorBillingCode></PriorBillingCodes><Name>Aequalis Ascend Flex Reversed Insert</Name><Description>Reversed insert/ retentive reversed insert - UHMWPE and Ti Alloy</Description><Size>Diameter: 33mm, 36mm, 39mm, 42mm  Thickness: 6mm, 9mm  Angulation: 7.5º, 12.5º, 17.5º</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112374</SubGroupID><ARTGs><ARTG>218735</ARTG></ARTGs><MinimumBenefit>774</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA110</BillingCode><Name>Comprehensive Reverse Humeral Cup</Name><Description>Humeral Cup</Description><Size>Standard or Retentive</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112374</SubGroupID><ARTGs><ARTG>324463</ARTG></ARTGs><MinimumBenefit>774</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW869</BillingCode><PriorBillingCodes><PriorBillingCode>WR339</PriorBillingCode></PriorBillingCodes><Name>Aequalis Reversed Shoulder Eccentric humeral Insert (High Mobility Cup)</Name><Description>Eccentric Humeral Insert (High Mobility Cup) for Aequalis Reversed Shoulder</Description><Size>36mm and 42mm, 2mm eccentric +6mm and +9mm, 4mm eccentric +9mm and +12mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112374</SubGroupID><ARTGs><ARTG>209514</ARTG></ARTGs><MinimumBenefit>774</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA532</BillingCode><Name>Affinis Inverse inlay</Name><Description>Humeral Cup</Description><Size>36+0 to 42+6mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112374</SubGroupID><ARTGs><ARTG>215500</ARTG></ARTGs><MinimumBenefit>774</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA552</BillingCode><Name>Affinis Inverse inlay ceramys</Name><Description>Ceramic Humeral Cup</Description><Size>Size 36, 39, 42. Height 0mm, 3mm, 6mm.</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112374</SubGroupID><ARTGs><ARTG>238291</ARTG></ARTGs><MinimumBenefit>774</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH055</BillingCode><Name>Comprehensive shoulder - reverse humeral cup</Name><Description>Reverse shoulder humeral bearing, highly cross linked UHMWPE</Description><Size>(Standard or Retentive) x (std, +3) x (36 to 41)mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112374</SubGroupID><ARTGs><ARTG>272677</ARTG></ARTGs><MinimumBenefit>774</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC177</BillingCode><Name>SMR Reverse Liner (Cup) CoCrMo</Name><Description>Reverse Liner Standard &amp; Excentric CoCrMo</Description><Size>Dia 40 - 44mm x Short to Long</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112374</SubGroupID><ARTGs><ARTG>212775</ARTG></ARTGs><MinimumBenefit>774</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI577</BillingCode><Name>Anatomical Shoulder</Name><Description>Anatomical Inverse/Reverse Humeral Poly inlay</Description><Size>36mm x 0, 3 &amp; 6mm; 40mm x 0, 3 &amp; 6mm.</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112374</SubGroupID><ARTGs><ARTG>275660</ARTG></ARTGs><MinimumBenefit>774</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EX048</BillingCode><Name>Equinoxe Humeral Liner</Name><Description>The Equinoxe Reverse Shoulder System includes a reverse semi-constrained prosthesis for use in total-shoulder joint replacement procedures in cases with an irreparable or nonfunctional rotator cuff.</Description><Size>Liner: 36mm+0, 36mm+2.5, 38mm+0, 38mm+2.5, 40mm+0, 40mm+2.5, 42mm+0, 42mm+2.5, 46mm+0, 46mm+2.5  Constrained Humeral Liner: 36mm+0, 36mm+2.5, 38mm+0, 38mm+2.5, 40mm+0, 40mm+2.5, 42mm+0, 42mm+2.5, 46mm+0, 46mm+2.5</Size><SupplierCode>40074</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112374</SubGroupID><ARTGs><ARTG>264172</ARTG><ARTG>279721</ARTG></ARTGs><MinimumBenefit>774</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH342</BillingCode><Name>Comprehensive Segmental Revision System (SRS)</Name><Description>Comprehensive SRS Humeral Coupler</Description><Size>100mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112378</SubGroupID><ARTGs><ARTG>277259</ARTG></ARTGs><MinimumBenefit>10877</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA034</BillingCode><Name>Equinoxe HRP Middle Segment</Name><Description>HRP middle segment is used to reconstruct the humerus due to the varying levels of humeral resections</Description><Size>25mm - 75mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112378</SubGroupID><ARTGs><ARTG>396473</ARTG></ARTGs><MinimumBenefit>10877</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH343</BillingCode><Name>Comprehensive Segmental Revision System (SRS)</Name><Description>Comprehensive SRS Anti Rotation Intercalary Segment</Description><Size>30mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112378</SubGroupID><ARTGs><ARTG>277259</ARTG></ARTGs><MinimumBenefit>10877</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ616</BillingCode><Name>Global AP Shoulder</Name><Description>Ball Taper Adjustable Neck Assembly</Description><Size>N/A</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112381</SubGroupID><ARTGs><ARTG>224369</ARTG></ARTGs><MinimumBenefit>998</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD002</BillingCode><Name>Turon Shoulder System - Humeral Neck</Name><Description>Turon - Humeral Neck</Description><Size>Neutral and 7.5 Degree</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108826</GroupID><SubGroupID>112381</SubGroupID><ARTGs><ARTG>216043</ARTG></ARTGs><MinimumBenefit>998</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA450</BillingCode><Name>Affinis Total Shoulder</Name><Description>Glenoid - UHMWPE</Description><Size>Size 1 to 4</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112402</SubGroupID><ARTGs><ARTG>219394</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA028</BillingCode><PriorBillingCodes><PriorBillingCode>EX061</PriorBillingCode></PriorBillingCodes><Name>Equinoxe Glenoid, pegged</Name><Description>UHMWPE component used to replace the Glenoid during total shoulder arthroplasty. This component is to be used with the Equinoxe total shoulder replacement</Description><Size>small, medium, large, X-Large</Size><SupplierCode>40074</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112402</SubGroupID><ARTGs><ARTG>278648</ARTG><ARTG>264381</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA547</BillingCode><Name>Affinis Glenoid cemented vitamys</Name><Description>Cemented glenoid - vitamys UHMWPE</Description><Size>Sizes 1 - 4</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112402</SubGroupID><ARTGs><ARTG>238288</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW952</BillingCode><PriorBillingCodes><PriorBillingCode>WR441</PriorBillingCode></PriorBillingCodes><Name>Aequalis PerFORM Pegged Glenoid</Name><Description>UHMWPE pegged glenoid</Description><Size>Small - backside radius: 30mm, 35mm, 40mm  Medium - backside radius: 30mm, 35mm, 40mm  Large - backside radius: 40mm, 50mm, 60mm  Extra large - backside radius: 40mm, 50mm, 60mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112402</SubGroupID><ARTGs><ARTG>206662</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ964</BillingCode><Name>Global Shoulder System</Name><Description>Glenoid component</Description><Size>40 to 56mm including XL</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112402</SubGroupID><ARTGs><ARTG>224217</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH049</BillingCode><Name>Comprehensive shoulder - glenoid</Name><Description>Modular hybrid glenoid base UHMWPE; Titanium</Description><Size>small, medium, large</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112402</SubGroupID><ARTGs><ARTG>270472</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH050</BillingCode><Name>Comprehensive Shoulder - Glenoid Stem</Name><Description>Glenoid Post, Ti Regenerx or Polyethylene</Description><Size>1 size</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112402</SubGroupID><ARTGs><ARTG>144584</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN332</BillingCode><Name>StepTech Anchor Peg Glenoid</Name><Description>Glenoid component</Description><Size>40 to 56 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112402</SubGroupID><ARTGs><ARTG>381043</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC172</BillingCode><Name>SMR Cemented Glenoid</Name><Description>All Poly Glenoid Cemented UHMWPE</Description><Size>Small - Large</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112402</SubGroupID><ARTGs><ARTG>211974</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC173</BillingCode><Name>SMR - Glenoid 3 Peg UHMWPE</Name><Description>Glenoid 3 Peg UHMWPE X-Lima</Description><Size>Extra small, Standard, Small, and Large</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112402</SubGroupID><ARTGs><ARTG>210963</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH698</BillingCode><PriorBillingCodes><PriorBillingCode>OO155</PriorBillingCode></PriorBillingCodes><Name>PE Glenoid</Name><Description>PE glenoid</Description><Size>Small and Standard</Size><SupplierCode>40192</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112402</SubGroupID><ARTGs><ARTG>244654</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW947</BillingCode><PriorBillingCodes><PriorBillingCode>WR436</PriorBillingCode></PriorBillingCodes><Name>Aequalis PerFORM Glenoid - CortiLoc</Name><Description>UHMWPE pegged glenoid with CortiLoc central peg</Description><Size>Small - backside radius of 30mm, 35mm and 40mm  Medium - backside radius of 30mm, 35mm and 40mm  Large - backside radius of 40mm, 50mm and 60mm  Extra large - backside radius of 40mm, 50mm and 60mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112402</SubGroupID><ARTGs><ARTG>206662</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV014</BillingCode><Name>Tornier PerFORM +</Name><Description>Anatomic Keeled Glenoid</Description><Size>Size Small - Medium - Large - Extra Large</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112402</SubGroupID><ARTGs><ARTG>293660</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST675</BillingCode><Name>Osteonics Solar Shoulder Prostheses </Name><Description>Glenoid component polyethylene</Description><Size>5,7,9,11</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112402</SubGroupID><ARTGs><ARTG>128449</ARTG><ARTG>12875</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW986</BillingCode><PriorBillingCodes><PriorBillingCode>WR442</PriorBillingCode></PriorBillingCodes><Name>Aequalis PerFORM Keeled Glenoid</Name><Description>UHMWPE keeled glenoid</Description><Size>Small - backside radius: 30mm, 35mm, 40mm  Medium - backside radius: 30mm, 35mm, 40mm  Large - backside radius: 40mm, 50mm, 60mm  Extra large - backside radius: 40mm, 50mm, 60mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112402</SubGroupID><ARTGs><ARTG>206662</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD004</BillingCode><Name>Turon Shoulder System - All-Poly Glenoid</Name><Description>Turon - All-Poly Glenoid, Keeled and Pegged</Description><Size>38mm, 42mm, 46mm, 50mm, 54mm</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112402</SubGroupID><ARTGs><ARTG>210954</ARTG><ARTG>210955</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HU262</BillingCode><PriorBillingCodes><PriorBillingCode>DE172</PriorBillingCode></PriorBillingCodes><Name>Univers Glenoid Shoulder Prostheses</Name><Description>Cemented glenoid</Description><Size>Small, Medium, Large, Extra-Large</Size><SupplierCode>40475</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112402</SubGroupID><ARTGs><ARTG>308803</ARTG><ARTG>308804</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC038</BillingCode><Name>SMR Shoulder System</Name><Description>Metal Back Glenoid</Description><Size> Small, Small R, Standard, Large</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112403</SubGroupID><ARTGs><ARTG>218703</ARTG></ARTGs><MinimumBenefit>2109</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF176</BillingCode><Name>Signature PMGA Glenoid Insert</Name><Description>3D porous glenoid insert</Description><Size>5 Sizes, 15 - 30 degree inclination</Size><SupplierCode>40413</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112403</SubGroupID><ARTGs><ARTG>313285</ARTG></ARTGs><MinimumBenefit>2109</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ289</BillingCode><Name>Affinis Glenoid vitamys uncemented</Name><Description>RM titanium coated vitamin-E glenoid component </Description><Size>Size 1 to 4</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112403</SubGroupID><ARTGs><ARTG>238289</ARTG></ARTGs><MinimumBenefit>2109</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA029</BillingCode><PriorBillingCodes><PriorBillingCode>EX061</PriorBillingCode></PriorBillingCodes><Name>Equinoxe Glenoid, Cage Pegged</Name><Description>UHMWPE component with Ti Alloy peripheral pegs and a Ti Alloy &amp; Ti plasma-coated central peg. It is used to replace the Glenoid during total shoulder arthroplasty. This component is to be used with the Equinoxe total shoulder replacement.</Description><Size>small, medium, large, X-Large</Size><SupplierCode>40074</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112404</SubGroupID><ARTGs><ARTG>293762</ARTG><ARTG>270232</ARTG></ARTGs><MinimumBenefit>2600</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI529</BillingCode><Name>Zimmer Trabecular Metal Reverse Shoulder System</Name><Description>Polyethylene Liner</Description><Size>Standard 7 Deg. &amp; Retentive 65 Deg; 36mm - Neutral, Plus 3mm, Plus 6mm; 40mm - Neutral, Plus 3mm, Plus 6mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112405</SubGroupID><ARTGs><ARTG>231818</ARTG></ARTGs><MinimumBenefit>1862</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ120</BillingCode><Name>Verso Shoulder System - Liner</Name><Description>Verso Shoulder Liner</Description><Size>3-12mm Offsets</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112405</SubGroupID><ARTGs><ARTG>284175</ARTG><ARTG>284176</ARTG></ARTGs><MinimumBenefit>1862</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC174</BillingCode><Name>SMR - Glenoid Component UHMWPE</Name><Description>Glenoid - MB Liner - UHMWPE</Description><Size>3 to 6mm thick x small-R to Large</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112405</SubGroupID><ARTGs><ARTG>221714</ARTG></ARTGs><MinimumBenefit>1862</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH052</BillingCode><Name>Comprehensive Shoulder - Reverse Glenoid Baseplate</Name><Description>Reverse glenoid baseplate, Ti, Porous coating</Description><Size>28mm, 25mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112409</SubGroupID><ARTGs><ARTG>144584</ARTG></ARTGs><MinimumBenefit>1991</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA535</BillingCode><Name>Affinis Inverse revision metaglene</Name><Description>Revision Metaglene, Ti plasma plus CaP Coating</Description><Size>one size only</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112409</SubGroupID><ARTGs><ARTG>224964</ARTG></ARTGs><MinimumBenefit>1991</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EX049</BillingCode><Name>Equinoxe Glenoid Plate</Name><Description>The glenoid plate provides multiple options for screw insertion</Description><Size>0 degree, 8 degree, 10 degree</Size><SupplierCode>40074</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112409</SubGroupID><ARTGs><ARTG>262854</ARTG><ARTG>284693</ARTG><ARTG>284694</ARTG><ARTG>284695</ARTG></ARTGs><MinimumBenefit>1991</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW940</BillingCode><PriorBillingCodes><PriorBillingCode>WR427</PriorBillingCode></PriorBillingCodes><Name>Aequalis Reversed Shoulder - Hemi Prosthesis Adaptor</Name><Description>Hemi Prosthesis Adaptor including union screw</Description><Size>36mm and 42mm diameter</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112409</SubGroupID><ARTGs><ARTG>209724</ARTG></ARTGs><MinimumBenefit>1991</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ974</BillingCode><Name>Delta Shoulder System</Name><Description>Metaglene</Description><Size>Standard, Revision, +10 to +15mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112409</SubGroupID><ARTGs><ARTG>307920</ARTG></ARTGs><MinimumBenefit>1991</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC186</BillingCode><Name>SMR Reverse Glenoid Base Plate</Name><Description>Reverse Glenoid Base Plate</Description><Size>Small-R or Small/Standard</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112409</SubGroupID><ARTGs><ARTG>210956</ARTG></ARTGs><MinimumBenefit>1991</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ117</BillingCode><Name>Verso Shoulder System - Glenoid Baseplate</Name><Description>Verso Shoulder Glenoid Base Plate</Description><Size>Standard, Long (Revision)</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112409</SubGroupID><ARTGs><ARTG>284178</ARTG></ARTGs><MinimumBenefit>1991</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA534</BillingCode><Name>Affinis Inverse Metaglene, DP</Name><Description>Metaglene, uncemented. Ti plasma plus CaP coating</Description><Size>One size only</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112409</SubGroupID><ARTGs><ARTG>215497</ARTG></ARTGs><MinimumBenefit>1991</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI533</BillingCode><Name>Zimmer Trabecular Metal Reverse Shoulder System</Name><Description>Trabecular Metal Reverse Base Plate - Ti Alloy &amp; Tantalum</Description><Size>15mm, 25mm, 30mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112409</SubGroupID><ARTGs><ARTG>228451</ARTG></ARTGs><MinimumBenefit>1991</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW879</BillingCode><PriorBillingCodes><PriorBillingCode>WR349</PriorBillingCode></PriorBillingCodes><Name>Aequalis Reversed Shoulder, Glenoid Base Plate</Name><Description>Glenoid Base Plate (Metaglene) with Long Post option for revision</Description><Size>Standard or Revision (Long Post)  dia 25mm and dia 29mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112409</SubGroupID><ARTGs><ARTG>209243</ARTG></ARTGs><MinimumBenefit>1991</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW990</BillingCode><Name>Aequalis Reversed II Threaded Post Baseplate</Name><Description>Glenoid Base Plate</Description><Size>Length (mm) Post: 20 - 50  Diameter (mm): 25 - 29</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112409</SubGroupID><ARTGs><ARTG>230918</ARTG></ARTGs><MinimumBenefit>1991</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD057</BillingCode><Name>Reverse Shoulder - Glenoid Baseplate</Name><Description>Reverse Glenoid Component, Baseplate</Description><Size>6.5mm x 30mm</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112409</SubGroupID><ARTGs><ARTG>210932</ARTG></ARTGs><MinimumBenefit>1991</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU195</BillingCode><Name>MSS - Medacta Shoulder System Baseplate</Name><Description>Glenoid Baseplate</Description><Size>Diameter 22, 24.5 and 27 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112409</SubGroupID><ARTGs><ARTG>400834</ARTG></ARTGs><MinimumBenefit>1991</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV012</BillingCode><Name>Perform Reversed Glenoid Baseplate</Name><Description>Reverse glenoid baseplate</Description><Size>25mm, 29mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112409</SubGroupID><ARTGs><ARTG>386957</ARTG><ARTG>386959</ARTG><ARTG>386956</ARTG></ARTGs><MinimumBenefit>1991</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA095</BillingCode><Name>Comprehensive Reverse Augmented Baseplate</Name><Description>Augmented Baseplate</Description><Size>25mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112409</SubGroupID><ARTGs><ARTG>345190</ARTG></ARTGs><MinimumBenefit>1991</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA551</BillingCode><Name>Affinis Inverse Glenosphere</Name><Description>Glenosphere vitamys</Description><Size>36mm, 39mm, 42mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112410</SubGroupID><ARTGs><ARTG>238290</ARTG></ARTGs><MinimumBenefit>2139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ967</BillingCode><Name>Delta Shoulder System</Name><Description>Glenosphere</Description><Size>38 to 42</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112410</SubGroupID><ARTGs><ARTG>217442</ARTG></ARTGs><MinimumBenefit>2139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC185</BillingCode><Name>SMR Reverse Glenosphere</Name><Description>Reverse Glenosphere CoCrMo</Description><Size>36mm Standard and Eccentric</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112410</SubGroupID><ARTGs><ARTG>211985</ARTG></ARTGs><MinimumBenefit>2139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV010</BillingCode><Name>Perform Reverse Glenosphere</Name><Description>Glenosphere - standard, eccentric, or lateralised</Description><Size>33mm, 36mm, 39mm, 42mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112410</SubGroupID><ARTGs><ARTG>386955</ARTG></ARTGs><MinimumBenefit>2139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI532</BillingCode><Name>Zimmer Trabecular Metal Reverse Shoulder System</Name><Description>Glenosphere - CoCr - Mo Alloy</Description><Size>36mm, 40mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112410</SubGroupID><ARTGs><ARTG>230876</ARTG></ARTGs><MinimumBenefit>2139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH051</BillingCode><Name>Comprehensive Shoulder - Reverse Glenosphere</Name><Description>Reverse glenosphere</Description><Size>36mm to 41mm  (standard, +3, +6)</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112410</SubGroupID><ARTGs><ARTG>324462</ARTG><ARTG>227969</ARTG></ARTGs><MinimumBenefit>2139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA533</BillingCode><Name>Affinis Inverse glenosphere</Name><Description>Glenosphere</Description><Size>36 to 42mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112410</SubGroupID><ARTGs><ARTG>215499</ARTG></ARTGs><MinimumBenefit>2139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EX050</BillingCode><Name>Equinoxe Glenosphere</Name><Description>The glenosphere aids in glenosphere insertion and protects any remaining intact soft tissues.</Description><Size>36mm, 38mm, 42mm &amp; 46mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112410</SubGroupID><ARTGs><ARTG>266161</ARTG><ARTG>279903</ARTG></ARTGs><MinimumBenefit>2139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW880</BillingCode><PriorBillingCodes><PriorBillingCode>WR350</PriorBillingCode></PriorBillingCodes><Name>Aequalis Reversed Shoulder, Glenoid Sphere</Name><Description>Glenoid Sphere, standard, eccentric, wear compensation or   lateralised</Description><Size>Diameter 33, 36, 39 and 42mm  Centre, or Eccentricity +2mm, or Wear Compensations 10deg, or Lateralised +6mm / +8mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112410</SubGroupID><ARTGs><ARTG>209244</ARTG></ARTGs><MinimumBenefit>2139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU196</BillingCode><Name>MSS - Medacta Shoulder System Glenosphere</Name><Description>Glenosphere</Description><Size>Diameter 32, 36, 39 and 42 mm Standard +4mm and lateralized +9mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112410</SubGroupID><ARTGs><ARTG>400835</ARTG></ARTGs><MinimumBenefit>2139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD058</BillingCode><Name>Reverse Shoulder – Glenosphere Head</Name><Description>Glenosphere</Description><Size>32mm to 44mm, neutral or -4mm offset</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112410</SubGroupID><ARTGs><ARTG>210932</ARTG></ARTGs><MinimumBenefit>2139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC184</BillingCode><Name>SMR Reverse Poly Gleonsphere</Name><Description>Reverse Glenophere UHMWPE X-Lima Ti6AI4V</Description><Size>40 - 44 Standard &amp; Exxentric</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112410</SubGroupID><ARTGs><ARTG>211987</ARTG></ARTGs><MinimumBenefit>2139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ118</BillingCode><Name>Verso Shoulder System - Glenoid Head</Name><Description>Verso Shoulder Glenoid Head</Description><Size>36mm, 41mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112410</SubGroupID><ARTGs><ARTG>284177</ARTG></ARTGs><MinimumBenefit>2139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN358</BillingCode><Name>Delta XTEND Revolution Lateralized Glenoid</Name><Description>Glenosphere</Description><Size>Standard and Eccentric diameter: 38 - 42 mm            Lateralization:  +0 mm  +2 mm      +4 mm       +6 mm      +8 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108827</GroupID><SubGroupID>112410</SubGroupID><ARTGs><ARTG>217442</ARTG></ARTGs><MinimumBenefit>2139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EX065</BillingCode><Name>Equinoxe Torque Definition Screw Kit.</Name><Description>Torque Definition Screw with Drive.</Description><Size>One size only.</Size><SupplierCode>40074</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112412</SubGroupID><ARTGs><ARTG>252473</ARTG></ARTGs><MinimumBenefit>1132</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA531</BillingCode><Name>Affinis Fixation Screw</Name><Description>Fixation Screw Long</Description><Size>one size only</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112412</SubGroupID><ARTGs><ARTG>257052</ARTG></ARTGs><MinimumBenefit>1132</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EX062</BillingCode><Name>Equinoxe Reverse Torque Definition Screw Kit</Name><Description>Reverse Torque Definition Screw with Drive</Description><Size>One size only</Size><SupplierCode>40074</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112412</SubGroupID><ARTGs><ARTG>252473</ARTG></ARTGs><MinimumBenefit>1132</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH344</BillingCode><Name>Comprehensive Segmental Revision System (SRS)</Name><Description>Comprehensive SRS Modular Regenerex Augment</Description><Size>Small, Large</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112413</SubGroupID><ARTGs><ARTG>277259</ARTG></ARTGs><MinimumBenefit>903</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC036</BillingCode><Name>SMR Shoulder - Modular Augment</Name><Description>Modular Augment Ti6AI4V</Description><Size>20 - 50mm</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112414</SubGroupID><ARTGs><ARTG>225458</ARTG></ARTGs><MinimumBenefit>950</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW865</BillingCode><PriorBillingCodes><PriorBillingCode>WR334</PriorBillingCode></PriorBillingCodes><Name>Aequalis Shoulder Prostheses Reverse</Name><Description>CoCr Reverse Humeral Neck</Description><Size>diameter 36 &amp; 42mm wide x 9mm high</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112414</SubGroupID><ARTGs><ARTG>242575</ARTG></ARTGs><MinimumBenefit>950</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW942</BillingCode><PriorBillingCodes><PriorBillingCode>WR430</PriorBillingCode></PriorBillingCodes><Name>Aequalis Reversed Fracture - Humeral Spacer</Name><Description>Lateralized Spacer</Description><Size>9mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112414</SubGroupID><ARTGs><ARTG>242575</ARTG></ARTGs><MinimumBenefit>950</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI531</BillingCode><Name>Zimmer Trabecular Metal Reverse Shoulder System</Name><Description>Dual Taper Insert</Description><Size>One Size Only</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112414</SubGroupID><ARTGs><ARTG>232002</ARTG></ARTGs><MinimumBenefit>950</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ968</BillingCode><Name>Delta Shoulder System</Name><Description>Humeral Spacer</Description><Size>Diameter 36, 42; +9mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112414</SubGroupID><ARTGs><ARTG>310880</ARTG></ARTGs><MinimumBenefit>950</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI530</BillingCode><Name>Zimmer Trabecular Metal Reverse Shoulder System</Name><Description>Spacer</Description><Size>9mm, 12mm Taper Insert</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112414</SubGroupID><ARTGs><ARTG>260177</ARTG></ARTGs><MinimumBenefit>950</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC117</BillingCode><Name>SMR Shoulder Accessories</Name><Description>SMR Connector and Screw</Description><Size>Small R / Small STD</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112416</SubGroupID><ARTGs><ARTG>210861</ARTG></ARTGs><MinimumBenefit>991</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ615</BillingCode><Name>Global AP Shoulder</Name><Description>Fixed 135 Degree Taper Assembly</Description><Size>135 Degree Angle</Size><SupplierCode>39932</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112416</SubGroupID><ARTGs><ARTG>224368</ARTG></ARTGs><MinimumBenefit>991</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW943</BillingCode><PriorBillingCodes><PriorBillingCode>WR431</PriorBillingCode></PriorBillingCodes><Name>Aequalis Reversed Fracture - Hemi-prosthesis Adaptor</Name><Description>Hemi-prosthesis Adaptor including union screw</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112417</SubGroupID><ARTGs><ARTG>211056</ARTG></ARTGs><MinimumBenefit>1159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA001</BillingCode><Name>Equinoxe Replicator Plate</Name><Description>The Equinoxe Replicator Plate is intended to connect the humeral head to the stem and to position the replacement humeral head in a variety of positions to match patient’s anatomy.</Description><Size>0mm – 4.5mm Offset</Size><SupplierCode>40074</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112417</SubGroupID><ARTGs><ARTG>278519</ARTG><ARTG>266159</ARTG></ARTGs><MinimumBenefit>1159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH127</BillingCode><Name>Versadial Humeral Head</Name><Description>Eccentric adaptor, taper insert</Description><Size>Std, reverse</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112417</SubGroupID><ARTGs><ARTG>104347</ARTG></ARTGs><MinimumBenefit>1159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC175</BillingCode><Name>SMR Reverse Modular Humeral Body Extension</Name><Description>Reverse Modular Mumeral Body Extension Ti6AI4V</Description><Size>+9mm</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112417</SubGroupID><ARTGs><ARTG>168581</ARTG></ARTGs><MinimumBenefit>1159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC037</BillingCode><Name>SMR Adaptor</Name><Description>Adaptor Eccentric / Neutral / CTA</Description><Size>Standard &amp; long 0 to +8mm</Size><SupplierCode>40191</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112417</SubGroupID><ARTGs><ARTG>221473</ARTG><ARTG>221712</ARTG></ARTGs><MinimumBenefit>1159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA537</BillingCode><Name>Affinis Inverse head adaptor</Name><Description>Adaptor for conversion tohemi prostheses, includes fixation screw</Description><Size>One size only</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112417</SubGroupID><ARTGs><ARTG>224965</ARTG></ARTGs><MinimumBenefit>1159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA538</BillingCode><Name>Affinis Inverse inlay spacer</Name><Description>Humeral offset spacer. Supplied with screw</Description><Size>+9mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112417</SubGroupID><ARTGs><ARTG>224412</ARTG></ARTGs><MinimumBenefit>1159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD063</BillingCode><Name>RSP Spacer</Name><Description>Spacer</Description><Size>8mm</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112417</SubGroupID><ARTGs><ARTG>284539</ARTG></ARTGs><MinimumBenefit>1159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD061</BillingCode><Name>RSP Hemi Adaptor</Name><Description>Adaptor for conversion of Reverse Shoulder Prostheses (RSP) to a hemi arthroplasty prosthesis</Description><Size>One size only</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112417</SubGroupID><ARTGs><ARTG>302695</ARTG></ARTGs><MinimumBenefit>1159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD062</BillingCode><Name>RSP Humeral Stem Adapter</Name><Description>RSP Humeral Stem Adapter for conversion to hemiarthroplasty prostheses</Description><Size>6 &amp; 12mm</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112417</SubGroupID><ARTGs><ARTG>302694</ARTG></ARTGs><MinimumBenefit>1159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW941</BillingCode><PriorBillingCodes><PriorBillingCode>WR429</PriorBillingCode></PriorBillingCodes><Name>Aequalis Reversed Fracture - Humeral Insert</Name><Description>Polyethylene Insert</Description><Size>Height 6.25 -13.5mm, Width 6mm-12mm, Articular Diameter- 36mm &amp; 42mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112419</SubGroupID><ARTGs><ARTG>211016</ARTG></ARTGs><MinimumBenefit>829</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EX064</BillingCode><Name>Equinoxe Reverse Shoulder Humeral Adapter Tray.</Name><Description>Reverse humeral adapter tray.</Description><Size>+0mm, +5mm, +10mm, +15mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112419</SubGroupID><Suffix>Metaphyseal component</Suffix><ARTGs><ARTG>244994</ARTG></ARTGs><MinimumBenefit>1840</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW871</BillingCode><PriorBillingCodes><PriorBillingCode>WR341</PriorBillingCode></PriorBillingCodes><Name>Aequalis Reversed Shoulder - Lateralized Insert</Name><Description>The humeral cup is made of UHMWPE. It comes in two diameters (36 + 42mm) to correspond with the humeral metaphyseal components with the following heights 6, 9, 12  and 15mm.</Description><Size>D. 36mm +6mm, D.36mm +9mm, D.36mm +12mm, D.36mm +15mm, D.42mm +6mm, D. 42mm +9mm, D.42mm +12mm D.42mm +15mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112419</SubGroupID><ARTGs><ARTG>209514</ARTG></ARTGs><MinimumBenefit>829</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD064</BillingCode><Name>Turon to RSP Conversion Module</Name><Description>Conversion Module</Description><Size>Neutral and Offset</Size><SupplierCode>39986</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112419</SubGroupID><ARTGs><ARTG>302688</ARTG></ARTGs><MinimumBenefit>829</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH054</BillingCode><Name>Comprehensive Shoulder - reverse humeral tray</Name><Description>Modular Reverse Humeral tray, to mount onto Comprehensive stem</Description><Size>Std, +5, +10</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112419</SubGroupID><ARTGs><ARTG>263032</ARTG></ARTGs><MinimumBenefit>829</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW951</BillingCode><PriorBillingCodes><PriorBillingCode>WR440</PriorBillingCode></PriorBillingCodes><Name>Aequalis Ascend Flex Reversed Tray</Name><Description>Reverse humeral tray - Titanium</Description><Size>Thickness: 0mm, 6mm, 12mm  Offset: 0mm, 1.5mm, 3.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112419</SubGroupID><ARTGs><ARTG>218734</ARTG></ARTGs><MinimumBenefit>829</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA109</BillingCode><Name>Comprehensive Reverse Humeral Tray</Name><Description>Epiphysis</Description><Size>Std, +5, +10</Size><SupplierCode>40315</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112419</SubGroupID><ARTGs><ARTG>324465</ARTG></ARTGs><MinimumBenefit>829</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UK030</BillingCode><Name>Spacer-S</Name><Description>A device temporarily placed into the shoulder joint space to prevent bone on bone contact and contraction of soft tissue during the treatment of an infected joint. The device locally releases gentamicin to help the treatment of the infection. The Spacer-S comes in 2 sizes</Description><Size>41 mm Head- 99 mm Stem  46 mm Head - 125 mm Stem  </Size><SupplierCode>40267</SupplierCode><CategoryID>107566</CategoryID><SubCategoryID>107709</SubCategoryID><GroupID>108828</GroupID><SubGroupID>112420</SubGroupID><ARTGs><ARTG>387272</ARTG></ARTGs><MinimumBenefit>1309</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV057</BillingCode><Name>Evolution Medial Pivot Knee System</Name><Description>Stemmed Femoral CS</Description><Size>3-8  Left, Right</Size><SupplierCode>40177</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><Suffix>Revision</Suffix><ARTGs><ARTG>392216</ARTG></ARTGs><MinimumBenefit>5276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU081</BillingCode><Name>GMK Revision cemented standard femur</Name><Description>Cemented minimally stabilised femoral component</Description><Size>Sizes 1 to 6, Left and Right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><Suffix>Revision</Suffix><ARTGs><ARTG>211444</ARTG></ARTGs><MinimumBenefit>5276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI961</BillingCode><Name>Persona Knee System</Name><Description>Persona CR Femoral Component, Cemented</Description><Size>Sizes 1-12</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>261278</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR288</BillingCode><PriorBillingCodes><PriorBillingCode>GO196</PriorBillingCode></PriorBillingCodes><Name>Apex Knee - Cemented Femoral Component</Name><Description>CR Cemented Femoral Component, Non-Porous, Size 1 to 6</Description><Size>Size 1-6, 1+, 2+, 3+, 4+, 5+, 6+ in Left &amp; Right</Size><SupplierCode>39996</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>273814</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MJ020</BillingCode><Name>MRK (Medial Rotation Knee) Total Knee System Femoral Component </Name><Description>Pegged Femoral Component, Cemented, CoCr</Description><Size>0-5 Left and Right</Size><SupplierCode>40173</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>192370</ARTG><ARTG>117768</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU145</BillingCode><Name>GMK Sphere Femoral Component</Name><Description>Cemented femoral component</Description><Size>1 to 7 Left
1 to 7 Right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>211411</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD017</BillingCode><Name>3D Knee System Femoral Component </Name><Description>Femoral Component, cemented, CoCr </Description><Size>Size 2 to 12</Size><SupplierCode>39986</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>161909</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR249</BillingCode><Name>Unity Knee - Cruciate Retaining Femur Cemented</Name><Description>Femoral Component Cemented - Cruciate Retaining</Description><Size>Size 1 – 9, Left and Right</Size><SupplierCode>39996</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>223554</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA108</BillingCode><Name>balanSys Femoral Component</Name><Description>Femoral component, cemented, CoCr</Description><Size>XS TO F Left and Right</Size><SupplierCode>40172</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>206062</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MJ005</BillingCode><Name>Saiph Knee System Femoral Component Cemented</Name><Description>CoCr Polished Cemented Femoral Component</Description><Size>1 - 8 Left &amp; Right</Size><SupplierCode>40173</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>117768</ARTG><ARTG>192370</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH609</BillingCode><PriorBillingCodes><PriorBillingCode>OO017</PriorBillingCode></PriorBillingCodes><Name>ACS Knee System - ACS LS Revision Femoral component, Cemented</Name><Description>Cemented femoral component, revision, for use with stems</Description><Size>Left/Right Sizes 2/3/4/5/6</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><Suffix>Revision</Suffix><ARTGs><ARTG>265605</ARTG></ARTGs><MinimumBenefit>5276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY368</BillingCode><Name>LCS Complete Knee System femoral component </Name><Description>Femoral component, cemented, CoCr</Description><Size>Sizes small to large+</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><Suffix>Revision</Suffix><ARTGs><ARTG>216984</ARTG></ARTGs><MinimumBenefit>5276</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MJ021</BillingCode><Name>MRK (Medial Rotation Knee) Total Knee System Revision Femoral Component</Name><Description>Stemmed Femoral Component, Cemented, CoCr</Description><Size>0-5 Left and Right</Size><SupplierCode>40173</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><Suffix>Fixed Stem</Suffix><ARTGs><ARTG>117768</ARTG><ARTG>192370</ARTG></ARTGs><MinimumBenefit>3877</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB360</BillingCode><Name>AS Columbus Knee System Femur CR cemented</Name><Description>Columbus cemented AS coated CR Fixed bearing femoral component for total knee arthroplasty</Description><Size>1-8 Left and Right</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><Suffix>Ceramic Surface</Suffix><ARTGs><ARTG>279466</ARTG></ARTGs><MinimumBenefit>3009</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU027</BillingCode><Name>Evolis Knee System Femoral Component </Name><Description>Femoral Component, cemented, CoCr, with TiNi (TiNibN) surface coating</Description><Size>1 - 6, left and right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><Suffix>Ceramic Surface</Suffix><ARTGs><ARTG>205141</ARTG></ARTGs><MinimumBenefit>3009</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI898</BillingCode><Name>Vanguard Total Knee System</Name><Description>Femoral Component, CR, Cemented, anatomic, CoCr.</Description><Size>55, 57.5, 60, 62.5, 65, 67.5, 70, 75, 80 Left and Right</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>218494</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK324</BillingCode><Name>Triathlon Knee System Femoral Component</Name><Description>Minimally stabilised, cemented, CoCr</Description><Size>Sizes 1 to 8</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>212698</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP004</BillingCode><Name>LCS Complete Knee System femoral component </Name><Description>Femoral cemented, CoCr</Description><Size>Sizes small to large+</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>216983</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW671</BillingCode><PriorBillingCodes><PriorBillingCode>SR063</PriorBillingCode><PriorBillingCode>SK332</PriorBillingCode></PriorBillingCodes><Name>Scorpio Knee System - Femoral Component</Name><Description>Minimally stabilised, cemented, alloy.</Description><Size>Sizes 3 - 13</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>211461</ARTG><ARTG>211480</ARTG><ARTG>211484</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA008</BillingCode><Name>Optetrak Logic Total Knee System, Femoral Component, CR, Cemented</Name><Description>Femoral Component, cemented, CoCr</Description><Size>Size 0 - 6, Left and Right</Size><SupplierCode>40074</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>285439</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA490</BillingCode><Name>balanSys Knee System / Femoral Component, CR, cemented, TiNbN coated</Name><Description>Balansys Femoral Component/ CR cemented, TiNbN coated</Description><Size>XS to F, left and right</Size><SupplierCode>40172</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>206173</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AE039</BillingCode><Name>Active Knee Femoral Component </Name><Description>Femoral Component, Cemented, CoCr </Description><Size>Sizes 00 - 5 Left &amp; Right</Size><SupplierCode>40045</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>164032</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB205</BillingCode><Name>Columbus Total Knee System (TKS) Femoral Component</Name><Description>Femoral component, cemented, CR, CoCr</Description><Size>F1 - F8, Left and Right</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>279465</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB348</BillingCode><Name>e.motion Total Knee System FP/UC Femoral Component cemented</Name><Description>e.motion mobile bearing FP/UC Femoral Component cemented</Description><Size>2-8, Left and right</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>293930</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH600</BillingCode><PriorBillingCodes><PriorBillingCode>OO001</PriorBillingCode></PriorBillingCodes><Name>ACS Knee System - Femoral component cemented</Name><Description>Cemented resurfacing femoral component for use in knee athroplasty</Description><Size>Left/Right 1-7</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>265601</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN991</BillingCode><Name>Genesis II Knee System Femoral Component</Name><Description>Femoral Component, cemented, CoCr</Description><Size>1-8
Left &amp; Right</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>207041</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI062</BillingCode><Name>Score Knee System Femoral Component</Name><Description>Femoral component, Cemented, CoCr, with extended patellar groove </Description><Size>7 sizes</Size><SupplierCode>40041</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>210577</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ953</BillingCode><Name>Attune Knee System</Name><Description>Cruciate Retaining Cemented Femur</Description><Size>1-10 including narrow</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>220502</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF139</BillingCode><Name>Active Knee Femoral Component </Name><Description>Femoral Component, Cemented, CoCr </Description><Size>Sizes 00 - 5 Left &amp; Right</Size><SupplierCode>40413</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>276959</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT010</BillingCode><PriorBillingCodes><PriorBillingCode>TZ009</PriorBillingCode></PriorBillingCodes><Name>Genus Knee System - Genus Cemented Femoral Component</Name><Description>Femoral Component for Total Knee Arthroplasty</Description><Size>1-7 right, 1-7 left, Minus</Size><SupplierCode>40232</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>232056</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FL007</BillingCode><Name>iTotal Cruciate-Retaining (CR) Total Knee Replacement System – iTotal Femoral Component</Name><Description>Minimally stabilised femoral component, cemented, CoCrMo</Description><Size>Left Knee, Right Knee, patient-specific</Size><SupplierCode>40018</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>377130</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN992</BillingCode><Name>Legion Knee System Femoral Component</Name><Description>Legion Femoral, cemented, CoCr</Description><Size>2-8
Left &amp; Right</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>212548</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU063</BillingCode><Name>GMK Primary Cemented Standard Femoral Component</Name><Description>Cemented standard femoral component</Description><Size>0 to 7, left to right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>211426</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU026</BillingCode><Name>Evolis Knee System Femoral Component </Name><Description>Femoral component, cemented, CoCr </Description><Size>1- 6, left and right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>204213</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU112</BillingCode><Name>GMK Cemented Standard Femur - TiNbN coated</Name><Description>Cemented standard femoral component, with TiNbN surface coating</Description><Size>sizes 0 to 7, left to right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>254612</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV003</BillingCode><Name>Evolution Medial Pivot Knee System</Name><Description>Cemented, grit blasted, minimally stabilised, femoral component</Description><Size>1-8
Left, Right</Size><SupplierCode>40177</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>225086</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH553</BillingCode><Name>Trekking Knee System, Femoral Component - CR</Name><Description>Femoral Component - CR</Description><Size>Shape: Left and Right
Width (mm): 59 - 79
Width (mm): Depth 53-73
Size: T1L - T5L
Size: T1R - T5R</Size><SupplierCode>40113</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112491</SubGroupID><ARTGs><ARTG>287516</ARTG></ARTGs><MinimumBenefit>2793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI736</BillingCode><Name>NexGen LPS-Flex Tivanium Femoral Component</Name><Description>LPS-Flex Tivanium Femoral Component, Size C Left
LPS-Flex Tivanium Femoral Component, Size C Right
LPS-Flex Tivanium Femoral Component, Size D Left
LPS-Flex Tivanium Femoral Component, Size D Right
LPS-Flex Tivanium Femoral Component, Size E Left
LPS</Description><Size>00-5968-013-51 LPS-Flex Tivanium Femoral Component, Size C Left
00-5968-013-52 LPS-Flex Tivanium Femoral Component, Size C Right
00-5968-014-51 LPS-Flex Tivanium Femoral Component, Size D Left
00-5968-014-52 LPS-Flex Tivanium Femoral Component, Size D </Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><ARTGs><ARTG>231632</ARTG></ARTGs><MinimumBenefit>2855</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA487</BillingCode><Name>balanSys Femoral Component</Name><Description>Femoral component, cemented, CoCr, posterior stabilised </Description><Size>XS to F, Left and Right</Size><SupplierCode>40172</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><ARTGs><ARTG>206047</ARTG></ARTGs><MinimumBenefit>2855</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH419</BillingCode><Name>Trekking Knee System: TCK Revision Femoral Component PS</Name><Description>Femoral Component Revision - PS</Description><Size>Size: T1R - T5R
Size: T1L - T5L
Shape: Left and Right
Width (mm): 59 - 79
Width (mm): Depth 53-73</Size><SupplierCode>40113</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><ARTGs><ARTG>287507</ARTG></ARTGs><ChangeExplanation>Change to Group benefit</ChangeExplanation><MinimumBenefit>5363</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU089</BillingCode><Name>GMK Revision cemented posterior-stabilised femur</Name><Description>Cemented posterior stabilised femoral component</Description><Size>Sizes 1 to 6, Left and Right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><Suffix>Revision</Suffix><ARTGs><ARTG>211486</ARTG></ARTGs><MinimumBenefit>5363</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA506</BillingCode><Name>Balansys Revision Knee</Name><Description>Femoral component, contrained</Description><Size>A to E, right to left</Size><SupplierCode>40172</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><Suffix>Revision</Suffix><ARTGs><ARTG>209536</ARTG></ARTGs><MinimumBenefit>5363</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR295</BillingCode><PriorBillingCodes><PriorBillingCode>GO286</PriorBillingCode></PriorBillingCodes><Name>Apex PS Cemented Revision Femoral Component</Name><Description>The femoral component of a total knee revision system that incorporates a proportionally sized box.</Description><Size>Sizes 1-6, plus Sizes 1+ to 5+ Left and Right</Size><SupplierCode>39996</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><Suffix>Revision</Suffix><ARTGs><ARTG>311060</ARTG></ARTGs><MinimumBenefit>5363</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI063</BillingCode><Name>Score Knee System Femoral Component</Name><Description>Femoral Component, CoCr, cemented, Posterior Stabilised</Description><Size>4 sizes in left and right</Size><SupplierCode>40041</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><Suffix>Revision</Suffix><ARTGs><ARTG>210579</ARTG></ARTGs><MinimumBenefit>5363</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN989</BillingCode><Name>Genesis II Knee System Femoral Component</Name><Description>Femoral component, cemented posterior stabilised, CoCr</Description><Size>1-8
Left &amp; Right</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>207012</ARTG></ARTGs><MinimumBenefit>2855</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR259</BillingCode><Name>Unity Knee – Posterior Stabilised Femur Cemented</Name><Description>Femoral Component Cemented - Posterior Stabilised</Description><Size>Size 1 – 9, Left and Right</Size><SupplierCode>39996</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><ARTGs><ARTG>223555</ARTG></ARTGs><MinimumBenefit>2855</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN990</BillingCode><Name>Legion Knee System Femoral Component</Name><Description>Femoral Component, cemented posterier stabilised, CoCr</Description><Size>2-8
Left &amp; Right</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><ARTGs><ARTG>212549</ARTG></ARTGs><MinimumBenefit>2855</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL172</BillingCode><Name>Journey II BCS Femoral CoCr</Name><Description>Femoral component, CoCr, cemented</Description><Size>1 - 9; Left/Right</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><ARTGs><ARTG>375295</ARTG></ARTGs><MinimumBenefit>2855</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB196</BillingCode><Name>E.motion Total Knee System</Name><Description>Posterior Stabilised Knee Component cemented</Description><Size>F2 - F8 Right Left</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><ARTGs><ARTG>293934</ARTG><ARTG>296713</ARTG><ARTG>296714</ARTG><ARTG>293932</ARTG></ARTGs><MinimumBenefit>2855</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH610</BillingCode><Name>ACS Knee System - PS Femoral component, cemented</Name><Description>ACS posterior stabilised femoral component, cemented</Description><Size>Size 1,2,2.5,3,4,5,6,7 left/right slim</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><ARTGs><ARTG>265603</ARTG></ARTGs><MinimumBenefit>2855</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI111</BillingCode><Name>Anatomic Cemented Femur</Name><Description>Cemented Posterior Stabilised Femoral Component</Description><Size>0 to 8</Size><SupplierCode>40041</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><ARTGs><ARTG>222529</ARTG></ARTGs><MinimumBenefit>2855</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB206</BillingCode><Name>Columbus Total Knee System (TKS) Femoral Component</Name><Description>Femoral component, cemented, CoCr, posterior stabilised</Description><Size>F1 - F8, Left and Right</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><ARTGs><ARTG>279467</ARTG></ARTGs><MinimumBenefit>2855</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU113</BillingCode><Name>GMK Posterior Stabilised Cemented Femur -TiNbN coated</Name><Description>Cemented posterior stabilised femoral component, with TiNbN surface coating</Description><Size>sizes 0 to 7, left and right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><ARTGs><ARTG>254613</ARTG></ARTGs><MinimumBenefit>2855</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU028</BillingCode><Name>Evolis Knee System Femoral Component </Name><Description>Femoral Component, cemented, CoCr, posterior stabilised </Description><Size>1 - 6, left and right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><ARTGs><ARTG>205428</ARTG></ARTGs><MinimumBenefit>2855</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR009</BillingCode><Name>Triathlon Knee System Femoral Component </Name><Description>Posterior stabilised, cemented, CoCr, with ability to add lugs or augments </Description><Size>Sizes 1 to 8</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><ARTGs><ARTG>213155</ARTG></ARTGs><MinimumBenefit>2855</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA493</BillingCode><Name>Balansys Knee System / Femoral Component, PS, cemented, TiNbN coated</Name><Description>Balansys Femoral Component/PS cemented, TiNbN coated, CoCrMo, TiNbN</Description><Size>XS to F, Left and Right</Size><SupplierCode>40172</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><ARTGs><ARTG>206174</ARTG></ARTGs><MinimumBenefit>2855</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI897</BillingCode><Name>Vanguard Total Knee System</Name><Description>Femoral Component, Posterior Stabilised, Cemented, anatomic, CoCr.</Description><Size>55, 57.5, 60, 62.5, 65, 67.5, 70, 75, 80 Left and Right</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><ARTGs><ARTG>98449</ARTG></ARTGs><MinimumBenefit>2855</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI933</BillingCode><Name>Persona Knee System</Name><Description>Persona PS Femoral Component, Cemented</Description><Size>1-12, including narrow</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><ARTGs><ARTG>261279</ARTG></ARTGs><MinimumBenefit>2855</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA011</BillingCode><Name>Optetrak Logic Total Knee System, Femoral Component, PS, Cemented</Name><Description>Femoral Component, PS, Cemented</Description><Size>Size 0 - 6, Left and Right</Size><SupplierCode>40074</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><ARTGs><ARTG>285440</ARTG></ARTGs><MinimumBenefit>2855</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR296</BillingCode><PriorBillingCodes><PriorBillingCode>GO287</PriorBillingCode></PriorBillingCodes><Name>Apex PS Cemented Femoral Component</Name><Description>The femoral component of a total knee system that incorporates a proportionally sized box.</Description><Size>Sizes 1-6, plus Sizes 1+ to 6+ Left and Right</Size><SupplierCode>39996</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><ARTGs><ARTG>278616</ARTG></ARTGs><MinimumBenefit>2855</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW670</BillingCode><PriorBillingCodes><PriorBillingCode>ST984</PriorBillingCode><PriorBillingCode>SR003</PriorBillingCode></PriorBillingCodes><Name>Scorpio Knee System - Femoral Component</Name><Description>Posterior stabilised, cemented, alloy.</Description><Size>Sizes 3 - 13</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><ARTGs><ARTG>211480</ARTG><ARTG>211857</ARTG><ARTG>211477</ARTG></ARTGs><MinimumBenefit>2855</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WQ005</BillingCode><Name>Origin PS Femur Cemented</Name><Description>Patient-Matched posterior stabilised cemented femoral component  </Description><Size>Patient Specific - Left and Right Knee</Size><SupplierCode>40394</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><ARTGs><ARTG>382626</ARTG></ARTGs><MinimumBenefit>2855</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU064</BillingCode><Name>GMK posterior stabilised cemented femur</Name><Description>Cemented posterior stabilised femoral component</Description><Size>0 to 7, left to right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><ARTGs><ARTG>223521</ARTG></ARTGs><MinimumBenefit>2855</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ954</BillingCode><Name>Attune Knee System</Name><Description>Posterior Stabilised Cemented Femur</Description><Size>1-10 including narrow</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><ARTGs><ARTG>220504</ARTG></ARTGs><MinimumBenefit>2855</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU029</BillingCode><Name>Evolis Knee System Femoral Component </Name><Description>Femoral Component, cemented, CoCr, posterior stabilised with TiNi (TiNibN) surface coating</Description><Size>1 - 6, left and right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><ARTGs><ARTG>205777</ARTG></ARTGs><MinimumBenefit>2855</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH552</BillingCode><Name>Trekking Knee System, Femoral Component - PS</Name><Description>Femoral Component - PS</Description><Size>Size: T1R - T5R
Size: T1L - T5L
Width (mm): 59 - 79
Width (mm) Depth 53-73
Shape: Left and Right</Size><SupplierCode>40113</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112492</SubGroupID><ARTGs><ARTG>287517</ARTG></ARTGs><MinimumBenefit>2855</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EX066</BillingCode><Name>Optetrak Total Knee System CCK (Constrained Condylar Knee) Femoral Component</Name><Description>Femoral Component, cemented, CoCr, totally stabilised</Description><Size>Size 1 - 6</Size><SupplierCode>40074</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112493</SubGroupID><Suffix>Revision</Suffix><ARTGs><ARTG>277741</ARTG></ARTGs><MinimumBenefit>5450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU099</BillingCode><Name>GMK Hinge femur</Name><Description>Rotating hinge femoral component</Description><Size>1 to 6 Left and Right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112493</SubGroupID><Suffix>Revision, Hinged</Suffix><ARTGs><ARTG>211408</ARTG></ARTGs><MinimumBenefit>5887</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO157</BillingCode><Name>Link Modular Knee Prosthesis
System</Name><Description>Femoral Components</Description><Size>Extra Small - Extra Large</Size><SupplierCode>40190</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112493</SubGroupID><Suffix>Revision, Hinged</Suffix><ARTGs><ARTG>224956</ARTG><ARTG>221853</ARTG></ARTGs><MinimumBenefit>5887</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM158</BillingCode><Name>Legion Hinge Femur CoCr</Name><Description>The femoral component of the Legion Hinge system.</Description><Size>Size 2 to 7</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112493</SubGroupID><Suffix>Revision, Hinged</Suffix><ARTGs><ARTG>232073</ARTG></ARTGs><MinimumBenefit>5887</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA091</BillingCode><Name>Persona Revision Femur Cemented</Name><Description>Femoral component, CoCr, for cemented use</Description><Size>1, 1+, 3, 3+, 5, 5+, 7, 7+, 9, 9+, 11, 11+, 13 in right and left configurations</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112493</SubGroupID><Suffix>Revision</Suffix><ARTGs><ARTG>374550</ARTG></ARTGs><MinimumBenefit>5450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI119</BillingCode><Name>NexGen LCCK (Legacy Constrained Condylar Knee)  Femoral Component</Name><Description>Femoral component, totally constrained, CoCr</Description><Size>A - H (L&amp;R)</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112493</SubGroupID><Suffix>Revision</Suffix><ARTGs><ARTG>214729</ARTG></ARTGs><MinimumBenefit>5450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI933</BillingCode><Name>Vanguard 360 Knee System</Name><Description>Femoral Component, CoCr, Ti</Description><Size>55 to 80mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112493</SubGroupID><Suffix>Revision</Suffix><ARTGs><ARTG>275615</ARTG></ARTGs><MinimumBenefit>5450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH608</BillingCode><PriorBillingCodes><PriorBillingCode>OO016</PriorBillingCode></PriorBillingCodes><Name>ACS Knee System - ACS SC Revision Femoral component, Cemented</Name><Description>Cemented femoral component, Cemented</Description><Size>Left/Right Sizes 2/2.5/3/4/5/6</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112493</SubGroupID><Suffix>Revision</Suffix><ARTGs><ARTG>265609</ARTG></ARTGs><MinimumBenefit>5450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO170</BillingCode><Name>LINK Endo Model Rotational and Hinge Knee Prostheses</Name><Description>Femoral Components</Description><Size>Extra Small - Extra Large</Size><SupplierCode>40190</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112493</SubGroupID><ARTGs><ARTG>157545</ARTG></ARTGs><MinimumBenefit>3053</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF134</BillingCode><Name>SHiVA Modular Knee Hinge Prosthesis - Femoral Component</Name><Description>Hinge Knee Femoral Component</Description><Size>Sizes 2,3 and 4 Left and right</Size><SupplierCode>40413</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112493</SubGroupID><Suffix>Revision, Hinged</Suffix><ARTGs><ARTG>192962</ARTG></ARTGs><MinimumBenefit>5887</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK440</BillingCode><Name>Triathlon TS Knee System Femoral Component </Name><Description>Totally constrained, cemented, CoCr</Description><Size>Left &amp; Right Size 1-8</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112493</SubGroupID><Suffix>Revision</Suffix><ARTGs><ARTG>217421</ARTG></ARTGs><MinimumBenefit>5450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP150</BillingCode><Name>PFC Sigma Knee System TC3 femoral component</Name><Description>Femoral component, cemented, CoCr, totally constrained</Description><Size>Size 1.5-5</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112493</SubGroupID><Suffix>Revision</Suffix><ARTGs><ARTG>227177</ARTG></ARTGs><MinimumBenefit>5450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV055</BillingCode><Name>Evolution Medial Pivot Knee System</Name><Description>Revision CCK Femoral Component</Description><Size>Sizes 3-8  Left, Right</Size><SupplierCode>40177</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112493</SubGroupID><Suffix>Revision</Suffix><ARTGs><ARTG>317408</ARTG></ARTGs><MinimumBenefit>5450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB390</BillingCode><Name>AS Columbus Revision Femoral Component Cemented</Name><Description>Revision Femoral Component AS (Advanced Surface)</Description><Size>1 - 7</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112493</SubGroupID><Suffix>Revision</Suffix><ARTGs><ARTG>312584</ARTG></ARTGs><MinimumBenefit>5450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW143</BillingCode><Name>MRH (Modular Rotating Hinge) (Modular Rotating Hinge) Femoral Component</Name><Description>MRH Rotating Hinge Femoral component, CoCr (Vitallium), cemented, w/attachable stem, Fixed</Description><Size>Left, Right</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112493</SubGroupID><Suffix>Revision, Hinged</Suffix><ARTGs><ARTG>223914</ARTG></ARTGs><MinimumBenefit>5887</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY148</BillingCode><Name>LCS Complete Knee System femoral component </Name><Description>Femoral component, cemented, CoCr, totally constrained</Description><Size>Sizes small to large+</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112493</SubGroupID><Suffix>Revision</Suffix><ARTGs><ARTG>259353</ARTG></ARTGs><MinimumBenefit>5450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB387</BillingCode><Name>AS EnduRo Femoral Component Cemented</Name><Description>EnduRo Rotating Hinge Knee Femoral Component AS (Advanced Surface)</Description><Size>1 - 3 R
1 - 3 L</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112493</SubGroupID><Suffix>Revision, Hinged</Suffix><ARTGs><ARTG>312500</ARTG></ARTGs><MinimumBenefit>5887</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN222</BillingCode><Name>Attune Knee System</Name><Description>Cemented Revision Femur</Description><Size>Sizes 1 to 10</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112493</SubGroupID><Suffix>Revision</Suffix><ARTGs><ARTG>298538</ARTG></ARTGs><MinimumBenefit>5450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN851</BillingCode><Name>Legion Knee System Femoral Component</Name><Description>Femoral Component, CoCr, Cemented, totally constrained</Description><Size>Sizes 1-10, Left and Right</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112493</SubGroupID><Suffix>Revision</Suffix><ARTGs><ARTG>208088</ARTG></ARTGs><MinimumBenefit>5450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP254</BillingCode><Name>SROM Noiles Knee System femoral component </Name><Description>Rotating Hinge, cemented, CoCr femoral component.</Description><Size>Sizes X-Small - Medium (M/L – 66-71mm; A/P – 58-66mm). </Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112493</SubGroupID><Suffix>Hinged</Suffix><ARTGs><ARTG>219088</ARTG></ARTGs><MinimumBenefit>5887</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI305</BillingCode><Name>Nexgen Rotating Hinged Knee Femoral Component</Name><Description>Femoral Component, with a fixed rotating hinge on UHMWPE bearings, cemented, CoCr </Description><Size>B-F</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112493</SubGroupID><Suffix>Hinged</Suffix><ARTGs><ARTG>220388</ARTG></ARTGs><MinimumBenefit>5887</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH639</BillingCode><PriorBillingCodes><PriorBillingCode>OO097</PriorBillingCode></PriorBillingCodes><Name>MUTARS - Genux Hinged knee femoral component</Name><Description>Cemented Hinge Knee</Description><Size>Size 3,4,5 left and right</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112493</SubGroupID><Suffix>Revision, Hinged</Suffix><ARTGs><ARTG>223514</ARTG></ARTGs><MinimumBenefit>5887</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB350</BillingCode><Name>EnduRo Rotating Hinge Knee Femoral Component</Name><Description>The EnduRo is a Rotating Hinge Knee prosthesis that enables the Orthopaedic Surgeon to treat complex revision knee arthroplasty as well as unstable knees.</Description><Size>1-3 Right  1-3 Left</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112493</SubGroupID><Suffix>Revision, Hinged</Suffix><ARTGs><ARTG>303701</ARTG></ARTGs><MinimumBenefit>5887</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH702</BillingCode><PriorBillingCodes><PriorBillingCode>OO159</PriorBillingCode></PriorBillingCodes><Name>MUTARS GenuX MK Femoral Component Cemented</Name><Description>MUTARS GenuX MK Femoral Component Cemented</Description><Size>Left/Right
2,3,4,5,6</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108652</GroupID><SubGroupID>112493</SubGroupID><Suffix>Hinged</Suffix><ARTGs><ARTG>238795</ARTG></ARTGs><MinimumBenefit>5887</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI590</BillingCode><Name>NexGen CR Flex Femoral Components - Precoat</Name><Description>Cobalt Chrome, High Flex, Precoat cemented, Cruciate retaining</Description><Size>Sizes A to G, Left to Right, GSF C to G Left to Right</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108653</GroupID><SubGroupID>112494</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>214841</ARTG></ARTGs><MinimumBenefit>2873</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL047</BillingCode><Name>Genesis II Oxinium</Name><Description>Genesis II Femoral component, Oxinium, cemented</Description><Size>Left / Right 1-9</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108654</GroupID><SubGroupID>112496</SubGroupID><Suffix>Ceramic Surface, SCP</Suffix><ARTGs><ARTG>207016</ARTG></ARTGs><MinimumBenefit>3662</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL048</BillingCode><Name>Legion Oxinium</Name><Description>Legion Femoral component, Oxinium, cemented</Description><Size>Left / Right 1-9</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108654</GroupID><SubGroupID>112496</SubGroupID><Suffix>Ceramic Surface</Suffix><ARTGs><ARTG>224561</ARTG></ARTGs><MinimumBenefit>3662</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN987</BillingCode><Name>Genesis II Oxinium</Name><Description>Genesis II Femoral Component, cemented, posterior stabilised, Oxinium</Description><Size>Left / Right 1-9</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108654</GroupID><SubGroupID>112497</SubGroupID><Suffix>Ceramic Surface, SCP</Suffix><ARTGs><ARTG>207011</ARTG></ARTGs><MinimumBenefit>3751</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL167</BillingCode><Name>Journey II BCS Femoral Oxinium</Name><Description>Femoral component, Oxinium, cemented</Description><Size>1-10, Left/Right</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108654</GroupID><SubGroupID>112497</SubGroupID><Suffix>Ceramic Surface</Suffix><ARTGs><ARTG>370843</ARTG></ARTGs><MinimumBenefit>3751</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN988</BillingCode><Name>Legion Oxinium</Name><Description>Femoral Component, cemented, posterior stabilised, Oxinium</Description><Size>Left / Right 1-9</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108654</GroupID><SubGroupID>112497</SubGroupID><Suffix>Ceramic Surface</Suffix><ARTGs><ARTG>224562</ARTG></ARTGs><MinimumBenefit>3751</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN736</BillingCode><Name>Legion Knee System Femoral Component</Name><Description>Femoral Component, Oxinium, Cemented, totally constrained</Description><Size>Size 1 - 9</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108654</GroupID><SubGroupID>112498</SubGroupID><Suffix>Revision</Suffix><ARTGs><ARTG>210518</ARTG></ARTGs><MinimumBenefit>6541</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH601</BillingCode><PriorBillingCodes><PriorBillingCode>OO002</PriorBillingCode></PriorBillingCodes><Name>ACS Knee System - Femoral component porous coated</Name><Description>Porous coated resurfacing femoral component</Description><Size>Left/Right 1-6</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108655</GroupID><SubGroupID>112499</SubGroupID><ARTGs><ARTG>265596</ARTG></ARTGs><MinimumBenefit>3226</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA457</BillingCode><Name>Balansys Femoral Component</Name><Description>Femur, CoCr with Ti vacuum plasma spray coating</Description><Size>XS TO F Left and Right</Size><SupplierCode>40172</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108655</GroupID><SubGroupID>112499</SubGroupID><ARTGs><ARTG>206063</ARTG></ARTGs><MinimumBenefit>3226</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA009</BillingCode><Name>Optetrak Logic Total Knee System, Femoral Component, CR, Porous</Name><Description>Femoral Component, CR, Porous Coated</Description><Size>Size 0 - 6, Left and Right</Size><SupplierCode>40074</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108655</GroupID><SubGroupID>112499</SubGroupID><ARTGs><ARTG>285901</ARTG></ARTGs><MinimumBenefit>3226</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP003</BillingCode><Name>LCS Complete Knee System femoral component </Name><Description>Femoral component, uncemented, CoCr, beaded (Porocoat)</Description><Size>Sizes small to large+</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108655</GroupID><SubGroupID>112499</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>216982</ARTG></ARTGs><MinimumBenefit>3226</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY373</BillingCode><Name>LCS Complete Knee System femoral component</Name><Description>Femoral component, uncemented, Porocoat, beaded Titanium with TiN surface treatment </Description><Size>Sizes MED - LG+</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108655</GroupID><SubGroupID>112499</SubGroupID><Suffix>Ceramic Surface, SCP</Suffix><ARTGs><ARTG>220219</ARTG></ARTGs><MinimumBenefit>3357</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA003</BillingCode><Name>Persona Knee System</Name><Description>Persona CR Femoral Component, Uncemented</Description><Size>Sizes 3-12</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108655</GroupID><SubGroupID>112499</SubGroupID><ARTGs><ARTG>222703</ARTG></ARTGs><MinimumBenefit>3226</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST033</BillingCode><Name>Scorpio Knee System Femoral Component</Name><Description>Minimally stabilised, uncemented, beaded, (microstructure), CoCr</Description><Size>3,5,7,9,11,13</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108655</GroupID><SubGroupID>112499</SubGroupID><ARTGs><ARTG>211476</ARTG></ARTGs><MinimumBenefit>3226</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ606</BillingCode><Name>PFC Sigma Knee System femoral component</Name><Description>Femoral component, uncemented, CoCr, beaded (Porocoat)</Description><Size>Size 1.5-6</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108655</GroupID><SubGroupID>112499</SubGroupID><ARTGs><ARTG>227157</ARTG></ARTGs><MinimumBenefit>3226</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN326</BillingCode><Name>'Genesis II Knee System Femoral Component</Name><Description>Femoral Component, CoCr, uncemented, beaded</Description><Size>Left/Right Size 1-8</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108655</GroupID><SubGroupID>112499</SubGroupID><ARTGs><ARTG>242832</ARTG></ARTGs><MinimumBenefit>3226</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN273</BillingCode><Name>Attune Knee System</Name><Description>Cruciate Retaining Cementless Component</Description><Size>Sizes 1-10 including narrow</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108655</GroupID><SubGroupID>112499</SubGroupID><ARTGs><ARTG>290326</ARTG></ARTGs><MinimumBenefit>3226</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR287</BillingCode><PriorBillingCodes><PriorBillingCode>GO195</PriorBillingCode></PriorBillingCodes><Name>Apex Knee, Femoral Component Porous Coated</Name><Description>Femoral Component Porous Coated Size 1 to 6 left &amp; Right.</Description><Size>Sizes 1-6, 1+, 2+, 3+, 4+, 5+, 6+ in Left &amp; Right</Size><SupplierCode>39996</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108655</GroupID><SubGroupID>112499</SubGroupID><ARTGs><ARTG>286880</ARTG></ARTGs><MinimumBenefit>3226</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD018</BillingCode><Name>3D Knee System Femoral Component </Name><Description>Femoral Component, uncemented,  beaded, CoCr</Description><Size>Size 2 to 12</Size><SupplierCode>39986</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108655</GroupID><SubGroupID>112499</SubGroupID><ARTGs><ARTG>161909</ARTG></ARTGs><MinimumBenefit>3226</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV042</BillingCode><Name>Evolution Medial Pivot Knee System</Name><Description>Uncemented, beaded, CoCr</Description><Size>1-8
Left, Right</Size><SupplierCode>40177</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108655</GroupID><SubGroupID>112499</SubGroupID><ARTGs><ARTG>290173</ARTG></ARTGs><MinimumBenefit>3226</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU038</BillingCode><Name>Evolis Knee System Femoral Component </Name><Description>Femoral component, uncemented, CoCr, titanium plasma spray</Description><Size>1 - 6, left to right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108655</GroupID><SubGroupID>112499</SubGroupID><ARTGs><ARTG>204254</ARTG></ARTGs><MinimumBenefit>3226</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU039</BillingCode><Name>Evolis Knee System Femoral Component </Name><Description>Femoral component, uncemented, CoCr, titanium plasma spray, posterior stabilised </Description><Size>1 - 6, left to right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108655</GroupID><SubGroupID>112500</SubGroupID><ARTGs><ARTG>204595</ARTG></ARTGs><MinimumBenefit>3314</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN873</BillingCode><Name>Genesis II Knee System Femoral Component</Name><Description>Femoral component, CoCr, cementless, beaded, posterior stabilised</Description><Size>Left / Right 1-8</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108655</GroupID><SubGroupID>112500</SubGroupID><ARTGs><ARTG>242833</ARTG></ARTGs><MinimumBenefit>3314</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR007</BillingCode><Name>Scorpio Knee System Femoral Component</Name><Description>Posterior stabilised, CoCr, uncemented, beaded, (microstructured), with TiNi surface treatment (LFIT - Low friction ion treatment)</Description><Size>3,5,7,9,11,13</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108655</GroupID><SubGroupID>112500</SubGroupID><ARTGs><ARTG>211479</ARTG></ARTGs><MinimumBenefit>3314</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH603</BillingCode><PriorBillingCodes><PriorBillingCode>OO004</PriorBillingCode></PriorBillingCodes><Name>ACS Knee System - Posterior stabilised femoral component porous coated</Name><Description>Posterior stabilised, porous coated, femoral component for use in knee arthroplasty</Description><Size>Left/Right 1-6</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108655</GroupID><SubGroupID>112500</SubGroupID><ARTGs><ARTG>265604</ARTG></ARTGs><MinimumBenefit>3314</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MJ006</BillingCode><Name>MRK (Medial Rotation Knee) Total Knee System Femoral Component </Name><Description>Femoral Component, uncemented, CoCr with stippled surface titanium plasma spray HA coated  </Description><Size>0-5 Left and Right</Size><SupplierCode>40173</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108656</GroupID><SubGroupID>112502</SubGroupID><ARTGs><ARTG>192370</ARTG><ARTG>117768</ARTG></ARTGs><MinimumBenefit>3575</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH602</BillingCode><Name>ACS Knee System - Femoral component Ti/TCP coated</Name><Description>Tricalcium phosphate coated resurfacing femoral component for use in knee arthroplasty</Description><Size>Left/Right 1-7</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108656</GroupID><SubGroupID>112502</SubGroupID><ARTGs><ARTG>265602</ARTG></ARTGs><MinimumBenefit>3575</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB232</BillingCode><Name>Emotion Total Knee System (TKS) Femoral Component </Name><Description>Femoral Component, uncemented, CoCr Titanium plasma spray (Plasmapore), HA coated</Description><Size>F2 - F8, Left and Right</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108656</GroupID><SubGroupID>112502</SubGroupID><ARTGs><ARTG>293929</ARTG></ARTGs><MinimumBenefit>3575</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AE041</BillingCode><Name>Active Knee Femoral Component</Name><Description>Femoral Component, uncemented, distally beaded with HA</Description><Size>Sizes 00 -- 5 Left &amp; Right</Size><SupplierCode>40045</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108656</GroupID><SubGroupID>112502</SubGroupID><ARTGs><ARTG>282290</ARTG></ARTGs><MinimumBenefit>3575</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI064</BillingCode><Name>Score Knee System Femoral Component</Name><Description>Femoral Component, CoCr, uncemented, stippled surface, titanium plasma spray with HA, pegged </Description><Size>7 Sizes</Size><SupplierCode>40041</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108656</GroupID><SubGroupID>112502</SubGroupID><ARTGs><ARTG>210576</ARTG></ARTGs><MinimumBenefit>3575</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MJ007</BillingCode><Name>Saiph Knee System Femoral Component Cementless</Name><Description>CoCr Polished Cementless Femoral Component, Porous Titanium and HA</Description><Size>1 - 8 Left &amp; Right</Size><SupplierCode>40173</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108656</GroupID><SubGroupID>112502</SubGroupID><ARTGs><ARTG>117768</ARTG><ARTG>192370</ARTG></ARTGs><MinimumBenefit>3575</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK325</BillingCode><Name>Triathlon Knee System Femoral Component </Name><Description>Minimally stabilised, CoCr, uncemented, beaded with PA (Hydroxyapatite)</Description><Size>Sizes 1 to 8</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108656</GroupID><SubGroupID>112502</SubGroupID><ARTGs><ARTG>146118</ARTG></ARTGs><MinimumBenefit>3575</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK334</BillingCode><Name>Scorpio NRG Knee System Femoral Component</Name><Description>Minimally stabilised, uncemented, with Hydroxyapatite, CoCr</Description><Size>Sizes 3,4,5,6,7,9,11,13</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108656</GroupID><SubGroupID>112502</SubGroupID><ARTGs><ARTG>153875</ARTG></ARTGs><MinimumBenefit>3575</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST030</BillingCode><Name>Scorpio Knee System Femoral Component</Name><Description>Minimally stabilised, uncemented, beaded (microstructure) with PA, (Hydroxyapatite), CoCr, </Description><Size>3,5,7,9,11,13</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108656</GroupID><SubGroupID>112502</SubGroupID><ARTGs><ARTG>146116</ARTG></ARTGs><MinimumBenefit>3575</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN910</BillingCode><Name>Genesis II</Name><Description>CR HA Porous</Description><Size>1-8</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108656</GroupID><SubGroupID>112502</SubGroupID><ARTGs><ARTG>242854</ARTG><ARTG>248574</ARTG></ARTGs><MinimumBenefit>3575</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH550</BillingCode><Name>Trekking Knee System - Femoral Component - CR</Name><Description>Femoral Component Uncemented - CR</Description><Size>Size: T1R - T5R
Size: T1L - T5L
Shape: Left and Right
Width (mm) - Depth 53-73
Width (mm) - 59-79</Size><SupplierCode>40113</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108656</GroupID><SubGroupID>112502</SubGroupID><ARTGs><ARTG>287515</ARTG></ARTGs><MinimumBenefit>3575</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU066</BillingCode><Name>GMK Uncemented Standard Femur</Name><Description>Uncemented standard femoral component with titanium porous covered by an hydroxyapatite coating</Description><Size>1 to 7, left and right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108656</GroupID><SubGroupID>112502</SubGroupID><ARTGs><ARTG>225044</ARTG></ARTGs><MinimumBenefit>3575</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT011</BillingCode><PriorBillingCodes><PriorBillingCode>TZ012</PriorBillingCode></PriorBillingCodes><Name>Genus Knee System - Genus Cementless Femoral Component + HA</Name><Description>Cementless Femoral Component with HA coating</Description><Size>1-7 right, 1-7 left, Minus</Size><SupplierCode>40232</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108656</GroupID><SubGroupID>112502</SubGroupID><ARTGs><ARTG>232071</ARTG></ARTGs><MinimumBenefit>3575</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU200</BillingCode><Name>GMK Sphere Femoral component</Name><Description>Cementless femoral component</Description><Size>1 to 7 Left and Right  </Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108656</GroupID><SubGroupID>112502</SubGroupID><ARTGs><ARTG>400440</ARTG></ARTGs><MinimumBenefit>3575</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR024</BillingCode><Name>Triathlon Knee System Femoral Component</Name><Description>Posterior stabilised, uncemented, beaded with PA (Hydroxyapatite), CoCr  </Description><Size>Size 1 - 8</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108656</GroupID><SubGroupID>112503</SubGroupID><ARTGs><ARTG>146119</ARTG></ARTGs><MinimumBenefit>3663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR006</BillingCode><Name>Scorpio Knee System Femoral Component</Name><Description>Posterior stabilised, uncemented, beaded (microstructure) with PA (Hydroxyapatite), CoCr</Description><Size>3,5,7,9,11,13</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108656</GroupID><SubGroupID>112503</SubGroupID><ARTGs><ARTG>146117</ARTG></ARTGs><MinimumBenefit>3663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR004</BillingCode><Name>Scorpio NRG Knee System Femoral Component</Name><Description>Posterior stabilised, uncemented with Hydroxyapatite, CoCr, </Description><Size>Sizes 3,4,5,6,7,9,11,13</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108656</GroupID><SubGroupID>112503</SubGroupID><ARTGs><ARTG>153875</ARTG></ARTGs><MinimumBenefit>3663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI121</BillingCode><Name>Anatomic Cementless Femur</Name><Description>Posterior-Stabilised Cementless Femur Plasma-Sprayed Titanium and HAP</Description><Size>Sizes 0 to 8 left and right</Size><SupplierCode>40041</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108656</GroupID><SubGroupID>112503</SubGroupID><ARTGs><ARTG>222528</ARTG></ARTGs><MinimumBenefit>3663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH551</BillingCode><Name>Trekking Knee System - Femoral Component PS</Name><Description>Femoral Component PS</Description><Size>Shape: Left and Right
Width (mm): Depth 53-73
Width (mm): 59-79
Size: T1L - T5L
Size: T1R - T5R</Size><SupplierCode>40113</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108656</GroupID><SubGroupID>112503</SubGroupID><ARTGs><ARTG>287514</ARTG></ARTGs><MinimumBenefit>3663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU078</BillingCode><Name>GMK Uncemented Posterior stabilised femur</Name><Description>Uncemented posterior stabilised femoral component with titanium porus coating covered by an hydroxyapatite coating</Description><Size>0 to 7, left to right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108656</GroupID><SubGroupID>112503</SubGroupID><ARTGs><ARTG>211441</ARTG></ARTGs><MinimumBenefit>3663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN911</BillingCode><Name>Genesis II</Name><Description>PS HA Porous</Description><Size>1-8</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107682</SubCategoryID><GroupID>108656</GroupID><SubGroupID>112503</SubGroupID><ARTGs><ARTG>247734</ARTG></ARTGs><MinimumBenefit>3663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI494</BillingCode><Name>ZUK (Zimmer Uni-Compartmental High Flex Knee) Femoral Component </Name><Description>Femoral Component, cemented, CoCr, high flex </Description><Size>Sizes A to G</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107683</SubCategoryID><GroupID>108657</GroupID><SubGroupID>112504</SubGroupID><ARTGs><ARTG>220167</ARTG></ARTGs><MinimumBenefit>2007</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI966</BillingCode><Name>Oxford Meniscal Knee System</Name><Description>Femoral Component, Porous HA Coated CoCr, Ti, HA</Description><Size>Extra Small - Extra Large</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107683</SubCategoryID><GroupID>108659</GroupID><SubGroupID>112505</SubGroupID><ARTGs><ARTG>206977</ARTG></ARTGs><MinimumBenefit>2180</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT013</BillingCode><PriorBillingCodes><PriorBillingCode>TZ025</PriorBillingCode></PriorBillingCodes><Name>Genus Uni Cementless Co-Por Femoral Component</Name><Description>Genus Uni Cementless Femoral Component manufactured using CoPor - (CoCr powder manaufacturing) to provide a monolithic structure with three dimensional porous matrix at the bone interface which is then HA coated.</Description><Size>Sizes 1-6 RM/LL and LM/RL</Size><SupplierCode>40232</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107683</SubCategoryID><GroupID>108659</GroupID><SubGroupID>112505</SubGroupID><ARTGs><ARTG>287897</ARTG></ARTGs><MinimumBenefit>2180</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AE099</BillingCode><Name>Active Knee Tibial Baseplate</Name><Description>Tibial Baseplate, HA, uncemented, beaded, stemmed , CoCr</Description><Size>Sizes 1 to 5 (A-Narrow &amp; B-Wide)</Size><SupplierCode>40045</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108664</GroupID><SubGroupID>112508</SubGroupID><ARTGs><ARTG>276963</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK326</BillingCode><Name>Triathlon Knee System Tibial Baseplate</Name><Description>Tibial baseplate, uncemented, beaded with PA (Hydroxyapatite), without screw holes, CoCr</Description><Size>Sizes 1 to 8</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108664</GroupID><SubGroupID>112508</SubGroupID><ARTGs><ARTG>146115</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR273</BillingCode><PriorBillingCodes><PriorBillingCode>GO193</PriorBillingCode></PriorBillingCodes><Name>Apex Knee, Tibial Base Plate - Porous</Name><Description>Tibial Baseplate, Cementless</Description><Size>Size 1 Left &amp; Right, Size 2 Left &amp; Right, Size 3 Left &amp; Right, Size 4 Left &amp; Right, Size 5 Left &amp; Right, Size 6 Left &amp; Right</Size><SupplierCode>39996</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108664</GroupID><SubGroupID>112508</SubGroupID><ARTGs><ARTG>287595</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MJ011</BillingCode><Name>Saiph Knee System Tibial Component Cementless</Name><Description>CoCr Tibial Component, Porous Titanium and HA</Description><Size>A - F, Standard an Long Stem</Size><SupplierCode>40173</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108664</GroupID><SubGroupID>112508</SubGroupID><ARTGs><ARTG>117769</ARTG><ARTG>192371</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW669</BillingCode><PriorBillingCodes><PriorBillingCode>ST648</PriorBillingCode><PriorBillingCode>ST031</PriorBillingCode></PriorBillingCodes><Name>Scorpio Knee System - Tibial Baseplate</Name><Description>Tibial baseplate, uncemented, alloy, hydroxyapatite (HA) coating.</Description><Size>Sizes 3 - 13</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108664</GroupID><SubGroupID>112508</SubGroupID><ARTGs><ARTG>145648</ARTG><ARTG>146120</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MJ010</BillingCode><Name>MRK (Medial Rotation Knee) Total Knee System Tibial Baseplate </Name><Description>Tibial Baseplate, uncemented, Titanium with stippled surface titanium plasma spray HA coated</Description><Size>1-5</Size><SupplierCode>40173</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108664</GroupID><SubGroupID>112508</SubGroupID><ARTGs><ARTG>117769</ARTG><ARTG>192371</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF140</BillingCode><Name>Active Knee Tibial Baseplate </Name><Description>Tibial Baseplate, HA, uncemented, beaded, stemmed , CoCr</Description><Size>Sizes 1 to 5 (A-Narrow &amp; B-Wide)</Size><SupplierCode>40413</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108664</GroupID><SubGroupID>112508</SubGroupID><ARTGs><ARTG>276963</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN861</BillingCode><Name>Genesis II Knee System Tibial Baseplate</Name><Description>Tibial baseplate, cementless, titanium, beaded, HA for fixed insert</Description><Size>Left / Right 1 - 8</Size><SupplierCode>40406</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108664</GroupID><SubGroupID>112508</SubGroupID><ARTGs><ARTG>242855</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH426</BillingCode><Name>Trekking Knee System, tibial component</Name><Description>Tibial component uncemented</Description><Size>1 - 5</Size><SupplierCode>40113</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108664</GroupID><SubGroupID>112508</SubGroupID><ARTGs><ARTG>165471</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU067</BillingCode><Name>GMK Uncemented Fixed Tibia Tray</Name><Description>Asymmetric uncemented fixed tibial component</Description><Size>1 to 6, left and right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108664</GroupID><SubGroupID>112508</SubGroupID><ARTGs><ARTG>225045</ARTG></ARTGs><MinimumBenefit>2356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI069</BillingCode><Name>Score Knee System Tibial Baseplate </Name><Description>Tibial baseplate, CoCr, uncemented, stippled surface, titanium plasma spray with HA</Description><Size>9 Sizes</Size><SupplierCode>40041</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108666</GroupID><SubGroupID>112509</SubGroupID><ARTGs><ARTG>271352</ARTG></ARTGs><MinimumBenefit>3487</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH604</BillingCode><PriorBillingCodes><PriorBillingCode>OO007</PriorBillingCode></PriorBillingCodes><Name>ACS Knee System - TCP coated tibial component</Name><Description>Tibial base plate, TCP coated for use with mobile bearing insert, TiN coated</Description><Size>Sizes 2-7</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108666</GroupID><SubGroupID>112509</SubGroupID><ARTGs><ARTG>265621</ARTG></ARTGs><MinimumBenefit>2409</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU076</BillingCode><Name>GMK Uncemented mobile Tibia Tray</Name><Description>Asymmetric uncemented mobile tibia with titanium porous coating by an hydroxyapatite coating</Description><Size>1 to 6, left and right</Size><SupplierCode>40166</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108666</GroupID><SubGroupID>112509</SubGroupID><ARTGs><ARTG>210967</ARTG></ARTGs><MinimumBenefit>2409</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH421</BillingCode><Name>Trekking Knee System, Mobile Bearing Tibial Component</Name><Description>Mobile Bearing Tibial Component</Description><Size>Size: T1 - T5
Width (mm) Depth: 42-57
Width (mm): 64 - 86</Size><SupplierCode>40113</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108666</GroupID><SubGroupID>112509</SubGroupID><ARTGs><ARTG>287518</ARTG></ARTGs><MinimumBenefit>2409</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP035</BillingCode><Name>MBT Knee System tibial baseplate </Name><Description>Tibial baseplate, uncemented, CoCr, HA (Duofix), beaded (Porocoat) for rotating platform, ( non keeled only) </Description><Size>Size 1-7</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108666</GroupID><SubGroupID>112509</SubGroupID><ARTGs><ARTG>143525</ARTG></ARTGs><MinimumBenefit>2409</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB233</BillingCode><Name>Emotion Total Knee System (TKS) Tibial Baseplate</Name><Description>Tibial baseplate, uncemented, CoCr, Titanium plasma spray (Plasmapore) with polished insert surface, HA coated for mobile insert</Description><Size>T1 - T8</Size><SupplierCode>40020</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108666</GroupID><SubGroupID>112509</SubGroupID><ARTGs><ARTG>293933</ARTG></ARTGs><MinimumBenefit>2409</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT015</BillingCode><PriorBillingCodes><PriorBillingCode>TZ010</PriorBillingCode></PriorBillingCodes><Name>Genus Knee System - Genus Cementless Tibial Tray + HA</Name><Description>Mobile Bearing Cementless Tibial Tray with HA coating</Description><Size>1-7</Size><SupplierCode>40232</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107684</SubCategoryID><GroupID>108666</GroupID><SubGroupID>112509</SubGroupID><ARTGs><ARTG>232061</ARTG></ARTGs><MinimumBenefit>2409</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT018</BillingCode><PriorBillingCodes><PriorBillingCode>TZ026</PriorBillingCode></PriorBillingCodes><Name>Genus Uni Tibial Tray Cementless</Name><Description>Genus Uni Tibial Tray for cementless fixation using Ti-Por powder printed monolithic construct with HA Coating.</Description><Size>Sizes 1-6 RM/LL and LM/RL</Size><SupplierCode>40232</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107685</SubCategoryID><GroupID>108671</GroupID><SubGroupID>112510</SubGroupID><ARTGs><ARTG>287899</ARTG></ARTGs><MinimumBenefit>1570</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI860</BillingCode><Name>Oxford Meniscal Knee System Uni Tibial Baseplate </Name><Description>Uni Tibial Baseplate, uncemented Titanium plasma sprayed surface (Porous plasma spray PPS) with HA (Phase III)</Description><Size>(38-53) x (26-34)mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107685</SubCategoryID><GroupID>108672</GroupID><SubGroupID>112511</SubGroupID><ARTGs><ARTG>126863</ARTG></ARTGs><MinimumBenefit>1744</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JV019</BillingCode><Name>Triathlon Tritanium Metal Backed Patella</Name><Description>Patella component, Metal backed, Tritanium, uncemented, Moulded UHMWPE (N2VAC)</Description><Size>29mm - 40mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108681</GroupID><SubGroupID>112514</SubGroupID><ARTGs><ARTG>284592</ARTG></ARTGs><MinimumBenefit>385</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI147</BillingCode><Name>NexGen  Patella Component </Name><Description>Metal backed, trabecular metal (Tantalum), patella component, with moulded UHMWPE, uncemented</Description><Size>26 - 41</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108681</GroupID><SubGroupID>112514</SubGroupID><ARTGs><ARTG>227807</ARTG></ARTGs><MinimumBenefit>385</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI266</BillingCode><Name>NexGen Trabecular Metal Augmented Patella</Name><Description>Augmented trabecular metal  combined with NexGen all poly patella component (2 piece)</Description><Size>Small, medium, large and x-large</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107689</SubCategoryID><GroupID>108681</GroupID><SubGroupID>112514</SubGroupID><Suffix>Revision</Suffix><ARTGs><ARTG>228294</ARTG></ARTGs><MinimumBenefit>385</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW645</BillingCode><Name>METS Femoral Knee and Stem</Name><Description>CoCR-molybdenum hinged component with stem includes axle, bushes and circlip</Description><Size>Small and Std Left and Right</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108684</GroupID><SubGroupID>112516</SubGroupID><Suffix>Hinge included</Suffix><ARTGs><ARTG>275995</ARTG></ARTGs><MinimumBenefit>4543</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH647</BillingCode><PriorBillingCodes><PriorBillingCode>OO106</PriorBillingCode></PriorBillingCodes><Name>Mutars Distal Femur</Name><Description>Mutars Distal Femur</Description><Size>Left/Right 90mm -110mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108684</GroupID><SubGroupID>112517</SubGroupID><ARTGs><ARTG>284225</ARTG><ARTG>284581</ARTG><ARTG>284226</ARTG><ARTG>225901</ARTG><ARTG>227769</ARTG></ARTGs><MinimumBenefit>6984</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY188</BillingCode><Name>Limb Preservation System</Name><Description>Distal Femoral Replacement Component Left/Right</Description><Size>XX Small and X Small</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108684</GroupID><SubGroupID>112517</SubGroupID><ARTGs><ARTG>227901</ARTG></ARTGs><MinimumBenefit>6984</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK157</BillingCode><Name>GMRS (Global Modular Replacement System) Distal Femoral Component</Name><Description>GMRS Distal Femoral component, CoCr, uncemented, Fixed</Description><Size>Small Left 65mm, Small Left 75mm, Small Left 85mm, Small Left 95mm, Small Right 65mm, Small Right 75mm, Small Right 85mm, Small Right 95mm, Standard Left, Standard Right</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108684</GroupID><SubGroupID>112517</SubGroupID><ARTGs><ARTG>222994</ARTG></ARTGs><MinimumBenefit>6984</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI865</BillingCode><Name>Orthopaedic Salvage System</Name><Description>Femoral Component, Resurfacing or Segmental, CoCr,Ti</Description><Size>3 - 11cm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108684</GroupID><SubGroupID>112517</SubGroupID><ARTGs><ARTG>251372</ARTG><ARTG>238319</ARTG><ARTG>238320</ARTG><ARTG>247572</ARTG><ARTG>291299</ARTG><ARTG>177878</ARTG><ARTG>238693</ARTG><ARTG>238697</ARTG><ARTG>291303</ARTG></ARTGs><MinimumBenefit>6984</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW641</BillingCode><Name>METS Tibial Rotating Hinge Polyethylene</Name><Description>CoCr-Molybedenum tibial component</Description><Size>Stem length 105mm and 114mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108684</GroupID><SubGroupID>112517</SubGroupID><ARTGs><ARTG>278136</ARTG></ARTGs><MinimumBenefit>6984</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO156</BillingCode><Name>Link Modular Knee Prosthesis  System</Name><Description>Femoral Component</Description><Size>Extra Small - Extra Large</Size><SupplierCode>40190</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108684</GroupID><SubGroupID>112517</SubGroupID><ARTGs><ARTG>225703</ARTG><ARTG>225704</ARTG><ARTG>226433</ARTG><ARTG>222087</ARTG></ARTGs><MinimumBenefit>6984</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI570</BillingCode><Name>Zimmer segmental system - distal femoral component</Name><Description>Distal femoral component</Description><Size>B &amp; C, left and right</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108684</GroupID><SubGroupID>112517</SubGroupID><ARTGs><ARTG>292688</ARTG></ARTGs><MinimumBenefit>6984</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW194</BillingCode><Name>Howmedica Modular Resection System</Name><Description>Femoral Joint -  Vitallium</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108684</GroupID><SubGroupID>112517</SubGroupID><ARTGs><ARTG>262258</ARTG></ARTGs><MinimumBenefit>6984</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW227</BillingCode><Name>HMRS (Howmedica Modular Replacement System) Rotating Hinge Distal Femur Component</Name><Description>HMRS Rotating Hinge Distal Femur, CoCr (Vitallium) uncemented, porous coated, Fixed</Description><Size>120, 140, 160mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108684</GroupID><SubGroupID>112517</SubGroupID><ARTGs><ARTG>247672</ARTG></ARTGs><MinimumBenefit>6984</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW640</BillingCode><Name>METS Tibial Rotating Hinge Metal Casing</Name><Description>Ti casing and CoCr-Mo tibial component</Description><Size>Stem lengths 140mm and 180mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108684</GroupID><SubGroupID>112517</SubGroupID><ARTGs><ARTG>278137</ARTG></ARTGs><MinimumBenefit>6984</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW599</BillingCode><Name>METS Femoral Knee</Name><Description>CoCR-molybdenum hinged femoral component includes axle, bushes and circlip</Description><Size>Small left; small right; standard left; standard right</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108684</GroupID><SubGroupID>112517</SubGroupID><Suffix>Hinge included</Suffix><ARTGs><ARTG>269992</ARTG></ARTGs><MinimumBenefit>7619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH134</BillingCode><Name>Orthopaedic Salvage System</Name><Description>Tibial Component, Resurfacing or Segmental, Non-Modular tray, CoCr, Ti</Description><Size>63-83mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108685</GroupID><SubGroupID>112518</SubGroupID><ARTGs><ARTG>238321</ARTG><ARTG>247575</ARTG><ARTG>239174</ARTG><ARTG>247574</ARTG><ARTG>247576</ARTG><ARTG>247732</ARTG><ARTG>274304</ARTG><ARTG>238698</ARTG><ARTG>274303</ARTG><ARTG>238437</ARTG></ARTGs><MinimumBenefit>7066</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW234</BillingCode><Name>HMRS (Howmedica Modular Replacement System) Stemmed Tibial Baseplate</Name><Description>HMRS stemmed tibial baseplate, CoCr (Vitallium), uncemented, porous coated, w/large connecting stem attached for diaphyseal fixation, Fixed</Description><Size>One size only</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108685</GroupID><SubGroupID>112518</SubGroupID><ARTGs><ARTG>261674</ARTG></ARTGs><MinimumBenefit>7066</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH135</BillingCode><Name>Orthopaedic Salvage System</Name><Description>Tibial Component, Resurfacing or Segmental, Modular and Non-Modular tray, CoCr, Ti</Description><Size>63-83mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108685</GroupID><SubGroupID>112518</SubGroupID><ARTGs><ARTG>247574</ARTG><ARTG>247732</ARTG></ARTGs><MinimumBenefit>7066</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW617</BillingCode><Name>METS Tibial Component Rotating Hinge</Name><Description>
CoCr-Molybdenum with UHMWPE bumper pad</Description><Size>Small and standard</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108685</GroupID><SubGroupID>112518</SubGroupID><ARTGs><ARTG>278019</ARTG></ARTGs><MinimumBenefit>7066</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW196</BillingCode><Name>HMRS (Howmedica Modular Replacement System) Tibial Joint (Baseplate)</Name><Description>HMRS Tibial Joint (baseplate) - uncemented, CoCr (Vitallium), porous coated, w/medial &amp; lateral flanges moulde agaibnst tibia w/bar bolt fixation, and metal cHydroxyapatitember for axis of hinge</Description><Size>5553</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108685</GroupID><SubGroupID>112518</SubGroupID><ARTGs><ARTG>262256</ARTG></ARTGs><MinimumBenefit>7066</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH654</BillingCode><PriorBillingCodes><PriorBillingCode>OO113</PriorBillingCode></PriorBillingCodes><Name>Mutars – Proximal Tibia</Name><Description>Mutars – Proximal Tibia</Description><Size>100mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108685</GroupID><SubGroupID>112518</SubGroupID><ARTGs><ARTG>284586</ARTG><ARTG>227164</ARTG></ARTGs><MinimumBenefit>7066</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH650</BillingCode><PriorBillingCodes><PriorBillingCode>OO109</PriorBillingCode></PriorBillingCodes><Name>Mutars – tibial plateau</Name><Description>Tibial plateau for hinged knee</Description><Size>X small, small, standard, large</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108685</GroupID><SubGroupID>112518</SubGroupID><ARTGs><ARTG>225903</ARTG><ARTG>284585</ARTG></ARTGs><MinimumBenefit>7066</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI740</BillingCode><Name>Zimmer Segmental System - Proximal TM Tibia</Name><Description>Zimmer Segmental System - Proximal TM Tibia</Description><Size>1-3</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108685</GroupID><SubGroupID>112519</SubGroupID><ARTGs><ARTG>229674</ARTG></ARTGs><MinimumBenefit>7006</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW609</BillingCode><Name>METS Proximal Tibia Fixed Hinge Coated</Name><Description>CoCr-Molybdenum with HA coated patella tendon reattachment mechanism and bumper</Description><Size>Small and standard</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108685</GroupID><SubGroupID>112519</SubGroupID><ARTGs><ARTG>278016</ARTG></ARTGs><MinimumBenefit>7006</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW608</BillingCode><Name>METS Proximal Tibia Fixed Hinge</Name><Description>CoCr-Molybdenum proximal tibial component including bumper</Description><Size>Small and standard</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108685</GroupID><SubGroupID>112519</SubGroupID><ARTGs><ARTG>278015</ARTG></ARTGs><MinimumBenefit>7006</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK156</BillingCode><Name>GMRS (Global Modular Replacement System) Proximal Tibial Component</Name><Description>GMRS Proximal Tibial component, CoCr, uncemented, porous coated, 7 x tendon/suture holes for soft tissue re-attachment, Fixed</Description><Size>Small, Standard</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108685</GroupID><SubGroupID>112519</SubGroupID><ARTGs><ARTG>223660</ARTG></ARTGs><MinimumBenefit>7006</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW606</BillingCode><Name>METS Tibial Fixed Hinge</Name><Description>CoCr-Molybdenum</Description><Size>Stem lengths 140mm and 180mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108685</GroupID><SubGroupID>112519</SubGroupID><ARTGs><ARTG>278135</ARTG></ARTGs><MinimumBenefit>7006</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO160</BillingCode><Name>Link Modular Knee Prosthesis
System</Name><Description>Tibial Components</Description><Size>Small, Medium and Large
60, 65 and 70mm</Size><SupplierCode>40190</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108685</GroupID><SubGroupID>112519</SubGroupID><ARTGs><ARTG>225030</ARTG></ARTGs><MinimumBenefit>7006</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW630</BillingCode><Name>METS Proximal Tibia Rotating Hinge Coated</Name><Description>Titanium with UHMWPE bearing and HA coated patella tendon reattachment mechanism</Description><Size>Small and Std</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108685</GroupID><SubGroupID>112519</SubGroupID><ARTGs><ARTG>278018</ARTG></ARTGs><MinimumBenefit>7006</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW616</BillingCode><Name>METS Proximal Tibia Rotating Hinge</Name><Description>Titanium with UHMWPE bearing</Description><Size>Small and standard</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108685</GroupID><SubGroupID>112519</SubGroupID><ARTGs><ARTG>278017</ARTG></ARTGs><MinimumBenefit>7006</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY195</BillingCode><Name>Limb Preservation System</Name><Description>Tibial Replacement Component</Description><Size>X-small</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108685</GroupID><SubGroupID>112519</SubGroupID><ARTGs><ARTG>226874</ARTG></ARTGs><MinimumBenefit>7006</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK161</BillingCode><Name>GMRS (Global Modular Replacement System) Extension Piece</Name><Description>GMRS Extension Piece, uncemented Titanium, connects to anchorage piece (optional) for increases diaphyseal replacement</Description><Size>30, 40, 50, 60, 70, 80, 100, 120, 140, 160, 180, 200, 220mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108686</GroupID><SubGroupID>112520</SubGroupID><ARTGs><ARTG>242293</ARTG></ARTGs><MinimumBenefit>3991</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI963</BillingCode><Name>Compress Compliant Prestress System</Name><Description>Anchor Assembly: Plug, Transverse pin, spindle, nut, cap.</Description><Size>10-28mm femoral canal diameter,</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108687</GroupID><SubGroupID>112521</SubGroupID><ARTGs><ARTG>177878</ARTG></ARTGs><MinimumBenefit>9035</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO164</BillingCode><Name>Link Modular Knee Prosthesis
System</Name><Description>Collar Couplings</Description><Size>Terminal round: 14 and 16mm
Oval Terminal: 26 x 34, 30 x 44, 34 x 48mm
Support Ring: 10mm
Coupling: Short and Long</Size><SupplierCode>40190</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108691</GroupID><SubGroupID>112523</SubGroupID><ARTGs><ARTG>257500</ARTG><ARTG>257612</ARTG><ARTG>257497</ARTG></ARTGs><MinimumBenefit>3923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW614</BillingCode><Name>METS Tibial Collar Coated</Name><Description>Titanium collar with HA coating</Description><Size>5 diameters 20-32mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108691</GroupID><SubGroupID>112523</SubGroupID><ARTGs><ARTG>278021</ARTG></ARTGs><MinimumBenefit>3923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI583</BillingCode><Name>Zimmer segmental system - TM stem collar</Name><Description>Segmental TM stem collar</Description><Size>9-16mm, 25mm: 9-16mm, 30mm: 9-16mm, 35mm; 17-19mm, 30mm; 17-19mm, 35mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108691</GroupID><SubGroupID>112523</SubGroupID><ARTGs><ARTG>284920</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>3923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI964</BillingCode><Name>Compress Compliant Prestress System</Name><Description>Medullary Centering Sleeve</Description><Size>13-28mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108691</GroupID><SubGroupID>112523</SubGroupID><ARTGs><ARTG>177878</ARTG></ARTGs><MinimumBenefit>3923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI572</BillingCode><Name>Zimmer segmental system - smooth stem collar</Name><Description>Segmental smooth stem collar</Description><Size>9-16mm &amp; 17-19mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108691</GroupID><SubGroupID>112523</SubGroupID><ARTGs><ARTG>284868</ARTG></ARTGs><MinimumBenefit>3923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW658</BillingCode><PriorBillingCodes><PriorBillingCode>CR141</PriorBillingCode></PriorBillingCodes><Name>METS Smooth Collar</Name><Description>Titanium, uncoated, round or oval</Description><Size>4 sizes round, 4 sizes oval</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108691</GroupID><SubGroupID>112523</SubGroupID><ARTGs><ARTG>246505</ARTG></ARTGs><MinimumBenefit>3923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW611</BillingCode><Name>METS Stippled Collar</Name><Description>Titanium, HA coated, round or oval</Description><Size>4 sizes round, 4 sizes oval</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108691</GroupID><SubGroupID>112523</SubGroupID><ARTGs><ARTG>246515</ARTG><ARTG>246514</ARTG></ARTGs><MinimumBenefit>3923</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH655</BillingCode><PriorBillingCodes><PriorBillingCode>OO114</PriorBillingCode></PriorBillingCodes><Name>Mutars – reducer</Name><Description>Mutars – reducer</Description><Size>20mm/30mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108691</GroupID><SubGroupID>112524</SubGroupID><ARTGs><ARTG>284271</ARTG><ARTG>237292</ARTG></ARTGs><MinimumBenefit>1482</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO161</BillingCode><Name>Link Modular Knee Coupling</Name><Description>Coupling</Description><Size>One Size only</Size><SupplierCode>40190</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108691</GroupID><SubGroupID>112524</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>245852</ARTG></ARTGs><MinimumBenefit>6356</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI965</BillingCode><Name>Compress Compliant Prestress System</Name><Description>Femoral Adapter</Description><Size>OSS or Finn Adapter</Size><SupplierCode>40315</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108691</GroupID><SubGroupID>112524</SubGroupID><ARTGs><ARTG>177878</ARTG></ARTGs><MinimumBenefit>1482</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ827</BillingCode><Name>Limb Preservation System - Sleeve Adapter</Name><Description>Diaphyseal sleeve adapter</Description><Size>+0 to +10mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108691</GroupID><SubGroupID>112524</SubGroupID><ARTGs><ARTG>252532</ARTG></ARTGs><MinimumBenefit>1482</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH656</BillingCode><PriorBillingCodes><PriorBillingCode>OO115</PriorBillingCode></PriorBillingCodes><Name>Mutars – Proximal tibia connecting piece</Name><Description>Mutars – Proximal tibia connecting piece</Description><Size>105mm, 125mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108691</GroupID><SubGroupID>112524</SubGroupID><ARTGs><ARTG>284223</ARTG><ARTG>244316</ARTG></ARTGs><MinimumBenefit>1482</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH690</BillingCode><PriorBillingCodes><PriorBillingCode>OO141</PriorBillingCode></PriorBillingCodes><Name>MUTARS RS Hip System. MUTARS RS coupling device</Name><Description>RS coupling device</Description><Size>30mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108691</GroupID><SubGroupID>112524</SubGroupID><ARTGs><ARTG>284583</ARTG><ARTG>237292</ARTG></ARTGs><MinimumBenefit>1482</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK172</BillingCode><Name>Howmedica Modular Resection System</Name><Description>GMRS Adaptors Male/Female Taper, Titanium/Forged Cobalt Chrome</Description><Size>Male Taper; Female Taper</Size><SupplierCode>40329</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108691</GroupID><SubGroupID>112524</SubGroupID><ARTGs><ARTG>224767</ARTG><ARTG>224413</ARTG></ARTGs><MinimumBenefit>1482</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH646</BillingCode><PriorBillingCodes><PriorBillingCode>OO105</PriorBillingCode></PriorBillingCodes><Name>Mutars Diaphyseal connecting piece</Name><Description>Mutars Diaphyseal connecting piece</Description><Size>100mm -120mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108691</GroupID><SubGroupID>112524</SubGroupID><ARTGs><ARTG>221740</ARTG><ARTG>284221</ARTG><ARTG>284224</ARTG></ARTGs><MinimumBenefit>1482</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH648</BillingCode><Name>Mutars Diaphyseal extension piece</Name><Description>Mutars Diaphyseal extension piece</Description><Size>30/100mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108691</GroupID><SubGroupID>112525</SubGroupID><ARTGs><ARTG>284224</ARTG></ARTGs><MinimumBenefit>3838</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO162</BillingCode><Name>Link Modular Knee ProsthesisSystem</Name><Description>Stem extender, segment</Description><Size>30mm - 250mm</Size><SupplierCode>40190</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108691</GroupID><SubGroupID>112525</SubGroupID><ARTGs><ARTG>245852</ARTG></ARTGs><MinimumBenefit>3838</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY192</BillingCode><Name>Limb Preservation System</Name><Description>Segmental Component (Male/Female)</Description><Size>25 to 125mm Length</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108691</GroupID><SubGroupID>112525</SubGroupID><ARTGs><ARTG>252532</ARTG></ARTGs><MinimumBenefit>3838</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY191</BillingCode><Name>Limb Preservation System</Name><Description>Total Femoral Segment Component (Male/Male)</Description><Size>55 mm Length</Size><SupplierCode>39932</SupplierCode><CategoryID>107563</CategoryID><SubCategoryID>107690</SubCategoryID><GroupID>108691</GroupID><SubGroupID>112525</SubGroupID><ARTGs><ARTG>252532</ARTG></ARTGs><MinimumBenefit>3838</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO181</BillingCode><Name>Lubinus SPII Hip Prosthesis Stem cemented</Name><Description>anatomical shaped hip prosthesis stem for cemented fixation in the human body.
· Minimal bone resection
· Uniform cement mantle around the whole stem
· Anatomically shaped stem resists rotational forces
Modular system allows adjustment to suit anatomical conditions</Description><Size>Stem Length: 130mm - 170mm
Throat Length: Short; Medium; XL
CCD Angle: 117 degrees; 126 degrees; 135 degrees
Shape: Left; Right</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112526</SubGroupID><ARTGs><ARTG>212075</ARTG></ARTGs><MinimumBenefit>1312</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN273</BillingCode><Name>Echelon/Spectron</Name><Description>Revision Hip Stem - Non-porous</Description><Size>165mm - 200mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112526</SubGroupID><ARTGs><ARTG>220103</ARTG></ARTGs><MinimumBenefit>1312</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN301</BillingCode><Name>Spectron and Synergy</Name><Description>Femoral Stem Non Porous Offset</Description><Size>1- 20</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112526</SubGroupID><ARTGs><ARTG>220401</ARTG></ARTGs><MinimumBenefit>1312</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA016</BillingCode><Name>CCA Cemented Femoral Stem</Name><Description>SS, straight, not polished</Description><Size>7.50mm -17.5mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112526</SubGroupID><ARTGs><ARTG>274203</ARTG></ARTGs><MinimumBenefit>1312</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST576</BillingCode><Name>Stryker Omnifit Cemented Stem</Name><Description>Cemented  femoral component Cobal Chrome </Description><Size>Stem sizes 4-11</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112526</SubGroupID><ARTGs><ARTG>217008</ARTG><ARTG>216632</ARTG></ARTGs><MinimumBenefit>1312</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB275</BillingCode><Name>Excia Hip Stem</Name><Description>Cemented CoCr Femoral Stem</Description><Size>9mm-18mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112526</SubGroupID><ARTGs><ARTG>321607</ARTG></ARTGs><MinimumBenefit>1312</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB386</BillingCode><Name>Excia T Hip Stem</Name><Description>Cemented CoCr Femoral Stem</Description><Size>10 - 20 mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112526</SubGroupID><ARTGs><ARTG>321608</ARTG></ARTGs><MinimumBenefit>1312</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TG014</BillingCode><Name>Furlong Hemi Range</Name><Description>Cemented femoral stem</Description><Size>XXS, XS, S, M &amp; L</Size><SupplierCode>40373</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112527</SubGroupID><ARTGs><ARTG>132591</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ242</BillingCode><Name>X-acta Short Femoral Stem</Name><Description>Stainless Steel Femoral Stems</Description><Size>Sizes 0 - 4 / Offsets 37.5 - 44 - 50 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112528</SubGroupID><ARTGs><ARTG>229510</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ786</BillingCode><Name>Corail Hip System Cemented Femoral Stem</Name><Description>Stainless steel cemented, polished femoral stem, standard and high offsets</Description><Size>Size 8 - 20</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112528</SubGroupID><ARTGs><ARTG>273725</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC026</BillingCode><Name>Lima Accent Hip System</Name><Description>Femoral Stem Cemented, tapered, polished</Description><Size>1 -6</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112528</SubGroupID><ARTGs><ARTG>168581</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL156</BillingCode><Name>Polarstem Cemented</Name><Description>Cemented femoral stems</Description><Size>0 to 8</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112528</SubGroupID><ARTGs><ARTG>297722</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC005</BillingCode><Name>Friendly Femoral Stem</Name><Description>Femoral Stem Cemented Tapered Polished FeCrNiMnMoNbN</Description><Size>0, 1, 2, 3</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112528</SubGroupID><ARTGs><ARTG>210666</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU198</BillingCode><Name>AMIStem-C Femoral stems</Name><Description>Stainless Steel Cemented Femoral Stems</Description><Size>00 to 8 std 0 to 8 lat</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112528</SubGroupID><ARTGs><ARTG>233610</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV034</BillingCode><Name>Profemur Xm Femoral Stem</Name><Description>Femoral Stem, CoCr, Cemented, Polished</Description><Size>0-4</Size><SupplierCode>40177</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112528</SubGroupID><Suffix>Removable Neck</Suffix><ARTGs><ARTG>234445</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW041</BillingCode><Name>Exeter Hip System</Name><Description>Stainless Steel (Orthinox)</Description><Size>Stem Sizes 0-6, Offsets 30, 33, 35.5, 37.5, 44, 50 &amp; 56mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112528</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>205392</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI009</BillingCode><Name>Zimmer CPT Hip Systems Femoral Stem</Name><Description>Co Cr (Zimaloy), polished and tapered</Description><Size>Sizes 1 - 5</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112528</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>208688</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU110</BillingCode><Name>X-Acta Femoral Stems</Name><Description>Stainless Steel Femoral Stems</Description><Size>Sizes 0 - 4 / Offsets 35.5 - 50 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112528</SubGroupID><ARTGs><ARTG>229510</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU001</BillingCode><Name>CONE Cemented Femoral Stem</Name><Description>CoCr, highly polished, triple taper</Description><Size>Standard sizes 1 to 8, Lateralized sizes 2 to 7</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112528</SubGroupID><ARTGs><ARTG>208874</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU004</BillingCode><Name>Quadra Hip Cemented Femoral Stem</Name><Description>High nitrogen stainless steel alloy, highly polished, double taper</Description><Size>Std 0 to 8. Lat 0 to 8  Std short neck 0 to 7.  Lat short neck 1 to 7.</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112528</SubGroupID><ARTGs><ARTG>356196</ARTG><ARTG>210442</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI373</BillingCode><Name>MS-30 Hip prosthesis</Name><Description>Stainless steel, polished tapered</Description><Size>6 to 16</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112528</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>210391</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP546</BillingCode><Name>C-Stem AMT Femoral Stem</Name><Description>Stainless steel Ortron 90, highly polished, triple taper</Description><Size>Size 1-8 standard Offset, Size 1-8 High Offset, Long Size 2-3, Standard Offset; Long Size 2-3 High Offset; CDH and 1A to 3A sizes</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112528</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>312661</ARTG><ARTG>312663</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Size</ChangeExplanation><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GG014</BillingCode><Name>Korus Stem Cemented</Name><Description>A straight femoral stem for use in hip prostheses systems.</Description><Size>125 and 135 degrees; sizes 1 to 9; offset 37 to 50 mm</Size><SupplierCode>40371</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112528</SubGroupID><ARTGs><ARTG>368330</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF041</BillingCode><Name>Evolve ™ Cemented Stem</Name><Description>Polished Stem</Description><Size>Sizes 0-5, various offsets</Size><SupplierCode>40413</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112528</SubGroupID><ARTGs><ARTG>279502</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA463</BillingCode><Name>twinSys Cemented Femoral Stem</Name><Description>stainless steel, highly polished, triple tapered</Description><Size>8 sizes in standard and lateral version (Size 9, 10, 11, 12, 13, 14, 15, 16)</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112528</SubGroupID><ARTGs><ARTG>274206</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR024</BillingCode><Name>Taperfit Femoral Stem</Name><Description>Double taper stainless steel femoral stem</Description><Size>sizes 0-4 with 4 different offsets</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112528</SubGroupID><ARTGs><ARTG>106747</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI100</BillingCode><Name>E2 Cemented Stem</Name><Description>Cemented Femoral Stems</Description><Size>size 0 - 4</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112528</SubGroupID><ARTGs><ARTG>228276</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN268</BillingCode><Name>CPCS</Name><Description>Femoral Stem Polished Non Porous, Std and High Offset</Description><Size>XSM, 0-5</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112528</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>225651</ARTG><ARTG>220355</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI127</BillingCode><Name>E2 Femoral Stem</Name><Description>Cemented Femoral Stem</Description><Size>Size 0 - 4  Offset 35.5mm, 37.5mm, 44mm and 50mm</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112528</SubGroupID><ARTGs><ARTG>383710</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT033</BillingCode><PriorBillingCodes><PriorBillingCode>TZ035</PriorBillingCode></PriorBillingCodes><Name>Pantheon Cemented Stem</Name><Description>Ti6Al4V Mirror polished</Description><Size>Diameter 10-16mm Length 115</Size><SupplierCode>40232</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108595</GroupID><SubGroupID>112529</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>389894</ARTG></ARTGs><MinimumBenefit>2648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF032</BillingCode><Name>Adapter GHE Femoral Long Stem Cemented </Name><Description>CoCr, non polished, long stem</Description><Size>200mm - 350mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108596</GroupID><SubGroupID>112530</SubGroupID><ARTGs><ARTG>175346</ARTG></ARTGs><MinimumBenefit>2980</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST584</BillingCode><Name>Osteonics omnifit cemented long stem</Name><Description>cobalt chrome unpolished long </Description><Size>Stem sizes  5-11, stem length 200, 250 AND 300mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108596</GroupID><SubGroupID>112530</SubGroupID><ARTGs><ARTG>217480</ARTG></ARTGs><MinimumBenefit>2980</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW040</BillingCode><Name>Exeter Hip System</Name><Description>Stainless Steel (Orthinox) polished long</Description><Size>37.5 and 44mm offsets</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108596</GroupID><SubGroupID>112530</SubGroupID><ARTGs><ARTG>205392</ARTG></ARTGs><MinimumBenefit>2980</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI301</BillingCode><Name>CPT Hip System</Name><Description>Cobalt Chrome, polished, tapered, long stems </Description><Size>Sizes 1 - 4</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108596</GroupID><SubGroupID>112530</SubGroupID><ARTGs><ARTG>208688</ARTG></ARTGs><MinimumBenefit>2980</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI025</BillingCode><Name>Zimmer VerSys CRC Hip Systems Femoral Stem</Name><Description> Cobalt Chrome, unpolished long stem with calcar attachment option</Description><Size>13 - 19</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108596</GroupID><SubGroupID>112530</SubGroupID><ARTGs><ARTG>208884</ARTG></ARTGs><MinimumBenefit>2980</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH683</BillingCode><PriorBillingCodes><PriorBillingCode>OO173</PriorBillingCode></PriorBillingCodes><Name>MUTARS Femoral Stem Cemented with TiN and HA Collar</Name><Description>MUTARS Femoral Stem Cemented with TiN and HA Collar</Description><Size>11/13/15/17 
120/160/200/240mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108596</GroupID><SubGroupID>112530</SubGroupID><ARTGs><ARTG>244313</ARTG></ARTGs><MinimumBenefit>2980</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN271</BillingCode><Name>Spectron</Name><Description>Revision Hip Stem - Non-porous</Description><Size>225mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108596</GroupID><SubGroupID>112530</SubGroupID><ARTGs><ARTG>220103</ARTG></ARTGs><MinimumBenefit>2980</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP550</BillingCode><Name>C-Stem AMT Femoral Stem</Name><Description>Stainless steel Ortron 90, highly polished, triple taper, long stem</Description><Size>Size 3 x 205; 240mm; Standard Offset</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108596</GroupID><SubGroupID>112530</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>312663</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Size</ChangeExplanation><MinimumBenefit>2980</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI376</BillingCode><Name>Cone Hip prosthesis</Name><Description>Titanium, grit blast, non HA</Description><Size>13 to 24mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108597</GroupID><SubGroupID>112531</SubGroupID><ARTGs><ARTG>210381</ARTG></ARTGs><MinimumBenefit>2883</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL092</BillingCode><Name>REDAPT</Name><Description>Revision stem with standard and high offset options.</Description><Size>190mm x 12-27mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108597</GroupID><SubGroupID>112531</SubGroupID><ARTGs><ARTG>293662</ARTG></ARTGs><MinimumBenefit>2883</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC011</BillingCode><Name>C2 Femoral Stem</Name><Description>C2 Femoral Stem Standard / Lateralised / Revision 12/14 Taper Ti6AI4V</Description><Size>02 to 12</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108597</GroupID><SubGroupID>112531</SubGroupID><ARTGs><ARTG>210720</ARTG><ARTG>210716</ARTG></ARTGs><MinimumBenefit>2883</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI463</BillingCode><Name>Alloclassic Hip Stem</Name><Description>Zweymuller, Ti alloy, Short Cone, Slender Neck</Description><Size>01, 0, 1, 10-13</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108597</GroupID><SubGroupID>112531</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>206912</ARTG></ARTGs><MinimumBenefit>2883</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI468</BillingCode><Name>CLS Cementless Hip</Name><Description>Titanium, grit blast, non HA</Description><Size>5 - 20</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108597</GroupID><SubGroupID>112531</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>206682</ARTG></ARTGs><MinimumBenefit>2883</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI462</BillingCode><Name>Alloclassic Hip Stem</Name><Description>Titanium, grit blast, non HA, standard and high offset</Description><Size>1 - 14</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108597</GroupID><SubGroupID>112531</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>206912</ARTG></ARTGs><MinimumBenefit>2883</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ813</BillingCode><Name>Summit Femoral Hip</Name><Description>Titanium, beaded proximally, distal grit blast</Description><Size>0-12</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108597</GroupID><SubGroupID>112532</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>208216</ARTG></ARTGs><MinimumBenefit>2340</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ777</BillingCode><Name>Tri-Lock Gription Femoral Stem</Name><Description>Titanium, Femoral stem, GRIPTION coated</Description><Size>Size 0-12 standard and high offset</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108597</GroupID><SubGroupID>112533</SubGroupID><ARTGs><ARTG>217546</ARTG></ARTGs><MinimumBenefit>2827</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB393</BillingCode><Name>Excia T Hip Stem</Name><Description>Cementless CoCr Plasma Femoral Stem</Description><Size>8 - 20 mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108597</GroupID><SubGroupID>112534</SubGroupID><ARTGs><ARTG>321609</ARTG></ARTGs><MinimumBenefit>3100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV040</BillingCode><Name>Profemur Hip System</Name><Description>Primary stem, tapered wedge, plasma coated, fixed neck</Description><Size>1-10
Extended, Neutral</Size><SupplierCode>40177</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108597</GroupID><SubGroupID>112534</SubGroupID><ARTGs><ARTG>240573</ARTG></ARTGs><MinimumBenefit>3100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU182</BillingCode><Name>Masterloc Stems - Ti</Name><Description>Cementless Femoral Stem - Ti Coated</Description><Size>1 to 12 - Std   1 to 14 - Lat  4 to 14 - Lat Plus</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108597</GroupID><SubGroupID>112534</SubGroupID><ARTGs><ARTG>286794</ARTG></ARTGs><MinimumBenefit>3100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI074</BillingCode><Name>Biomet Taperloc Hip System</Name><Description>Titanium unpolished</Description><Size>4mm- 25mm diameter</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108597</GroupID><SubGroupID>112534</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>223294</ARTG><ARTG>237027</ARTG><ARTG>257352</ARTG><ARTG>257356</ARTG><ARTG>237028</ARTG><ARTG>257354</ARTG></ARTGs><MinimumBenefit>3100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI981</BillingCode><Name>Echo Hip System Bi Metric Femoral Stem</Name><Description>Echo Bi Metric Cementless Titanium Femoral Component</Description><Size>7 - 19mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108597</GroupID><SubGroupID>112534</SubGroupID><ARTGs><ARTG>223029</ARTG></ARTGs><MinimumBenefit>3100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI095</BillingCode><Name>CL2 Cementless Femoral Stem</Name><Description>Titanium, grit plast full HA coating</Description><Size>8 - 18</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112535</SubGroupID><ARTGs><ARTG>228604</ARTG></ARTGs><MinimumBenefit>3174</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA462</BillingCode><Name>twinSys Non Cemented Femoral Stem</Name><Description>Titanium, grit blast, fully HA</Description><Size>Various offsets and sizes under 200mm length</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112535</SubGroupID><ARTGs><ARTG>274437</ARTG></ARTGs><MinimumBenefit>3174</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR117</BillingCode><Name>Metafix Femoral Stem</Name><Description>Titanium femoral stem striated and fully coated with HA</Description><Size>standard, lateralised, short neck and 125 and 135 degree</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112535</SubGroupID><ARTGs><ARTG>207831</ARTG><ARTG>281110</ARTG></ARTGs><MinimumBenefit>3174</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI556</BillingCode><Name>Avenir- Muller Stem</Name><Description>Titanium, grit blast, with HA</Description><Size>Standard sizes 1-8;  Lateral sizes 1-8</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112535</SubGroupID><ARTGs><ARTG>216175</ARTG></ARTGs><MinimumBenefit>3174</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI119</BillingCode><Name>EVOK Stem</Name><Description>Cementless Stem with HA</Description><Size>Sizes 7 to 20  Collared and Collarless</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112535</SubGroupID><ARTGs><ARTG>315774</ARTG><ARTG>315775</ARTG></ARTGs><MinimumBenefit>3174</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB405</BillingCode><Name>Trend Hip Cementless Femoral Stem</Name><Description>Trend Hip Cementless Femoral Stem</Description><Size>1 - 8, Stem Length 134mm - 169mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112535</SubGroupID><ARTGs><ARTG>392930</ARTG></ARTGs><MinimumBenefit>3174</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC159</BillingCode><Name>H-Max S Femoral Stem</Name><Description>H-Max S Femoral Stem HA Coated Ti6AI4V</Description><Size>9 - 18</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112535</SubGroupID><ARTGs><ARTG>218784</ARTG></ARTGs><MinimumBenefit>3174</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI056</BillingCode><Name>Integrale Femoral Stem</Name><Description>Anodised titanium, fully HA Coated,straight stem and used with separate neck</Description><Size>7 Sizes</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112535</SubGroupID><Suffix>Removable Neck</Suffix><ARTGs><ARTG>210194</ARTG><ARTG>210195</ARTG></ARTGs><MinimumBenefit>3174</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI054</BillingCode><Name>Acor Anatomic Femoral Stem for Modular Neck</Name><Description>Anodised titanium, fully HA Coated, curved stem and used with separate neck</Description><Size>7 Sizes</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112535</SubGroupID><Suffix>Removable Neck</Suffix><ARTGs><ARTG>210109</ARTG></ARTGs><MinimumBenefit>3174</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GG009</BillingCode><Name>Cementless Korus Stem</Name><Description>A straight femoral stem, with or without collar, for use in hip prostheses systems.</Description><Size>125 and 135 degrees; sizes 1 to 9; ; offset 37 to 50 mm; with and without collar</Size><SupplierCode>40371</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112535</SubGroupID><ARTGs><ARTG>312760</ARTG></ARTGs><MinimumBenefit>3174</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC013</BillingCode><Name>FIT Femoral Stem</Name><Description>FIT Femoral Stem 12/14 Taper Ti6AI4V HA Coated</Description><Size>Size 1-7, Left &amp; Right</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112535</SubGroupID><ARTGs><ARTG>210717</ARTG></ARTGs><MinimumBenefit>3174</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY514</BillingCode><Name>Corail Revision Femoral Stem</Name><Description>Titanium, grit blast, full HA coating, fluted distally</Description><Size>Size ≤13, (length less than 200mm)</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112535</SubGroupID><ARTGs><ARTG>173831</ARTG></ARTGs><MinimumBenefit>3174</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN256</BillingCode><Name>Corail Femoral Stem</Name><Description>Titanium, grit blast, full HA coating</Description><Size>Size 11 to 14; Offset Low, Standard; Angle (In degrees) 125-135</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112535</SubGroupID><ARTGs><ARTG>306751</ARTG></ARTGs><MinimumBenefit>3174</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FD006</BillingCode><PriorBillingCodes><PriorBillingCode>LI108</PriorBillingCode></PriorBillingCodes><Name>HACTIV Uncemented Stem</Name><Description>Titanium, gritblast, HA coated, collared, collarless and high offset</Description><Size>Sizes 7 to 20</Size><SupplierCode>40075</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112535</SubGroupID><ARTGs><ARTG>232289</ARTG><ARTG>268272</ARTG></ARTGs><MinimumBenefit>3174</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP943</BillingCode><Name>Corail Femoral Stem</Name><Description>Titanium, grit blast, full HA coating,</Description><Size>Size 6 to 20 or in lengths 110 -190mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112535</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>143073</ARTG><ARTG>268792</ARTG><ARTG>268793</ARTG></ARTGs><MinimumBenefit>3174</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FD005</BillingCode><Name>Stemsys Cementless HA Coated Stems</Name><Description>Uncemented Femoral Stem with HA Coating - Collared and Collarless</Description><Size>Sizes 7 to 20 - Standard and Laterlised</Size><SupplierCode>40075</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112535</SubGroupID><ARTGs><ARTG>356301</ARTG><ARTG>356300</ARTG></ARTGs><MinimumBenefit>3174</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC144</BillingCode><Name>ColloMis Femoral Stem</Name><Description>The COLLO-MIS Femoral Stem</Description><Size>Sizes 1 to 9</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112535</SubGroupID><ARTGs><ARTG>219427</ARTG></ARTGs><MinimumBenefit>3174</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU003</BillingCode><Name>Quadra Hip Femoral Stem</Name><Description>Titanium, grit blast, fully HA,</Description><Size>Std 0 to 10
Std (shortneck) 00 to 10
Lat 1 to 7
Lat (shortneck) 1 to 7</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112535</SubGroupID><ARTGs><ARTG>204336</ARTG></ARTGs><MinimumBenefit>3174</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV031</BillingCode><Name>Profemur L</Name><Description>Profemur L Hip Stem</Description><Size>1 - 11
Standard, Extended</Size><SupplierCode>40177</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112535</SubGroupID><ARTGs><ARTG>218787</ARTG><ARTG>234444</ARTG></ARTGs><MinimumBenefit>3174</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO111</BillingCode><Name>Beta-Cone Cementless Hip Prosthesis</Name><Description>Titanium, grit blast, with HA</Description><Size>9 Stem sizes 1-9 plus additional 9 stems with XL neck length.  Total 18 Sizes</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112535</SubGroupID><ARTGs><ARTG>114169</ARTG><ARTG>51002</ARTG></ARTGs><MinimumBenefit>3174</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO034</BillingCode><Name>CFP Hip Stem</Name><Description>Titanium, grit blast,  HA</Description><Size>Extra small to Extra Large</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112535</SubGroupID><ARTGs><ARTG>223134</ARTG></ARTGs><MinimumBenefit>3174</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU128</BillingCode><Name>AMIStem H Femoral Stem</Name><Description>Titanium, grit blast, HA coated</Description><Size>STD 00 to 9; LAT 0 to 8</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112535</SubGroupID><ARTGs><ARTG>287484</ARTG><ARTG>218795</ARTG></ARTGs><MinimumBenefit>3174</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF029</BillingCode><Name>Origin™ Stem</Name><Description>Cementless Stems are inteded for press-fit fixation and manufactured from titanium 6AI-4V and are fully HA coated</Description><Size>collarless: standard offset, 12/14, sizes 8-18 Extended offset 12/14, sizes 8-18, reduced offset 8-18, collared: standard offset 12/14, sizes 8-18, reduced offset sizes 8-18 Extended offset, all available in collared option and coxa vera 125 degree</Size><SupplierCode>40413</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112535</SubGroupID><ARTGs><ARTG>277417</ARTG></ARTGs><MinimumBenefit>3174</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT001</BillingCode><PriorBillingCodes><PriorBillingCode>TZ016</PriorBillingCode></PriorBillingCodes><Name>Hydra Hip Stem</Name><Description>Tapered, Titanium, HA Coated, Modular Uncemented Femoral Stem</Description><Size>Sizes 9 - 18</Size><SupplierCode>40232</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112535</SubGroupID><ARTGs><ARTG>315264</ARTG></ARTGs><MinimumBenefit>3174</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN303</BillingCode><Name>Synergy</Name><Description>Femoral Stem HA Coated beaded Titanium Alloy, Std and High offset</Description><Size>9 - 18</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112536</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>225532</ARTG></ARTGs><MinimumBenefit>2933</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY134</BillingCode><Name>Summit Femoral Stem</Name><Description>Titanium, beaded proximally with HA, duofix distal grit blast</Description><Size>Size 1-10</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112536</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>215936</ARTG></ARTGs><MinimumBenefit>2933</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN678</BillingCode><Name>Echelon with HA</Name><Description>Cobalt Chromium with Hyrdoxyapetite Coating, beaded</Description><Size>11-20</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112536</SubGroupID><ARTGs><ARTG>222602</ARTG><ARTG>257395</ARTG><ARTG>262974</ARTG><ARTG>253854</ARTG><ARTG>262520</ARTG><ARTG>262521</ARTG></ARTGs><MinimumBenefit>2933</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN275</BillingCode><Name>ACTIS Femoral Stem</Name><Description>Collared, proximal beaded with HA </Description><Size>Size 0-12</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112536</SubGroupID><ARTGs><ARTG>346130</ARTG></ARTGs><MinimumBenefit>2933</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN843</BillingCode><Name>Anthology Hip System</Name><Description>Titanium, Beaded and HA</Description><Size>0-20</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112536</SubGroupID><ARTGs><ARTG>218143</ARTG></ARTGs><MinimumBenefit>2933</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU201</BillingCode><Name>Quadra-P collarless</Name><Description>Titanium stem proximally coated with plasma spray and HA - collarless version</Description><Size>Std 00 to 10  Lat 0 to 10</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><ARTGs><ARTG>314889</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU202</BillingCode><Name>Quadra-P collared</Name><Description>Titanium stem proximally coated with plasma spray and HA - collared version</Description><Size>Std 00 to 10 Lat 0 to 10</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><ARTGs><ARTG>356197</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TG021</BillingCode><Name>Furlong Evolution</Name><Description>Collarless and collared 126-133 (degree)</Description><Size>6-17</Size><SupplierCode>40373</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><ARTGs><ARTG>132478</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WQ009</BillingCode><Name>Individual Hip TiHA </Name><Description>Uncemented Collarless Femoral Stem</Description><Size>Patient-Specific Collarless Hip</Size><SupplierCode>40394</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><ARTGs><ARTG>404155</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU188</BillingCode><Name>Masterloc Stems - Ti + HA</Name><Description>Cementless Femoral Stem - Ti + HA Coated</Description><Size>1 to 12 - Std   1 to 14 - Lat.  4 to 14 - Lat Plus</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><ARTGs><ARTG>286795</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU203</BillingCode><Name>AMIStem-P collared</Name><Description>Titanium, Plasma spray, proximal HA coating, collared version</Description><Size>Std 00 to 9 Lat 0 to 8</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><ARTGs><ARTG>388451</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU199</BillingCode><Name>AMIStem-P collarless</Name><Description>Titanium, Plasma spray, proximal HA coating - collarless version</Description><Size>Std 00 to 9   Lat 0 to 8 </Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><ARTGs><ARTG>314187</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT028</BillingCode><PriorBillingCodes><PriorBillingCode>TZ032</PriorBillingCode></PriorBillingCodes><Name>Hydra-Fix  </Name><Description>Forged titanium alloy stems with HA coating 12/14 taper  </Description><Size>8 - 18, standard, offset </Size><SupplierCode>40232</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><ARTGs><ARTG>325181</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM122</BillingCode><Name>Polarstem</Name><Description>Titanium Stem, Plasma Spray &amp; Full HA coating</Description><Size>01-11, various offsets</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><ARTGs><ARTG>225533</ARTG><ARTG>302532</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB274</BillingCode><Name>Excia Hip System</Name><Description>plasma titanium, HA</Description><Size>8mm-18mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><ARTGs><ARTG>123313</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN900</BillingCode><Name>NANOS Neck Preserving Stem</Name><Description>.Neck preserving femoral stem with vacuum plasma spray titanium porous coating and Calcium Phosphate electro chemical deposition process coating (Bonit Coating) for use without modular femoral neck choices</Description><Size>Size 0 to Size 9</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><ARTGs><ARTG>233103</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC015</BillingCode><Name>Sam-Fit modular stem</Name><Description>Modular stem</Description><Size>1 - 7</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><ARTGs><ARTG>210760</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM127</BillingCode><Name>SL Plus MIA Femoral Stem</Name><Description>Titanium, Plasma spray, proximal HA coating</Description><Size>01-12, various offsets</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><ARTGs><ARTG>225534</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH627</BillingCode><Name>Mutars RS revision system - cementless stem HA</Name><Description>RS Cementless stem HA</Description><Size>12 - 22mm dia stems, 150 - 190mm length</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><ARTGs><ARTG>236460</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI493</BillingCode><Name>M/L Taper   Stem</Name><Description>Plasma sprayed titanium with HA </Description><Size>Sizes 5 to 22 with standard and extended offsets</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><ARTGs><ARTG>207912</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA541</BillingCode><Name>optimys Stem</Name><Description>Ti with Ti Plasma spray and CaP coating</Description><Size>XS, 0 to 12, standard and lateral</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><ARTGs><ARTG>287920</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR294</BillingCode><PriorBillingCodes><PriorBillingCode>GO285</PriorBillingCode></PriorBillingCodes><Name>Paragon Hip Stem PCHA</Name><Description>Paragon Femoral Stem, Porous and HA coated</Description><Size>1-12, STD, High Offset, Coxa Vara, Collared</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><ARTGs><ARTG>296134</ARTG><ARTG>296139</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR086</BillingCode><Name>TriFit  System</Name><Description>Titanium stem proximally coated with plasma spray and HA</Description><Size>Sizes 1- 11</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><ARTGs><ARTG>342332</ARTG><ARTG>207830</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW529</BillingCode><Name>Accolade II Femoral Hip System</Name><Description>Femoral Hip Stem (127 &amp; 132 neck angle)</Description><Size>Size 0 - 11</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><ARTGs><ARTG>198383</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF018</BillingCode><Name>Hip and Go</Name><Description>Femoral Stem Component</Description><Size>Size 1-10, standard and lateralized</Size><SupplierCode>40106</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><ARTGs><ARTG>141168</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR157</BillingCode><Name>MiniHip Stem</Name><Description>Short stem, Titanium, Plasma Spray with HA</Description><Size>9 sizes</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><ARTGs><ARTG>106747</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI075</BillingCode><Name>Biomet Taperloc Hip System</Name><Description>titanium, plasma, HA</Description><Size>4mm - 25mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>257353</ARTG><ARTG>222180</ARTG><ARTG>257355</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST541</BillingCode><Name>SecurFit Plus Max</Name><Description>Titanium, plasma, HA </Description><Size>Stem sizes 7-14</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>152399</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST574</BillingCode><Name>SecurFit HA Max Hip Stem</Name><Description>Titanium, plasma coated, HA</Description><Size>Stem sizes 4-14 in 127 and 132 degree neck angles</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>152397</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TG024</BillingCode><Name>JRI Furlong Total Hip System</Name><Description>Uncemented Femoral Stem, titanium, plasma sprayed, with HA</Description><Size>12 /14 Taper, and 5mm offset, short and standard spigot</Size><SupplierCode>40373</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>302538</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WN001</BillingCode><PriorBillingCodes><PriorBillingCode>RL004</PriorBillingCode></PriorBillingCodes><Name>Permedica Exacta Femoral Stem HaX-Pore -Press-fit hip femur</Name><Description>The Permedica Exacta HaX-Pore Femoral stem is a press-fit stem with pure titanium and hydroxyapatite coating.  It is a self-locking stem with longitudinal and transverse grooves on the anterior and posterior surface to provide axial and rotational stability.  The stem is manufactured using Titanium Aluminium Niobium forged alloy (Ti6AI7Nb) ISO5832/11 with a surface finish of 300 micron pure Titanium and a 50 micron hydroxyapatite plasma sprayed coating.</Description><Size>Sized 1-12  Angle (in degrees) 127 degrees and 135 degrees</Size><SupplierCode>40384</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>220150</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB295</BillingCode><Name>Metha - modular short stem</Name><Description>Short stem, plasma, HA</Description><Size>1 -6</Size><SupplierCode>40020</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108598</GroupID><SubGroupID>112538</SubGroupID><Suffix>Removable Neck</Suffix><ARTGs><ARTG>126457</ARTG></ARTGs><MinimumBenefit>3263</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL093</BillingCode><Name>REDAPT</Name><Description>Revision stem with standard and high offset options.</Description><Size>240-300mm x 12-27mm.</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108599</GroupID><SubGroupID>112539</SubGroupID><ARTGs><ARTG>293662</ARTG></ARTGs><MinimumBenefit>4540</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC160</BillingCode><Name>C2 Revision Stem</Name><Description>C2 Revision Stem</Description><Size>Size 7-9 x 202 to 213mm Length</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108599</GroupID><SubGroupID>112539</SubGroupID><ARTGs><ARTG>210716</ARTG></ARTGs><MinimumBenefit>4540</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU058</BillingCode><Name>Quadra-R Hip Revision Stem</Name><Description>Uncemented revision stem, HA Coated</Description><Size>From size 0 to size 9`</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108600</GroupID><SubGroupID>112543</SubGroupID><ARTGs><ARTG>204290</ARTG></ARTGs><MinimumBenefit>4826</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA475</BillingCode><Name>twinSys Non Cemented Long Femoral Stem</Name><Description>Titanium, grit blast, fully HA, long</Description><Size>Various offsets and sizes &gt; 200mm length (12-15)</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108600</GroupID><SubGroupID>112543</SubGroupID><ARTGs><ARTG>287895</ARTG></ARTGs><MinimumBenefit>4826</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY515</BillingCode><Name>Corail Revision Femoral Stem</Name><Description>Titanium, grit blast, full HA coating, fluted distally</Description><Size>Sizes 14 - 20, (length 200mm &amp; greater)</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108600</GroupID><SubGroupID>112543</SubGroupID><ARTGs><ARTG>307520</ARTG></ARTGs><MinimumBenefit>4826</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TG013</BillingCode><Name>JRI Total Hip System</Name><Description>JRI Furlong Revision Plus Stem, Titanium Alloy with Supravit Zoned Coating, 12 / 14 Taper</Description><Size>12 / 14 Taper, 200mm long and 200ml long with 5mm offset</Size><SupplierCode>40373</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108600</GroupID><SubGroupID>112546</SubGroupID><ARTGs><ARTG>132478</ARTG></ARTGs><MinimumBenefit>5371</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH628</BillingCode><Name>Mutars RS revision system - cementless stem HA long</Name><Description>RS Cementless stem HA long</Description><Size>12 - 22mm dia stems, 200 to 250mm length</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108600</GroupID><SubGroupID>112546</SubGroupID><ARTGs><ARTG>236460</ARTG></ARTGs><MinimumBenefit>5371</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QG007</BillingCode><Name>MRP Trochanter</Name><Description>Body for Trochanteric attachment</Description><Size>Small &amp; Large</Size><SupplierCode>39928</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112547</SubGroupID><Suffix>Body</Suffix><ARTGs><ARTG>327880</ARTG></ARTGs><MinimumBenefit>2401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QG003</BillingCode><Name>MRP Titan Neck</Name><Description>Proximal femoral component</Description><Size>Small, Medium &amp; Large with standard 130º &amp; lateralised 123º options</Size><SupplierCode>39928</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112547</SubGroupID><Suffix>Body</Suffix><ARTGs><ARTG>327900</ARTG></ARTGs><MinimumBenefit>2401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA524</BillingCode><Name>Modular Revision Stem</Name><Description>Proximal body, grit Blasted Titanium</Description><Size>50-70mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112547</SubGroupID><Suffix>Body</Suffix><ARTGs><ARTG>274207</ARTG></ARTGs><MinimumBenefit>2401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC027</BillingCode><Name>Revision Modular Femoral Body</Name><Description>Revision Modular Femoral Body 12/14 Taper with Locking Screw Ti6AI4V</Description><Size>Std &amp; Lat x 50-70mm - Body Height</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112547</SubGroupID><Suffix>Body</Suffix><ARTGs><ARTG>210642</ARTG></ARTGs><MinimumBenefit>2401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GG010</BillingCode><Name>SMR Modular Femoral Stem Proximal Body</Name><Description>Titanium, grit blast, non HA,</Description><Size>40 to 70mm, Standard and Filling</Size><SupplierCode>40371</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112547</SubGroupID><Suffix>Body</Suffix><ARTGs><ARTG>277843</ARTG></ARTGs><MinimumBenefit>2401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC009</BillingCode><Name>Modulus Femoral Body</Name><Description>Femoral Body 12/14 Taper CCD 125* to 130* - Ti6AI4V</Description><Size>A &amp; B x Small to Large</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112547</SubGroupID><Suffix>Body</Suffix><ARTGs><ARTG>210669</ARTG></ARTGs><MinimumBenefit>2401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GG011</BillingCode><Name>SMR Femoral Stem</Name><Description>SMR Distal Component less than 200mm</Description><Size>SMR Distal Components:  14 x 100mm, 15 x 100mm, 16 x 100mm, 17 x 100mm, 18 x 100mm, 19 x 100mm, 20 x 100mm, 21 x 100mm, 22 x 100mm, 24 x 100mm, 14 x 160mm, 15 x 160mm, 16 x 160mm, 17 x 160mm, 18 x 160mm, 19 x 160mm,  20 x 160mm,  21 x 160mm, 22 x 160mm,  24 x 160mm</Size><SupplierCode>40371</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112547</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>277980</ARTG></ARTGs><MinimumBenefit>2619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC030</BillingCode><Name>Revision Modular Femoral Stem</Name><Description>Revision Modular Femoral Stem Ti6A4I</Description><Size>14-26mm Diameter x 140mm Length</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112547</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>210670</ARTG></ARTGs><MinimumBenefit>2619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ841</BillingCode><Name>Reclaim Revision Hip System - Standard Distal Stem</Name><Description>Standard distal stem</Description><Size>14-31mm x 140-190mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112547</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>219278</ARTG></ARTGs><MinimumBenefit>2619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC010</BillingCode><Name>Modulus Modular Femoral Stem</Name><Description>Modulus Modular Femoral Stem</Description><Size>Size A &amp; B x 13 to 26mm diameter</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112547</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>210668</ARTG></ARTGs><MinimumBenefit>2619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA500</BillingCode><Name>Modular Revision Stem</Name><Description>Titanium, grit blast, non HA</Description><Size>14mm x 140mm - 24mm x 140mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112547</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>274204</ARTG></ARTGs><MinimumBenefit>2619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK059</BillingCode><Name>Stryker Modular Revision Hip System</Name><Description>Titanium Alloy Bowed Conical Distal Stems</Description><Size>Restoration Modular bowed conical distal stem 195mm, 235mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112547</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>217729</ARTG></ARTGs><MinimumBenefit>2619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI081</BillingCode><Name>ARCOS Modular Revision Hip System</Name><Description>Grit Blast Distal Stems, non HA</Description><Size>Diameter (mm) 12-30  Length (mm) 150-190</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112547</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>274605</ARTG></ARTGs><MinimumBenefit>2619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QG008</BillingCode><Name>MRP Stems</Name><Description>Femoral stem component of a modular hip system</Description><Size>Ø13mm - Ø34mm    80mm - 140mm long</Size><SupplierCode>39928</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112547</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>327850</ARTG></ARTGs><MinimumBenefit>2619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO026</BillingCode><Name>Link spacer</Name><Description>Titanium, grit blast, non HA </Description><Size>10mm - 40mm</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112547</SubGroupID><Suffix>Spacer</Suffix><ARTGs><ARTG>51002</ARTG><ARTG>114169</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO187</BillingCode><Name>Link MP Reconstruction Proximal Spacer</Name><Description>MP Reconstruction Proximal Spacer, CoCrMO</Description><Size>5 mm, 10 mm; 20 mm</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112547</SubGroupID><Suffix>Spacer</Suffix><ARTGs><ARTG>245855</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QG006</BillingCode><Name>MRP Titan Sleeve</Name><Description>Modular extension sleeve </Description><Size>Ø16mm x 30mm, Ø18mm x 30mm, Ø20mm x 30mm, Ø22mm x 30mm, Ø24mm x 30mm</Size><SupplierCode>39928</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112547</SubGroupID><Suffix>Spacer</Suffix><ARTGs><ARTG>327849</ARTG></ARTGs><MinimumBenefit>1020</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO020</BillingCode><Name>Link MP Reconstruction Hip Prosthesis</Name><Description>Titanium, Grit blast, femoral Body</Description><Size>Length 35-65 mm   Offset Standard, XXL lateral</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112547</SubGroupID><Suffix>Body</Suffix><ARTGs><ARTG>223282</ARTG></ARTGs><MinimumBenefit>2401</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO021</BillingCode><Name>Link MP Reconstruction Hip Prosthesis</Name><Description>Stem, grit blast, titanium non HA</Description><Size>12 - 25mm x 160mm</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112547</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>51002</ARTG><ARTG>114169</ARTG></ARTGs><MinimumBenefit>2619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY187</BillingCode><Name>Limb Preservation System</Name><Description>Beaded, 'Porocoat' Standard &amp; Trochanter Replacement</Description><Size>Neutral, 15deg Left &amp; Right in both styles</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112548</SubGroupID><Suffix>Body, Tumor</Suffix><ARTGs><ARTG>226873</ARTG><ARTG>226872</ARTG></ARTGs><MinimumBenefit>5867</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI739</BillingCode><Name>Segmental Trabecular Metal Femoral Component</Name><Description>00-5850-032-38 Proximal TM Femur, 38mm offset
00-5850-032-46 Proximal TM Femur, 46mm offset</Description><Size>28mm &amp; 46mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112548</SubGroupID><Suffix>Stem, Tumour</Suffix><ARTGs><ARTG>95938</ARTG></ARTGs><MinimumBenefit>4010</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP982</BillingCode><Name>SROM ZTT Femoral Sleeve</Name><Description>Titanium, beaded without HA, proximal femoral cone</Description><Size>12A-24F</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112548</SubGroupID><Suffix>Cone</Suffix><ARTGs><ARTG>98085</ARTG><ARTG>98086</ARTG></ARTGs><MinimumBenefit>2619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH132</BillingCode><Name>ARCOS Modular Revision Hip System Short Distal Stems</Name><Description>Distal Stem bullet or slottedtip, porous plasma spray</Description><Size>&lt;200mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112550</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>274396</ARTG><ARTG>274398</ARTG></ARTGs><MinimumBenefit>2954</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI971</BillingCode><Name>ARCOS Proximal Body</Name><Description>Plasma spray coated proximal bodies</Description><Size>Sizes A-F</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112550</SubGroupID><Suffix>Body</Suffix><ARTGs><ARTG>222273</ARTG></ARTGs><MinimumBenefit>2619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH641</BillingCode><PriorBillingCodes><PriorBillingCode>OO099</PriorBillingCode></PriorBillingCodes><Name>Mutars RS revision system- Metaphyseal component</Name><Description>RS metaphyseal component</Description><Size>25mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112550</SubGroupID><Suffix>Body</Suffix><ARTGs><ARTG>237292</ARTG></ARTGs><MinimumBenefit>2619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW604</BillingCode><Name>METS Total Femoral Link Component</Name><Description>Curved titanium link shaft</Description><Size>165mm, 225mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112551</SubGroupID><Suffix>Stem, Tumour</Suffix><ARTGs><ARTG>259943</ARTG></ARTGs><MinimumBenefit>3591</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ749</BillingCode><Name>SROM Femoral Stem</Name><Description>Titanium, fluted, distal polished femoral stem &amp; neck</Description><Size>Stem diameter: proximal 12 - 24mm, distal 6 - 19mm;   Size Standard, Stem Length: 115 - 175mm;   Neck Length: 30 - 42mm;   Offset: 0 - 12mm  </Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112551</SubGroupID><Suffix>Stem, SCP</Suffix><ARTGs><ARTG>225291</ARTG></ARTGs><MinimumBenefit>2954</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT034</BillingCode><PriorBillingCodes><PriorBillingCode>TZ036</PriorBillingCode></PriorBillingCodes><Name>Pantheon Cementless Stem</Name><Description>Titanium Fluted</Description><Size>Diameters 11-24mm, Lengths 115-145mm</Size><SupplierCode>40232</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112551</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>389895</ARTG></ARTGs><MinimumBenefit>2954</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF004</BillingCode><Name>ESOP HA</Name><Description>ESOP Femoral Stem Diaphyseal Ti polished</Description><Size>Size 9-15</Size><SupplierCode>40106</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112551</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>141169</ARTG></ARTGs><MinimumBenefit>2954</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK022</BillingCode><Name>Modular Revision System Fluted Distal Stems</Name><Description>Titanium, polished, fluted, no HA</Description><Size>Stem Lengths 127 &amp; 167mm straight &amp; bowed. Diameter 11-26mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112551</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>217755</ARTG></ARTGs><MinimumBenefit>2954</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT023</BillingCode><PriorBillingCodes><PriorBillingCode>TZ027</PriorBillingCode></PriorBillingCodes><Name>Pantheon Bridging Collar</Name><Description>Ti6Al4V  additive manufactured porous collar  </Description><Size>Collar Diameters 26 - 36mm, for Stem diameters 10 to 24 mm, without or with plate attachment or cylindrical.</Size><SupplierCode>40232</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112551</SubGroupID><Suffix>Spacer, Tumour</Suffix><ARTGs><ARTG>342977</ARTG><ARTG>340803</ARTG></ARTGs><MinimumBenefit>3591</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW605</BillingCode><Name>METS Principal Shaft</Name><Description>Titanium shaft</Description><Size>45mm-150mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112551</SubGroupID><Suffix>Spacer, Tumour</Suffix><ARTGs><ARTG>246516</ARTG></ARTGs><MinimumBenefit>3591</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK158</BillingCode><Name>Howmedica Modular Resection System</Name><Description>GMRS Proximal Femoral Component, Cast Chrome Cobalt</Description><Size>Standard, Trochanteric, Smooth</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112551</SubGroupID><Suffix>Body, Tumour</Suffix><ARTGs><ARTG>222995</ARTG></ARTGs><MinimumBenefit>4322</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW600</BillingCode><Name>METS Smooth Trochanter</Name><Description>Titanium, uncoated</Description><Size>small and standard</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112551</SubGroupID><Suffix>Body, Tumour</Suffix><ARTGs><ARTG>276356</ARTG></ARTGs><MinimumBenefit>4322</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH657</BillingCode><Name>Mutars Proximal Femur</Name><Description>Mutars Proximal Femur</Description><Size>50/70mm length</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112551</SubGroupID><Suffix>Body, Tumour</Suffix><ARTGs><ARTG>284591</ARTG><ARTG>319680</ARTG><ARTG>227163</ARTG></ARTGs><MinimumBenefit>4322</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI889</BillingCode><Name>Orthopaedic Salvage System</Name><Description>Proximal Femoral Component, Letson or Finn, Elliptical, Low Profile, Anatomic, Ti</Description><Size>7cm Left or Right</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112551</SubGroupID><Suffix>Body, Tumour</Suffix><ARTGs><ARTG>238435</ARTG><ARTG>291301</ARTG><ARTG>238746</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Description</ChangeExplanation><MinimumBenefit>4322</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO179</BillingCode><Name>MegaSystem-C, Neck Segments</Name><Description>Massive, titanium</Description><Size>(35 - 65mm) length, (135 or 126) degree neck angle</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112551</SubGroupID><Suffix>Body, Tumour</Suffix><ARTGs><ARTG>223281</ARTG></ARTGs><MinimumBenefit>4322</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT032</BillingCode><PriorBillingCodes><PriorBillingCode>TZ034</PriorBillingCode></PriorBillingCodes><Name>Pantheon Proximal Body</Name><Description>Titanium alloy proximal body for Pantheon limb salvage system</Description><Size>Offset in Short, Medium, Long. Lengths 50 and 90 in Smooth or Flat</Size><SupplierCode>40232</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108601</GroupID><SubGroupID>112551</SubGroupID><Suffix>Body, Tumour</Suffix><ARTGs><ARTG>389891</ARTG><ARTG>389892</ARTG></ARTGs><MinimumBenefit>4322</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO186</BillingCode><Name>Link MP Reconstruction Neck Segment, Tilastan, HX-coated</Name><Description>MP Reconstruction Prosthesis, Neck Segment, Tilastan, HX-coated</Description><Size>35 mm - 65 mm; 126° - 135°CCD</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108602</GroupID><SubGroupID>112552</SubGroupID><Suffix>Body</Suffix><ARTGs><ARTG>222181</ARTG></ARTGs><MinimumBenefit>2106</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT031</BillingCode><PriorBillingCodes><PriorBillingCode>TZ033</PriorBillingCode></PriorBillingCodes><Name>Pantheon Cementless Stem HA</Name><Description>Ti6Al4V stem with HA Coating</Description><Size>Diameters 11-24mm, Length 115-145mm </Size><SupplierCode>40232</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108602</GroupID><SubGroupID>112552</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>389893</ARTG></ARTGs><MinimumBenefit>2376</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC158</BillingCode><Name>H-Max M Femoral Stem Ti6AI4V</Name><Description>H-Max M Femoral Stem HA Coated Ti6AI4V</Description><Size>9 - 18</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108602</GroupID><SubGroupID>112552</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>210634</ARTG></ARTGs><MinimumBenefit>2376</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF003</BillingCode><Name>ESOP HA</Name><Description>Esop Femoral body Metaphyseal grit blast Ti/HA, </Description><Size>Left and Right Size 5-20</Size><SupplierCode>40106</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108602</GroupID><SubGroupID>112552</SubGroupID><Suffix>Body</Suffix><ARTGs><ARTG>141169</ARTG></ARTGs><MinimumBenefit>2106</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO133</BillingCode><Name>Link MP Reconstruction Hip Prosthesis</Name><Description>Link body, Titanium, grit blast, HA</Description><Size>35-65mm IN 126 &amp; 135 degrees</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108602</GroupID><SubGroupID>112552</SubGroupID><Suffix>Body</Suffix><ARTGs><ARTG>222181</ARTG></ARTGs><MinimumBenefit>2106</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TG018</BillingCode><Name>Securus Modular Revision Hip System</Name><Description>Modular Proximal Body</Description><Size>Std &amp; 5mm offset</Size><SupplierCode>40373</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108602</GroupID><SubGroupID>112552</SubGroupID><Suffix>Body</Suffix><ARTGs><ARTG>132478</ARTG></ARTGs><MinimumBenefit>2106</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN896</BillingCode><Name>REDAPT Revision System</Name><Description>Modular Sleeve with HA coating</Description><Size> 12 to 27, Extra Small to Large</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108602</GroupID><SubGroupID>112553</SubGroupID><Suffix>Spacer</Suffix><ARTGs><ARTG>303781</ARTG><ARTG>303782</ARTG></ARTGs><MinimumBenefit>2619</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH626</BillingCode><PriorBillingCodes><PriorBillingCode>OO040</PriorBillingCode></PriorBillingCodes><Name>Mutars RS revision system - metaphyseal component</Name><Description>RS metaphyseal component</Description><Size>0mm, 50mm, 40mm tapered, 50mm tapered</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108602</GroupID><SubGroupID>112555</SubGroupID><Suffix>Cone</Suffix><ARTGs><ARTG>223511</ARTG></ARTGs><MinimumBenefit>2954</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK058</BillingCode><Name>Stryker Modular Revision Hip System</Name><Description>Porous Distal Stems Titanium Plasma Spray</Description><Size>Stem Lengths 127 &amp; 167mm straight &amp; bowed. Diameter 11-26mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108602</GroupID><SubGroupID>112555</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>145599</ARTG></ARTGs><MinimumBenefit>3290</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW601</BillingCode><Name>METS Spiked Trochanter</Name><Description>Titanium, HA coated</Description><Size>Small and Standard</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108602</GroupID><SubGroupID>112556</SubGroupID><Suffix>Body, Tumour</Suffix><ARTGs><ARTG>276557</ARTG></ARTGs><MinimumBenefit>3793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW610</BillingCode><Name>METS stippled Integral Shaft and Stem</Name><Description>Titanium, HA coated, shaft and stem with round or oval collar</Description><Size>L=15,30mm; D=27,30mm (round); D=30x38,36x44mm (oval)</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108602</GroupID><SubGroupID>112556</SubGroupID><Suffix>Stem, Tumour</Suffix><ARTGs><ARTG>278138</ARTG></ARTGs><MinimumBenefit>4128</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ843</BillingCode><Name>reclaim Revision Hip System - Proximal Body</Name><Description>Proximal Body</Description><Size>20-28 x 75-105mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108603</GroupID><SubGroupID>112557</SubGroupID><Suffix>Body</Suffix><ARTGs><ARTG>219085</ARTG></ARTGs><MinimumBenefit>3239</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA525</BillingCode><Name>Modular Revision Stem</Name><Description>Proximal Body, Long, Grit Blasted Titanium</Description><Size>80mm-110mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108603</GroupID><SubGroupID>112557</SubGroupID><Suffix>Body</Suffix><ARTGs><ARTG>274207</ARTG></ARTGs><MinimumBenefit>3239</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA501</BillingCode><Name>Modular Revision Stem - Long</Name><Description>Titanium, grit blast, non HA</Description><Size>14mm x 200mm - 24 x 200mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108603</GroupID><SubGroupID>112557</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>274204</ARTG></ARTGs><MinimumBenefit>3877</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST011</BillingCode><Name>Stryker Modular Hip System</Name><Description>Conical distal stems titanium, grit blasted</Description><Size>Length 155mm, Diameter 14 - 28mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108603</GroupID><SubGroupID>112557</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>217729</ARTG></ARTGs><MinimumBenefit>3877</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QG009</BillingCode><Name>MRP Long Stems</Name><Description>Femoral stem component of modular revision hips system</Description><Size>Ø11mm - Ø34mm  200mm - 340mm long</Size><SupplierCode>39928</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108603</GroupID><SubGroupID>112557</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>327850</ARTG></ARTGs><MinimumBenefit>3877</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC161</BillingCode><Name>Revision Modular Stem</Name><Description>Revision Modular Stem Ti6AI4V</Description><Size>14 - 26mm Diameter x 200mm Length</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108603</GroupID><SubGroupID>112557</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>210670</ARTG></ARTGs><MinimumBenefit>3877</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ842</BillingCode><Name>Reclaim Revision Hip System - Long Distal Stem</Name><Description>Long distal stem</Description><Size>16-31mm x 240-290mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108603</GroupID><SubGroupID>112557</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>219278</ARTG></ARTGs><MinimumBenefit>3877</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GG012</BillingCode><Name>SMR Femoral Stem</Name><Description>SMR Distal Component 200mm and greater.</Description><Size>SMR distal component 14 x 240mm, SMR distal component 15 x 240mm, SMR distal component 16 x 240mm, SMR distal component 17 x 240mm, SMR distal component 18 x 240mm, SMR distal component 19 x 240mm, SMR distal component 20 x 240mm,  SMR distal component 21 x 240mm, SMR distal component 22 x 240mm, SMR distal component 24 x 240mm  SMR distal component 14 x 200mm, SMR distal component 15 x 200mm, SMR distal component 16 x 200mm, SMR distal component 17 x200mm, SMR distal component 18 x 200mm, SMR distal component 19 x 200mm, SMR distal component 20 x 200mm, SMR distal component 21 x 200mm, SMR distal component 22 x 200mm, SMR distal component 24 x 200mm.</Size><SupplierCode>40371</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108603</GroupID><SubGroupID>112557</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>277980</ARTG></ARTGs><MinimumBenefit>3877</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO185</BillingCode><Name>Link MP Reconstruction Prosthesis Stem, cementless</Name><Description>Link MP Reconstruction Prosthesis Stem, with Microporous surface, cementless</Description><Size>180 mm - 330 mm;   12 mm - 25 mm</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108603</GroupID><SubGroupID>112557</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>234224</ARTG></ARTGs><MinimumBenefit>3877</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH133</BillingCode><Name>ARCOS Modular Revision Hip System Distal Stems</Name><Description>Distal Stems</Description><Size>Stems ≥200mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108603</GroupID><SubGroupID>112560</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>274396</ARTG><ARTG>274398</ARTG><ARTG>274397</ARTG><ARTG>274605</ARTG><ARTG>274608</ARTG></ARTGs><MinimumBenefit>4633</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI049</BillingCode><Name>'ZMR Taper System Modular Revision Hip </Name><Description>Titanium body, plasma coating, non HA</Description><Size>A - F</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108603</GroupID><SubGroupID>112560</SubGroupID><Suffix>Body</Suffix><ARTGs><ARTG>208275</ARTG><ARTG>208295</ARTG><ARTG>208654</ARTG><ARTG>216777</ARTG></ARTGs><MinimumBenefit>3793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY510</BillingCode><Name>SROM  Femoral  Calcar Replacement Stem, long</Name><Description>Titanium, fluted, distal polished femoral long stem &amp; neck, bowed and straight with Calcar Replacement</Description><Size>9 -21mm diameter, greater than 200mm length</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108603</GroupID><SubGroupID>112561</SubGroupID><Suffix>Stem, SCP</Suffix><ARTGs><ARTG>226914</ARTG></ARTGs><MinimumBenefit>4633</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT025</BillingCode><PriorBillingCodes><PriorBillingCode>TZ029</PriorBillingCode></PriorBillingCodes><Name>Pantheon Shaft</Name><Description>Ti6Al4V Smooth Shaft Extension Pieces</Description><Size>35 - 140mm</Size><SupplierCode>40232</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108603</GroupID><SubGroupID>112561</SubGroupID><Suffix>Spacer, Tumour</Suffix><ARTGs><ARTG>340801</ARTG></ARTGs><MinimumBenefit>3054</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR046</BillingCode><Name>Stryker Modular Revision Hip System</Name><Description>Modular Long Bowed Titanium Polished Fluted Stem</Description><Size>Length 217mm, 267mm and 317mm. Diamter 11mm-26mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108603</GroupID><SubGroupID>112561</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>217755</ARTG></ARTGs><MinimumBenefit>4633</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY511</BillingCode><Name>SROM Femoral Stem Long</Name><Description>Titanium, fluted, distal polished femoral long stem &amp; neck, bowed and straight</Description><Size>9 -21mm diameter, greater than 200mm length</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108603</GroupID><SubGroupID>112561</SubGroupID><Suffix>Stem, SCP</Suffix><ARTGs><ARTG>225291</ARTG><ARTG>226914</ARTG></ARTGs><MinimumBenefit>4633</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI049</BillingCode><Name>Extreme Hip System Femoral Stem</Name><Description>Stem component of modular femoral stem, titanium, HA, with distal screw holes</Description><Size>4 lengths - 250 to 400mm, 6 diameters</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108604</GroupID><SubGroupID>112562</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>210347</ARTG></ARTGs><MinimumBenefit>4213</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TG023</BillingCode><Name>Securus Modular Revision Hip System</Name><Description>Curved Femoral Stem</Description><Size>250 - 300mm</Size><SupplierCode>40373</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108604</GroupID><SubGroupID>112562</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>132478</ARTG></ARTGs><MinimumBenefit>4213</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI051</BillingCode><Name>Optimal Revision Stem</Name><Description>Cementless, modular revision / reconstruction stem</Description><Size>Sizes 1-5</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108604</GroupID><SubGroupID>112565</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>135326</ARTG></ARTGs><MinimumBenefit>4968</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR045</BillingCode><Name>Stryker Modular Revision Hip System</Name><Description>Modular Long Bowed Titanium Plasma HA Stem</Description><Size>Length 217mm, 267mm and 317mm. Diameter 11mm - 26mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108604</GroupID><SubGroupID>112565</SubGroupID><Suffix>Stem</Suffix><ARTGs><ARTG>145599</ARTG></ARTGs><MinimumBenefit>4968</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW523</BillingCode><Name>Restoration Modular Body</Name><Description>Milled, Broached, Cone and Calcar body options</Description><Size>Milled: Dia 19-25mm with 2 mill Depths; 27-29mm with Mill Depths  Broach: 1-8  Cone: Diam 19-31mm, Heights +0, +10, +20, +30  Calcar: Diameter 19-29mm, 3 Heights each</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108604</GroupID><SubGroupID>112565</SubGroupID><Suffix>Body</Suffix><ARTGs><ARTG>145600</ARTG><ARTG>145601</ARTG><ARTG>145602</ARTG><ARTG>145603</ARTG></ARTGs><MinimumBenefit>3793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI050</BillingCode><Name>Extreme Revision Hip Monobloc Epiphysis Metaphyseal Section</Name><Description>Combined metaphyseal and epiphyseal sections, adjustable rotation, anodized titanium with HA coating</Description><Size>4 sizes</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107678</SubCategoryID><GroupID>108604</GroupID><SubGroupID>112565</SubGroupID><Suffix>Body</Suffix><ARTGs><ARTG>217486</ARTG></ARTGs><MinimumBenefit>3793</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW038</BillingCode><Name>V40 Orthinox Head</Name><Description>Stainless Steel</Description><Size>22 - 28mm dia</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112574</SubGroupID><ARTGs><ARTG>211859</ARTG><ARTG>211869</ARTG></ARTGs><MinimumBenefit>671</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI058</BillingCode><Name>metallic femoral head</Name><Description>M30NW femoral head with 10/12 taper</Description><Size>22.2mm - 32mm short, medium, long</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112574</SubGroupID><ARTGs><ARTG>210159</ARTG></ARTGs><MinimumBenefit>671</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN697</BillingCode><Name>Femoral Head</Name><Description>Stainless steel</Description><Size>22-32mm,+0-+16mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112574</SubGroupID><ARTGs><ARTG>218184</ARTG></ARTGs><MinimumBenefit>671</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC195</BillingCode><Name>BioBall Femoral Head</Name><Description>Femoral Head Vivium ≤ 32mm</Description><Size>28mm,  32mm</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112574</SubGroupID><ARTGs><ARTG>227096</ARTG></ARTGs><MinimumBenefit>671</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA028</BillingCode><Name>Mathys Stainless Steel Femoral Heads</Name><Description>Stainless Steel, </Description><Size>22-32mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112574</SubGroupID><ARTGs><ARTG>210158</ARTG></ARTGs><MinimumBenefit>671</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ184</BillingCode><Name>Bioball </Name><Description>Bioball Vivium Femoral Head </Description><Size>28mm and 32mm</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112574</SubGroupID><ARTGs><ARTG>266538</ARTG></ARTGs><MinimumBenefit>671</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI358</BillingCode><Name>Durasul Ballhead for Inserts</Name><Description>CoCr femoral head</Description><Size>22, 28, 32</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>216181</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW032</BillingCode><Name>Stryker CoCr Femoral Head</Name><Description>Hip - Femoral Head</Description><Size>22, 26, 28, 30, 32mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>211858</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR026</BillingCode><Name>Stryker CoCr Femoral Head</Name><Description>Cobal Chrome with LFIT Treatment</Description><Size>22.2-32mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><Suffix>Low Frequency Ion Treatment</Suffix><ARTGs><ARTG>211868</ARTG><ARTG>211867</ARTG></ARTGs><MinimumBenefit>1280</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP124</BillingCode><Name>DePuy Femoral Head</Name><Description>CoCr Femoral Head Various Tapers &amp; Neck Lengths</Description><Size>22-32 mm </Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>224613</ARTG><ARTG>224755</ARTG><ARTG>211855</ARTG><ARTG>222991</ARTG><ARTG>231693</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FD001</BillingCode><Name>Evolutis CoCr Femoral Head</Name><Description>CoCr Femoral Head</Description><Size>22mm, 28mm and 32mm diameter</Size><SupplierCode>40075</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>268273</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC032</BillingCode><Name>Modular Head</Name><Description>Modular Head CoCrMo</Description><Size>28-32mm Diameter Small to XXXLarge</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>210718</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF046</BillingCode><Name>Signature Femoral Head &lt;=32mm</Name><Description>Cobalt Chrome Femoral head</Description><Size>Offsets S, M, L &amp; XL</Size><SupplierCode>40413</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>272594</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GG005</BillingCode><Name>SMR Femoral Head</Name><Description>CoCr</Description><Size>22 to 40mm</Size><SupplierCode>40371</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>280608</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TG005</BillingCode><Name>JRI Femoral Head</Name><Description>Cobalt Chrome Femoral; Heads</Description><Size>28mm, and 32mm head sizes</Size><SupplierCode>40373</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>132410</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV035</BillingCode><Name>Femoral Head</Name><Description>Femoral Head CoCr</Description><Size>22.25-32mm
Short-XLong
-3.5-+10.5mm</Size><SupplierCode>40177</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>263792</ARTG><ARTG>262372</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB246</BillingCode><Name>Aesculap 12/14 Metal Femoral Head</Name><Description>Isodur CoCr Femoral Head</Description><Size>28mm, 32mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>279750</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH621</BillingCode><PriorBillingCodes><PriorBillingCode>OO034</PriorBillingCode></PriorBillingCodes><Name>IC-Head CoCrMo</Name><Description>IC Head, CoCrMo</Description><Size>22,28,32mm - S-M-L-XL</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>291215</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI094</BillingCode><Name>Ampllitude CoCr Femoral Head</Name><Description>Femoral Heads, CoCr</Description><Size>Diameter 22.2mm, 28mm, 32mm  Short, Medium, Long and XLong.</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>389273</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW648</BillingCode><Name>METS CoCr Femoral Head</Name><Description>CoCr</Description><Size>28mm-32mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>330362</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA469</BillingCode><Name>Mathys CoCr Femoral Head </Name><Description>Hip Prosthesis Femoral Head CoCrMo ≤32mm</Description><Size>22.2mm, 28 mm &amp; 32mm, (S,M,L,XL,XXL)</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>274272</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI051</BillingCode><Name>Femoral Head</Name><Description>CoCr Femoral heads</Description><Size>22mm - 32mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>346245</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF005</BillingCode><Name>ESOP HA</Name><Description>Femoral Head CoCr</Description><Size>22.2 -32mm</Size><SupplierCode>40106</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>141169</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD050</BillingCode><Name>FMP Acetabular System - CoCro Femoral Heads</Name><Description>CoCro femoral heads in 22mm and 32mm diameters to fit with FMP acetabular liners and FMP acetabular shells</Description><Size>22mm in +0,+4,+8mm and 32mm in -4.0, +4, +8, +12mm, diameters</Size><SupplierCode>39986</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>210902</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO022</BillingCode><Name>Link Prosthesis Femoral Head</Name><Description>Prosthesis Head "B" CoCrMo</Description><Size>Short/medium-short/medium/Long/X-long  22mm - 32mm: Length -3.5 to +10.5</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>212089</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI973</BillingCode><Name>Modular Head Implants</Name><Description>Femoral Modular Head</Description><Size>22 - 32mm diameter, - 6 to =12mm neck, collared, no collar</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>98097</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU005</BillingCode><Name>Quadra Hip Femoral Head</Name><Description>CoCr</Description><Size>Dia 22mm (S to M)  Dia 28mm (S to XXL)  Dia 32mm (S to XXL)</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>210392</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF033</BillingCode><Name>Metal Femoral Head</Name><Description>Cobalt Chrome</Description><Size>28mm - 32mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>272594</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH434</BillingCode><Name>Samo acetabular cup femoral head</Name><Description>CoCr femoral head</Description><Size>S, M, L and XL</Size><SupplierCode>40113</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>165470</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR029</BillingCode><Name>CoCr Femoral Head</Name><Description>CoCr femoral head</Description><Size>Dia 22,26,28,32mm</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>220077</ARTG><ARTG>224980</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI380</BillingCode><Name>Femoral Head</Name><Description>Head - Metal (Zweymuller Allopro) - CoCr</Description><Size>22mm, 28mm, 32mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>216181</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN280</BillingCode><Name>Femoral Head</Name><Description>CoCr</Description><Size>&lt;=32mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>218139</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EX022</BillingCode><Name>Exactech Femoral Head</Name><Description>Cobalt Chrome Head</Description><Size>-3.5mm to +10mm, 22mm to 32mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>293800</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WQ003</BillingCode><Name>Cobalt Chrome Femoral Head</Name><Description>CoCr Femoral Head</Description><Size>22.2mm, 28mm, 32mm</Size><SupplierCode>40394</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112575</SubGroupID><ARTGs><ARTG>392730</ARTG></ARTGs><MinimumBenefit>621</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF006</BillingCode><Name>ESOP HA</Name><Description>Femoral Head Alumina Ceramic</Description><Size>28 and 32mm Diameter</Size><SupplierCode>40106</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112576</SubGroupID><ARTGs><ARTG>141169</ARTG></ARTGs><MinimumBenefit>1568</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TG015</BillingCode><Name>JRI Total Hip System</Name><Description>Ceramic femoral head with sleeve </Description><Size>28, 32, 36mm</Size><SupplierCode>40373</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112576</SubGroupID><Suffix>Sleeve</Suffix><ARTGs><ARTG>132410</ARTG></ARTGs><MinimumBenefit>1723</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TG020</BillingCode><Name>JRI Ceramic femoral Head </Name><Description>Total Hip Replacement (THR) Ceramic Femoral Heads, Biolox Delta Ceramic, and Alumina Oxide</Description><Size>12 / 14 Taper, Biolox Delta Ceramic head sizes 28mm, 32mm. Alumina Oxide head sizes 28mm</Size><SupplierCode>40373</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112576</SubGroupID><ARTGs><ARTG>132410</ARTG></ARTGs><MinimumBenefit>1568</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH433</BillingCode><Name>Samo acetabular cup ceramic head</Name><Description>Ceramic femoral head</Description><Size>S, M, L, and XL</Size><SupplierCode>40113</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112576</SubGroupID><ARTGs><ARTG>165470</ARTG></ARTGs><MinimumBenefit>1568</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA020</BillingCode><Name>Mathys Ceramic Femoral Head</Name><Description>Ceramic, Bionit (alumina)</Description><Size>diameter 28-32mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112576</SubGroupID><ARTGs><ARTG>210564</ARTG></ARTGs><MinimumBenefit>1568</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW017</BillingCode><Name>Stryker Biolox Forte Alumina Femoral Head</Name><Description>Hip - Femoral Head</Description><Size>28, 32mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112576</SubGroupID><ARTGs><ARTG>217828</ARTG><ARTG>206180</ARTG></ARTGs><MinimumBenefit>1568</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR028</BillingCode><Name>Stryker Delta Ceramic Heads</Name><Description>Femoral Head - Delta Ceramic</Description><Size>&amp;lt;32mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>206181</ARTG></ARTGs><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR310</BillingCode><PriorBillingCodes><PriorBillingCode>GO308</PriorBillingCode></PriorBillingCodes><Name>BioBall Delta Femoral Head, 32mm or less</Name><Description>Femoral Head Biolox Delta Ceramic, 28mm and 32mm</Description><Size>28mm, 32mm</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>276307</ARTG></ARTGs><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI058</BillingCode><Name>Modular Ceramic System</Name><Description>Ceramic Head, Aluminium Alloy, biolox Delta</Description><Size>28-32mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>231755</ARTG><ARTG>224752</ARTG></ARTGs><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA482</BillingCode><Name>Ceramys Ceramic Femoral Head</Name><Description>Ceramic, zirconia alumina combination</Description><Size>28 L,  28 M, 28 S, 32 XL, 32 L, 32 M, 32 S</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>236457</ARTG></ARTGs><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA002</BillingCode><Name>Ceramic modular head</Name><Description>Biolox Delta Ceramic heads 32mm or less</Description><Size>28 and 32mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>285507</ARTG></ARTGs><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH619</BillingCode><PriorBillingCodes><PriorBillingCode>OO032</PriorBillingCode></PriorBillingCodes><Name>IC- Head Biolox delta</Name><Description>Biolox delta ceramic head</Description><Size>28 and 32mm. Small, medium and large.</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>288475</ARTG></ARTGs><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI115</BillingCode><Name>Biolox Delta Ceramic Revision Head</Name><Description>Biolox Delta Femoral Head</Description><Size>28mm and 32mm</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>281065</ARTG></ARTGs><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI074</BillingCode><Name>Delta Ceramic Head</Name><Description>Biolox Delta Head</Description><Size>28 and 32mm heads
10/12 and 12/14</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>281064</ARTG></ARTGs><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB250</BillingCode><Name>Biolox Delta Ceramic Hip Prosthesis Head</Name><Description>Biolox Delta Ceramic Head</Description><Size>28 &amp; 32mm diameter</Size><SupplierCode>40020</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>291964</ARTG></ARTGs><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QG004</BillingCode><Name>Biolox Delta Head</Name><Description>Zirconia Toughened Alumina Femoral Head</Description><Size>Ø28mm - 32mm, 12/14 &amp; 16/18 Tapers, Short - Extra Long Offset</Size><SupplierCode>39928</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>326800</ARTG></ARTGs><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WQ001</BillingCode><Name>Biolox Delta Femoral Head</Name><Description>Biolox Delta Ceramic Femoral Head</Description><Size>28mm, 32mm</Size><SupplierCode>40394</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>391991</ARTG></ARTGs><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT029</BillingCode><PriorBillingCodes><PriorBillingCode>TZ002</PriorBillingCode></PriorBillingCodes><Name>Adler Ceramic Head</Name><Description>Ceramic Femoral Heads. Biolox Delta</Description><Size>Short, Medium, Long, Extra Long, 22 - 32mm Outer Diameter 12/14 Taper</Size><SupplierCode>40232</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>206143</ARTG><ARTG>296607</ARTG></ARTGs><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM144</BillingCode><Name>Universal Delta Ceramic Femoral Head</Name><Description>Delta Ceramic</Description><Size>&lt;=32 - S, M, L, XL,XXL</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>218138</ARTG></ARTGs><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WN004</BillingCode><PriorBillingCodes><PriorBillingCode>RL002</PriorBillingCode></PriorBillingCodes><Name>Mac Surgical BIOLOX Delta ceramic heads 28mm and 32mm</Name><Description>BIOLOX Delta ceramic heads</Description><Size>T28mm and 32mm is available with a diameter of 28 and 32mm. The 28mm diameter is availble in 3 different head-neck lengths ( Short, medium long). The 32mm diameter lengths (short, medium long, X-long)</Size><SupplierCode>40384</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>230837</ARTG></ARTGs><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR180</BillingCode><Name>Ceramic modular head</Name><Description>Biolox Delta Ceramic heads 32mm or less</Description><Size>28 and 32mm</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>157505</ARTG></ARTGs><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU117</BillingCode><Name>Mectacer Biolox Option Ceramic Heads (&lt;32)</Name><Description>Biolox Option Ceramic Femoral Heads</Description><Size>28mm &amp; 32mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>206684</ARTG></ARTGs><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU096</BillingCode><Name>Biolox Delta Ceramic Ball Heads</Name><Description>Ceramic femoral heads, BIOLOX® Delta AI2 O3 -ZrO2</Description><Size>Ball Head 12/14 Ø 28 Sizes: S, M and L
Ball Head 12/14 Ø 32 sizes: S, M, L and XL</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>205465</ARTG></ARTGs><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ752</BillingCode><Name>DePuy Delta Heads</Name><Description>Delta femoral head various tapers &amp; neck lengths</Description><Size>≤32mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>232415</ARTG></ARTGs><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC152</BillingCode><Name>Modular Biolox Delta Head</Name><Description>Modular Biolox Delta Head</Description><Size>28 - 32mm Small to Large</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>210721</ARTG></ARTGs><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GG006</BillingCode><Name>Biolox Delta Ceramic Femoral Heads</Name><Description>Biolox Delta Ceramic Femoral Heads 28mm 32mm</Description><Size>Biolox Delta Femoral Head 28mm - -3.5mm to +3.5mm and Biolox Delta Femoral Head 32mm - 3.5mm to +7mm</Size><SupplierCode>40371</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>279805</ARTG></ARTGs><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM165</BillingCode><Name>Biolox Option Femoral Head</Name><Description>Biolox Option Ceramic Femoral Head</Description><Size>28mm and 32mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>430153</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Description, Size</ChangeExplanation><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV038</BillingCode><Name>Delta Modular Heads</Name><Description>Biolox Delta Heads</Description><Size>28-32mm
Short, Medium, Long</Size><SupplierCode>40177</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>240574</ARTG></ARTGs><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO184</BillingCode><Name>Link Biolox Delta Head, ≤32mm</Name><Description>Link Biolox Delta Head, ≤32mm</Description><Size>28 mm - 32 mm diameter</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>212053</ARTG></ARTGs><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI538</BillingCode><Name>Ceramic primary &amp; revision femoral head</Name><Description>Biolox Delta Ceramic</Description><Size>28 &amp; 32mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>215999</ARTG></ARTGs><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FD003</BillingCode><Name>Delta Ceramic Femoral Head</Name><Description>Delta Ceramic Head</Description><Size>28mm to 32mm diameter</Size><SupplierCode>40075</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>273049</ARTG></ARTGs><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA484</BillingCode><Name>Ceramys Ceramic Revision Femoral Head</Name><Description>Ceramic, zirconia alumina combination, supplied with titanium taper sleeve</Description><Size>28 L, 28 M, 28 S, 28 XL, 32 L, 32 M, 32 S, 32 XL, 28, 32</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><Suffix>Sleeve</Suffix><ARTGs><ARTG>274113</ARTG></ARTGs><MinimumBenefit>1931</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC153</BillingCode><Name>Revision Modular Biolox Delta Head</Name><Description>Revision Modular Biolox Delta Head Ti6AI4V 12/14 Taper</Description><Size>28 - 32mm Small to Xlarge</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><Suffix>Sleeve</Suffix><ARTGs><ARTG>210872</ARTG></ARTGs><MinimumBenefit>1931</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ818</BillingCode><Name>DePuy Delta TS Heads</Name><Description>Delta ceramic femoral head with titanium sleeve</Description><Size>≤32mm, +1 to +12</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><Suffix>Sleeve</Suffix><ARTGs><ARTG>217543</ARTG></ARTGs><MinimumBenefit>1931</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF044</BillingCode><Name>Signature Delta Femoral Head &lt;=32mm</Name><Description>Ceramtec Delta Ceramic Femoral Head</Description><Size>Offsets S, M, L &amp; XL</Size><SupplierCode>40413</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112578</SubGroupID><ARTGs><ARTG>272595</ARTG></ARTGs><MinimumBenefit>1702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN687</BillingCode><Name>Femoral Head</Name><Description>12/14, 14/16 Taper, Oxinium</Description><Size>22 - 32mm, -3 - +16mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108610</GroupID><SubGroupID>112579</SubGroupID><ARTGs><ARTG>218140</ARTG></ARTGs><MinimumBenefit>1698</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC193</BillingCode><Name>BioBall Femoral Head</Name><Description>Femoral Head Vivium &gt; 32mm</Description><Size>36mm to 58mm</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112580</SubGroupID><ARTGs><ARTG>227098</ARTG></ARTGs><MinimumBenefit>681</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC156</BillingCode><Name>Cephalic Head</Name><Description>Cephalic Head AISI 316L</Description><Size>41 - 57mm Diameter</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112580</SubGroupID><ARTGs><ARTG>210761</ARTG></ARTGs><MinimumBenefit>681</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC191</BillingCode><Name>BioBall Femoral Head</Name><Description>Femoral Head Vivium &gt; 32mm</Description><Size>36mm to 58mm</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112580</SubGroupID><ARTGs><ARTG>227097</ARTG></ARTGs><MinimumBenefit>681</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC196</BillingCode><Name>BioBall Femoral Head</Name><Description>Femoral Head Vivium &gt; 32mm</Description><Size>36mm, 38mm</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112580</SubGroupID><ARTGs><ARTG>227096</ARTG></ARTGs><MinimumBenefit>681</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR314</BillingCode><PriorBillingCodes><PriorBillingCode>GO312</PriorBillingCode></PriorBillingCodes><Name>BioBall Femoral Head</Name><Description>Femoral DuoHead Vivium &gt; 32mm</Description><Size>36mm to 58mm</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112580</SubGroupID><ARTGs><ARTG>266540</ARTG></ARTGs><MinimumBenefit>681</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW395</BillingCode><Name>V40 Orthinox Head</Name><Description>Stainless Steel</Description><Size>&gt;32mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112580</SubGroupID><ARTGs><ARTG>211859</ARTG></ARTGs><MinimumBenefit>681</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA467</BillingCode><Name>Mathys Unipolar Femoral Head</Name><Description>Stainless steel, unipolar head</Description><Size>42 mm - 58mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112580</SubGroupID><ARTGs><ARTG>212967</ARTG></ARTGs><MinimumBenefit>681</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR308</BillingCode><PriorBillingCodes><PriorBillingCode>GO304</PriorBillingCode></PriorBillingCodes><Name>BioBall Femoral Head</Name><Description>Femoral Head Vivium &gt; 32mm</Description><Size>36mm to 58mm</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112580</SubGroupID><ARTGs><ARTG>266539</ARTG></ARTGs><MinimumBenefit>681</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ157</BillingCode><Name>Ultamet Metal Femoral Head</Name><Description> Metal Femoral Head - Ultamet</Description><Size>36mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112581</SubGroupID><ARTGs><ARTG>261993</ARTG></ARTGs><MinimumBenefit>632</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ156</BillingCode><Name>Modular M-Spec Metal Femoral Head</Name><Description> Metal Femoral Head - Modular M-Spec</Description><Size>36-40mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112581</SubGroupID><ARTGs><ARTG>264072</ARTG></ARTGs><MinimumBenefit>632</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ155</BillingCode><Name>Modular Cathcart Fracture Head Hip Ball and Articul/eze M-Spec Metal Femoral Head</Name><Description> Metal Femoral Head - Articul/eze, M-Spec, Unipolar</Description><Size>36mm to 60mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112581</SubGroupID><ARTGs><ARTG>235556</ARTG><ARTG>261972</ARTG></ARTGs><MinimumBenefit>632</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF047</BillingCode><Name>Signature Delta Femoral Head &gt;=36mm</Name><Description>Cobalt Delta Femoral Head</Description><Size>Offsets S, M, L &amp; XL</Size><SupplierCode>40413</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112581</SubGroupID><ARTGs><ARTG>272595</ARTG></ARTGs><MinimumBenefit>632</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA111</BillingCode><PriorBillingCodes><PriorBillingCode>BI877</PriorBillingCode><PriorBillingCode>BI974</PriorBillingCode><PriorBillingCode>ZI359</PriorBillingCode></PriorBillingCodes><Name>Zimmer Biomet Femoral Heads</Name><Description>Modular Femoral Head  </Description><Size>36-44 mm diameter</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112581</SubGroupID><ARTGs><ARTG>224807</ARTG><ARTG>237314</ARTG><ARTG>273693</ARTG><ARTG>231255</ARTG></ARTGs><MinimumBenefit>632</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC157</BillingCode><Name>Modular Head</Name><Description>Modular Head CoCrMo</Description><Size>36mm Diameter Small to XXXLarge</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112581</SubGroupID><ARTGs><ARTG>210718</ARTG></ARTGs><MinimumBenefit>632</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF025</BillingCode><Name>Unipolar Femoral head</Name><Description>Femoral head manufactured from Cobalt Chrome</Description><Size>40-62mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112581</SubGroupID><ARTGs><ARTG>298301</ARTG></ARTGs><MinimumBenefit>632</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FD002</BillingCode><Name>Evolutis CoCr Femoral Head</Name><Description>CoCr Femoral Heads</Description><Size>36mm diamater</Size><SupplierCode>40075</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112581</SubGroupID><ARTGs><ARTG>268273</ARTG></ARTGs><MinimumBenefit>632</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN809</BillingCode><Name>Femoral head</Name><Description>CoCr</Description><Size>&gt;32mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112581</SubGroupID><ARTGs><ARTG>218142</ARTG><ARTG>218139</ARTG></ARTGs><MinimumBenefit>632</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR301</BillingCode><PriorBillingCodes><PriorBillingCode>GO293</PriorBillingCode></PriorBillingCodes><Name>BioBall Femoral Head</Name><Description>Femoral Head Vivium &gt; 32mm</Description><Size>36mm to 58mm</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112581</SubGroupID><ARTGs><ARTG>266538</ARTG></ARTGs><MinimumBenefit>632</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA542</BillingCode><Name>Mathys CoCr Femoral Head</Name><Description>CoCr Femoral Head</Description><Size>36mm, S to XXL</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112581</SubGroupID><ARTGs><ARTG>274272</ARTG></ARTGs><MinimumBenefit>632</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV027</BillingCode><Name>Femoral Head</Name><Description>Femoral Head CoCr, Superfinished</Description><Size>33-36mm, XS-XXL (neck length), -3.5 to + 10.5 (neck offset)</Size><SupplierCode>40177</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112581</SubGroupID><ARTGs><ARTG>262372</ARTG><ARTG>263792</ARTG></ARTGs><MinimumBenefit>632</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN308</BillingCode><Name>Unipolar Head</Name><Description>Co Cr</Description><Size>12/14, 40-61mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112581</SubGroupID><ARTGs><ARTG>242994</ARTG></ARTGs><MinimumBenefit>632</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FD007</BillingCode><PriorBillingCodes><PriorBillingCode>LI118</PriorBillingCode></PriorBillingCodes><Name>Evolutis CoCr Femoral Heads</Name><Description>Large Diameter CoCr Femoral Heads</Description><Size>36mm  Short, Medium, Long, Extra Long  12/14 Taper</Size><SupplierCode>40075</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112581</SubGroupID><ARTGs><ARTG>268273</ARTG></ARTGs><MinimumBenefit>632</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK405</BillingCode><Name>LFIT Femoral Heads</Name><Description>Femoral head with low friction ion treatment</Description><Size>36mm-44mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112581</SubGroupID><Suffix>Low Frequency Ion Treatment</Suffix><ARTGs><ARTG>211868</ARTG><ARTG>211867</ARTG></ARTGs><MinimumBenefit>1447</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO183</BillingCode><Name>Link Prosthesis Femoral Head, &gt;32mm</Name><Description>CoCr Femoral Head, &gt;32mm</Description><Size>36mm diameter</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112581</SubGroupID><ARTGs><ARTG>212089</ARTG></ARTGs><MinimumBenefit>632</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU097</BillingCode><Name>Femoral Head</Name><Description>CoCr Femoral Ball Head 12/14</Description><Size>Ø 36mm &amp; Ø 40mm: both of sizes S-M-L-XL-XXL</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112581</SubGroupID><ARTGs><ARTG>210392</ARTG></ARTGs><MinimumBenefit>632</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AX103</BillingCode><Name>U2 Femoral Head</Name><Description>Unipolar Femoral heads, CoCr</Description><Size>Size 42 - 56mm</Size><SupplierCode>40029</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112581</SubGroupID><ARTGs><ARTG>172424</ARTG></ARTGs><MinimumBenefit>632</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI054</BillingCode><Name>Femoral Head</Name><Description>Cobalt Chrome Femoral Head</Description><Size>36-57mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112581</SubGroupID><ARTGs><ARTG>228449</ARTG><ARTG>346245</ARTG><ARTG>344990</ARTG><ARTG>274713</ARTG><ARTG>241192</ARTG><ARTG>241232</ARTG></ARTGs><MinimumBenefit>632</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST570</BillingCode><Name>UNITRAX</Name><Description>Vitallium alloy /CoCr</Description><Size>38-64mm OD 2mm increments</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112581</SubGroupID><ARTGs><ARTG>255133</ARTG></ARTGs><MinimumBenefit>632</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WQ004</BillingCode><Name>Cobalt Chrome Femoral Head</Name><Description>CoCr Femoral Head</Description><Size>36mm</Size><SupplierCode>40394</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112581</SubGroupID><ARTGs><ARTG>392730</ARTG></ARTGs><MinimumBenefit>632</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR084</BillingCode><Name>CoCr Femoral Head</Name><Description>CoCr Modular Head</Description><Size>Dia 36-62</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112581</SubGroupID><ARTGs><ARTG>224980</ARTG><ARTG>269352</ARTG></ARTGs><MinimumBenefit>632</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH705</BillingCode><Name>IC-Head</Name><Description>IC-Head, CoCrMo</Description><Size>36mm, S-XL</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112581</SubGroupID><ARTGs><ARTG>291215</ARTG></ARTGs><MinimumBenefit>632</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI096</BillingCode><Name>Amplitude CoCr Femoral Head</Name><Description>Femoral heads, CoCr</Description><Size>Diameter 36mm, -4, 0, +4, +8</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112581</SubGroupID><ARTGs><ARTG>389273</ARTG></ARTGs><MinimumBenefit>632</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA024</BillingCode><Name>Exactech Femoral Head CoCr</Name><Description>Cobalt Chrome Femoral Head</Description><Size>36mm, -3.5mm to +10mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112581</SubGroupID><ARTGs><ARTG>293800</ARTG></ARTGs><MinimumBenefit>632</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA517</BillingCode><Name>Bionit Ceramic Femoral Head</Name><Description>Femoral Head, Ceramic</Description><Size>36 to 54mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112582</SubGroupID><ARTGs><ARTG>210564</ARTG></ARTGs><MinimumBenefit>1357</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW394</BillingCode><Name>Stryker large ceramic femoral head </Name><Description>Biolox Forte</Description><Size>36mm - 60mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112582</SubGroupID><ARTGs><ARTG>217828</ARTG></ARTGs><MinimumBenefit>1357</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC155</BillingCode><Name>Revision Modular Biolox Delta Head</Name><Description>Revision Modular Biolox Delta Head Ti6AI4V 12/14 Taper</Description><Size>36 - 40mm Small to Xlarge</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><Suffix>Sleeve</Suffix><ARTGs><ARTG>210872</ARTG></ARTGs><MinimumBenefit>2097</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM167</BillingCode><Name>Biolox Option Femoral Head</Name><Description>Biolox Option Ceramic Femoral Head</Description><Size>36mm and 40mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>430153</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Description, Size</ChangeExplanation><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC192</BillingCode><Name>BioBall Delta Femoral Head</Name><Description>Femoral Head Biolox Delta</Description><Size>28mm, 32mm, 36mm, 40mm, 44mm, 48mm</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>227095</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO182</BillingCode><Name>Link Biolox Delta Ceramic Head &gt; 32mm</Name><Description>Biolox Delta Ceramic Head &gt; 32mm</Description><Size>36mm - 40mm diameter</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>212053</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU118</BillingCode><Name>Mectacer Biolox Option Ceramic Heads (&gt;32)</Name><Description>Biolox Option Ceramic Femoral Heads</Description><Size>36mm, 40mm, 44mm, 48mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>206684</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV028</BillingCode><Name>Delta Modular Heads</Name><Description>Biolox Delta Heads</Description><Size>33-40mm
Short, Medium, Long</Size><SupplierCode>40177</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>240574</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GG007</BillingCode><Name>Biolox Delta Ceramic Femoral Head 36mm</Name><Description>A sterile implantable component of a hip prostheses system intended to replace the femoral head in total hip arthroplasty procedures.</Description><Size>Diameter: 36mm
Taper: 12/14
Neck: S, M, L, XL
Centre of rotation: -3.5, 0, +3.5, +7.0mm</Size><SupplierCode>40371</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>279805</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WQ002</BillingCode><Name>Biolox Delta Femoral Head</Name><Description>Biolox Delta Ceramic Femoral Head</Description><Size>36mm, 40mm </Size><SupplierCode>40394</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>391991</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TG026</BillingCode><Name>JRI Total Hip System</Name><Description>Total Hip Replacement (THR)  Biolox Delta Ceramic Haeds</Description><Size>12 / 14 Taper, Biolox Delta Ceramic head sizes 36mm &amp; 40mm</Size><SupplierCode>40373</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>302740</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WN005</BillingCode><PriorBillingCodes><PriorBillingCode>RL001</PriorBillingCode></PriorBillingCodes><Name>Mac Surgical BIOLOX Delta Ceramic Heads 36mm and 40mm</Name><Description>BIOLOX Delta Ceramic Heads 36mm and 40mm</Description><Size>36mm and 40mm - both diameters are available in 4 different nead-neck-lengths (short, Medium, Long, X-Long)</Size><SupplierCode>40384</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>230837</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM095</BillingCode><Name>Universal Delta Ceramic Femoral Head</Name><Description>Delta Ceramic</Description><Size>&gt;32mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>218138</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FD004</BillingCode><Name>Delta Ceramic Femoral Head</Name><Description>Delta Femoral Head</Description><Size>36mm to 40mm</Size><SupplierCode>40075</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>273049</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT030</BillingCode><PriorBillingCodes><PriorBillingCode>TZ003</PriorBillingCode></PriorBillingCodes><Name>Adler Ceramic Head</Name><Description>Delta Alumina Ceramic Head</Description><Size>Short, Medium, Long, Extra Long; 36mm to 48mm</Size><SupplierCode>40232</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>206143</ARTG><ARTG>296607</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF023</BillingCode><Name>Ceramic Femoral Head</Name><Description>Ceramic Femoral Head - Delta</Description><Size>36 to 44mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>272595</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF045</BillingCode><Name>Signature Delta Femoral Head &gt;=36mm</Name><Description>Ceramtec Delta Femoral Head</Description><Size>offsets S, M, L &amp; XL</Size><SupplierCode>40413</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>272595</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY464</BillingCode><Name>DePuy Delta Ceramic Femoral Head</Name><Description>Ceramic delta &gt;32mm</Description><Size>&gt;32mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>232415</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC154</BillingCode><Name>Modular Biolox Delta Head</Name><Description>Modular Biolox Delta Head</Description><Size>36 - 40mm Small to Large</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>210721</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA483</BillingCode><Name>Ceramys Large Ceramic Femoral Head</Name><Description>Ceramic, zirconia alumina combination, large diameters</Description><Size>36 XL, 36 L, 36 M, 36 S</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>236457</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR179</BillingCode><Name>Ceramic Modular head</Name><Description>Biolox Delta Ceramic heads  &gt; 32mm</Description><Size>36, 40 and 44mm</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>157505</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB302</BillingCode><Name>Biolox Delta Ceramic Hip Prosthesis Head</Name><Description>Biolox Delta Ceramic Head</Description><Size>36 &amp; 40mm diameter</Size><SupplierCode>40020</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>291964</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QG002</BillingCode><Name>Biolox Delta Head</Name><Description>Zirconia toughened alumina femoral head</Description><Size>Ø36mm, 12/14 &amp; 16/18 tapers, Short - Extra Long Offsets</Size><SupplierCode>39928</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>326800</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI075</BillingCode><Name>Large Delta Ceramic Head</Name><Description>Biolox Delta Head</Description><Size>36mm heads
10/12 and 12/14</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>281064</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI116</BillingCode><Name>Biolox Delta Ceramic Revision Head</Name><Description>Biolox Delta Femoral Head</Description><Size>36mm</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>281065</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU095</BillingCode><Name>Biolox Delta Ceramic Ball heads</Name><Description>Ceramic femoral heads, BIOLOX® Delta Ai2 O3 -ZrO2</Description><Size>Ball Head 12/14 Ø 36 Sizes: S, M, L and XL
Ball Head 12/14 Ø 40 Sizes: S, M, L and XL
Ball Head 12/14 Ø 44 Sizes: S, M, L and XL</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>205465</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA004</BillingCode><Name>Ceramic Modular head</Name><Description>Biolox Delta Ceramic heads  &gt; 32mm</Description><Size>36, 40 and 44mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>285507</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR309</BillingCode><PriorBillingCodes><PriorBillingCode>GO307</PriorBillingCode></PriorBillingCodes><Name>BioBall Delta Femoral Head, &gt;32mm</Name><Description>Femoral Head Biolox Delta Ceramic, &gt;32mm</Description><Size>36mm, 40mm, 44mm, 48mm</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>276307</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI539</BillingCode><Name>Ceramic primary &amp; revision femoral head</Name><Description>Biolox Delta Ceramic</Description><Size>36 - 48mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>215999</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR029</BillingCode><Name>Stryker Large Femoral Head - Delta Ceramic </Name><Description>Delta Ceramic </Description><Size>36mm - 50mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>206181</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH036</BillingCode><Name>Biolox Delta Option Ceramic Femoral Heads</Name><Description>ceramic modular head, biolox delta</Description><Size>36mm to 60mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><ARTGs><ARTG>117715</ARTG></ARTGs><MinimumBenefit>1792</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ819</BillingCode><Name>DePuy Delta TS Heads</Name><Description>Delta ceramic femoral head with titanium sleeve</Description><Size>&gt;32mm, +1 to +12</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><Suffix>Sleeve</Suffix><ARTGs><ARTG>217543</ARTG></ARTGs><MinimumBenefit>2097</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA485</BillingCode><Name>Ceramys Large Ceramic Revision Femoral Head</Name><Description>Ceramic, zirconia alumina combination, large diameters, supplied with titanium taper sleeve</Description><Size>36 L, 36 M, 36 S, 36 XL, 36</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112584</SubGroupID><Suffix>Sleeve</Suffix><ARTGs><ARTG>274113</ARTG></ARTGs><MinimumBenefit>2097</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH620</BillingCode><Name>IC-Head Biolox delta</Name><Description>Biolox delta ceramic head</Description><Size>36mm and 40 mm. S, M, L and XL.</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112585</SubGroupID><ARTGs><ARTG>288475</ARTG></ARTGs><MinimumBenefit>1626</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN812</BillingCode><Name>Femoral Head</Name><Description>12/14, 14/16 Taper, Oxinium</Description><Size>&gt;32mm, -3 - +16mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108611</GroupID><SubGroupID>112585</SubGroupID><ARTGs><ARTG>218140</ARTG><ARTG>218141</ARTG></ARTGs><MinimumBenefit>1626</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN743</BillingCode><Name>Birmingham Hip Resurfacing Prostheses -  Femoral Component</Name><Description>Cobal Chrome</Description><Size>48-62mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108613</GroupID><SubGroupID>112586</SubGroupID><ARTGs><ARTG>274333</ARTG></ARTGs><MinimumBenefit>2812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MJ001</BillingCode><Name>ADEPT MoM Resurfacing Head</Name><Description>Resurfacing Head MoM, Cast CoChr</Description><Size>38-58 going up in 2mm increments</Size><SupplierCode>40173</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108613</GroupID><SubGroupID>112586</SubGroupID><ARTGs><ARTG>192533</ARTG><ARTG>192534</ARTG></ARTGs><MinimumBenefit>2812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU021</BillingCode><Name>Medacta Bipolar Head</Name><Description>Stainless Steel, with UHMWPE insert</Description><Size>Ball head diameter 22.2mm, sizes: from 39 to 52mm.
Ball head diameter 28mm, sizes: from 42 to 60mm.</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108615</GroupID><SubGroupID>112590</SubGroupID><ARTGs><ARTG>217252</ARTG></ARTGs><MinimumBenefit>654</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP188</BillingCode><Name>Self Centering Bipolar Head</Name><Description>Bipolar femoral head, CoCr with UHMWPE insert</Description><Size>39-65mm outer diameter</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108615</GroupID><SubGroupID>112590</SubGroupID><ARTGs><ARTG>235557</ARTG></ARTGs><MinimumBenefit>654</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST566</BillingCode><Name>Osteonics hip prostheses</Name><Description>Bipolar shell and polyethylene insert (factory Assembled)</Description><Size>ID 22, 26, 28, 32mm dia </Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108615</GroupID><SubGroupID>112590</SubGroupID><ARTGs><ARTG>247373</ARTG></ARTGs><MinimumBenefit>654</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN267</BillingCode><Name>Tandem/Convene</Name><Description>Shell/Liner</Description><Size>22 - 64mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108615</GroupID><SubGroupID>112590</SubGroupID><ARTGs><ARTG>242993</ARTG></ARTGs><MinimumBenefit>654</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA025</BillingCode><Name>Mathys Bipolar Femoral Head</Name><Description>Stainless steel with fixed UHMWPE insert</Description><Size>28mm Inner diameter, 42-58mm outer diameter</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108615</GroupID><SubGroupID>112590</SubGroupID><ARTGs><ARTG>212427</ARTG></ARTGs><MinimumBenefit>654</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI286</BillingCode><Name>Multipolar Bipolar</Name><Description>Multipolar Bipolar Shell and Liner</Description><Size>Outer Diameter 38 - 72mm, Inner Diameter 22 or 28mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108615</GroupID><SubGroupID>112590</SubGroupID><ARTGs><ARTG>273918</ARTG><ARTG>273919</ARTG></ARTGs><MinimumBenefit>654</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH622</BillingCode><PriorBillingCodes><PriorBillingCode>OO035</PriorBillingCode></PriorBillingCodes><Name>Bi-polar head</Name><Description>Bipolar head</Description><Size>38mm - 62mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108615</GroupID><SubGroupID>112590</SubGroupID><ARTGs><ARTG>271212</ARTG></ARTGs><MinimumBenefit>654</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO036</BillingCode><Name>LINK Vario bipolar Cup</Name><Description>Shell with unmodified polyethylene plus locking ring</Description><Size>Inner diameter: 28 - 32mm  Outer diameter: 44 - 65mm</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108615</GroupID><SubGroupID>112590</SubGroupID><ARTGs><ARTG>212055</ARTG></ARTGs><MinimumBenefit>654</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC162</BillingCode><Name>Lock Bipolar Head and Liner</Name><Description>Self Centering Head CoCrMo and UHMWPE Liner</Description><Size>Diameter x 28mm x OD 41-57mm</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108615</GroupID><SubGroupID>112591</SubGroupID><ARTGs><ARTG>216354</ARTG></ARTGs><MinimumBenefit>868</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC197</BillingCode><Name>Delta Mobile Liner UHMWPE</Name><Description>The Mobile Liner UHMWPE functions as part of a double mobility system. It is coupled with an outer liner before being fitted onto the head of a femoral stem. The inner liner provides the articulating surface within the outer liner and the coupled liner provides the articulating surface with the acetabular shell after insertion into the acetabular shell/Cup as part of a total hip arthroplasty.</Description><Size>Diameter (mm) 40 - 42 Outer</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108615</GroupID><SubGroupID>112591</SubGroupID><ARTGs><ARTG>294077</ARTG></ARTGs><MinimumBenefit>868</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC198</BillingCode><Name>2M Cups Double Mobility System Mobile Liners (UHMWPE)</Name><Description>The liner functions as part of a double mobility system. The liner articulates with an acetabular cup and femoral head as part of a total hip arthroplasty. The liner has an inner clearance of 0.3 mm with respect to the femoral head. The outer clearance has been increased to 0.6 mm to avoid locking of the outer joint due to the interposition of fibrous tissue. The centre of the inner head is cranialized with respect to the centre of the liner (1,5 mm), to permit the self-centring of the system.</Description><Size>Diameter (mm)
Outer 42 to 58
Diameter (mm)
Inner 22 to 28</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107679</SubCategoryID><GroupID>108615</GroupID><SubGroupID>112591</SubGroupID><ARTGs><ARTG>294065</ARTG></ARTGs><MinimumBenefit>868</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI384</BillingCode><Name>Low Profile Cup - Cups cemented</Name><Description>UHMPE unmodified</Description><Size>22/36 to 32/64</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112592</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>230852</ARTG></ARTGs><MinimumBenefit>629</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU144</BillingCode><Name>APRICOT full PE Cemented Cup</Name><Description>Flat edge full PE cemented cup</Description><Size>002, 028, 032</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112592</SubGroupID><ARTGs><ARTG>230649</ARTG></ARTGs><MinimumBenefit>629</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB236</BillingCode><Name>Polyethylene Acetabular Cup</Name><Description>Unmodified Polyethylene</Description><Size>22.2mm-32mm articulations; 40mm-64mm diameters</Size><SupplierCode>40020</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112592</SubGroupID><ARTGs><ARTG>297032</ARTG></ARTGs><MinimumBenefit>629</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH677</BillingCode><PriorBillingCodes><PriorBillingCode>OO138</PriorBillingCode></PriorBillingCodes><Name>IC Muller PE Cup</Name><Description>PE acetabulum cup with 0 and10 degree lip - cemented</Description><Size>44-62mm, 28-32mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112592</SubGroupID><ARTGs><ARTG>234879</ARTG></ARTGs><MinimumBenefit>629</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO018</BillingCode><Name>LINK IP Acetabular Cup</Name><Description>UHMWPE unmodified</Description><Size>40 - 64mm</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112592</SubGroupID><ARTGs><ARTG>223527</ARTG></ARTGs><MinimumBenefit>629</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GG003</BillingCode><Name>Contile Fin II Acetabular, Mueller Cup 28mm and 32mm</Name><Description>Mueller Cup</Description><Size>28mm Neutral and 10 Degree, 32mm Neutral and 10 Degree</Size><SupplierCode>40371</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112592</SubGroupID><ARTGs><ARTG>284657</ARTG><ARTG>285462</ARTG></ARTGs><MinimumBenefit>629</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC020</BillingCode><Name>Lima Cemented Cup</Name><Description>UHMWPE Cemented Cup Unmodified</Description><Size>28-36mm OD x 44-58mm OD 20*</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112592</SubGroupID><ARTGs><ARTG>213029</ARTG></ARTGs><MinimumBenefit>629</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA027</BillingCode><Name>CCB Cemented UHMWPE Cup</Name><Description>UHMWPE, low &amp; full profile</Description><Size>28/32 ID - 42/64 OD</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112592</SubGroupID><ARTGs><ARTG>211096</ARTG></ARTGs><MinimumBenefit>629</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI027</BillingCode><Name>ZCA Acetabular Cup</Name><Description>UHMPE unmodified</Description><Size>47 - 61</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112592</SubGroupID><ARTGs><ARTG>209894</ARTG><ARTG>212781</ARTG><ARTG>230915</ARTG></ARTGs><MinimumBenefit>629</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW030</BillingCode><Name>Contemporary Hip System Range</Name><Description>Exeter Contemporary Flanged modified  Enhanced Polyethylene </Description><Size>ID: 26, 28, 32.  OD 46, 48, 50, 52, 54, 56, 58, 60</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112593</SubGroupID><Suffix>Flange</Suffix><ARTGs><ARTG>205344</ARTG></ARTGs><MinimumBenefit>425</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ317</BillingCode><Name>RingLoc Bi-Polar Hip System</Name><Description>RingLoc Bi-Polar Acetabular Cup</Description><Size>ID 22mm, 28mm/ OD 41mm-61mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112593</SubGroupID><ARTGs><ARTG>451008</ARTG></ARTGs><ChangeExplanation>New listing</ChangeExplanation><MinimumBenefit>786</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Insert</ActionFlag><CycleStartDate>2024-08-08</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN696</BillingCode><Name>Reflection</Name><Description>Acetabular Cup - XLPE</Description><Size>22-64mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112593</SubGroupID><ARTGs><ARTG>218147</ARTG></ARTGs><MinimumBenefit>786</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ689</BillingCode><Name>MARATHON XLPE Cemented Cup</Name><Description>Cemented cross-linked polyethylene acetabular cup with flange</Description><Size>Inner diameter 22-36mm, outer diameter 38-53mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112593</SubGroupID><ARTGs><ARTG>210127</ARTG></ARTGs><MinimumBenefit>786</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW029</BillingCode><Name>Duration Polyethelene cemented acetabular component</Name><Description>Duration Poly Cup -  Enhanced Polyethylene</Description><Size>26 - 32 mm ID</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112593</SubGroupID><ARTGs><ARTG>205343</ARTG></ARTGs><MinimumBenefit>786</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK460</BillingCode><Name>Exeter Rim Fit Flanged X3 Cup</Name><Description>X3 Highly crosslinked Cup</Description><Size>40-60mm OD, 22.2-40mm ID</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112593</SubGroupID><ARTGs><ARTG>224769</ARTG></ARTGs><MinimumBenefit>786</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI957</BillingCode><Name>Exceed ABT Cemented Cup</Name><Description>Polyethylene - E1 Non-Flanged Cup</Description><Size>46-60 outer diameter</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112593</SubGroupID><ARTGs><ARTG>233757</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Description</ChangeExplanation><MinimumBenefit>786</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI314</BillingCode><Name>ZCA All Poly Acetabular Cup - XLPE</Name><Description>UHMPE modified </Description><Size>22, 26, 28 &amp; 32 mm heads; 47-61mm diameter; flanged and non-flanged</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112593</SubGroupID><ARTGs><ARTG>213175</ARTG></ARTGs><MinimumBenefit>786</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU143</BillingCode><Name>APRICOT full PE HC Cemented Cup</Name><Description>Flat Edge full High-Cross PE cemented Cup</Description><Size>022, 028, 032, 036</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112593</SubGroupID><ARTGs><ARTG>281575</ARTG></ARTGs><MinimumBenefit>786</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH676</BillingCode><Name>IC Muller PE snap lock cup</Name><Description>PE acetabulum cup , constrained</Description><Size>44 – 64mm, 32mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112594</SubGroupID><ARTGs><ARTG>234880</ARTG></ARTGs><MinimumBenefit>699</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK430</BillingCode><Name>Trident Constrained All Poly Acetabular Cup</Name><Description>UHMWPE constrained cemented cup</Description><Size>40-70mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112594</SubGroupID><ARTGs><ARTG>225310</ARTG></ARTGs><MinimumBenefit>699</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO019</BillingCode><Name>Lubinus Eccentric Acetabular Cup</Name><Description>UHMWPE constrained</Description><Size>44 - 68mm</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112594</SubGroupID><ARTGs><ARTG>223209</ARTG><ARTG>223210</ARTG><ARTG>234119</ARTG></ARTGs><MinimumBenefit>699</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI059</BillingCode><Name>Saturne Cemented Tripolar Cup</Name><Description>Stainless steel cemented acetabular cup with an anatomical anti-disloction profile</Description><Size>Sizes 44 - 60 in 2mm increments</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112595</SubGroupID><ARTGs><ARTG>210137</ARTG></ARTGs><MinimumBenefit>1511</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR232</BillingCode><Name>Dual Mobility Cup (MobiliT), Shell Cemented</Name><Description>Acetabular Shell, Cemented stainless steel with groove, internal mirror polished</Description><Size>42mm to 60mm</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112595</SubGroupID><ARTGs><ARTG>383311</ARTG></ARTGs><MinimumBenefit>1511</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH040</BillingCode><Name>Avantage Dual Mobility Cemented Acetabular Cup</Name><Description>Acetabular shell, polished inner surface, Stainless Steel</Description><Size>44mm - 60mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112595</SubGroupID><ARTGs><ARTG>223850</ARTG></ARTGs><MinimumBenefit>1511</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN349</BillingCode><Name>BI-MENTUM Dual Mobility System</Name><Description>Cemented metal acetabular dual mobility cup designed to be used with a polyethylene liner</Description><Size>43-63 mm diameter in 2mm increments</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112595</SubGroupID><ARTGs><ARTG>363211</ARTG></ARTGs><MinimumBenefit>1511</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM133</BillingCode><Name>Polar Cup Cemented Acetabular Shell</Name><Description>Stainless steel, cemented shell that has polished inner surface for dual mobility with constrained UHMWPE liner/head</Description><Size>43-63MM</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112595</SubGroupID><ARTGs><ARTG>231321</ARTG></ARTGs><MinimumBenefit>1511</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UK026</BillingCode><PriorBillingCodes><PriorBillingCode>GO282</PriorBillingCode></PriorBillingCodes><Name>Novae STICK Dual Mobility Cup</Name><Description>A cemented metal acetabular dual mobility cup designed to be used with a polyethylene liner</Description><Size>43-69mm diameter in 2mm increments</Size><SupplierCode>40267</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112595</SubGroupID><ARTGs><ARTG>298114</ARTG></ARTGs><MinimumBenefit>1511</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ222</BillingCode><Name>Versacem Double Mobility cemented cup</Name><Description>Cemented metal acetabular dual mobility cup designed to be used with a polyethylene liner</Description><Size>from 38 to 56 mm diameter in 2mm increments</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108616</GroupID><SubGroupID>112595</SubGroupID><ARTGs><ARTG>208703</ARTG></ARTGs><MinimumBenefit>1511</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI874</BillingCode><Name>Allofit IT Shell</Name><Description>Titanium Shell, Macro texture, Non HA</Description><Size>Shell outer diameter: 42mm-74mm in 2mm increments</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112596</SubGroupID><ARTGs><ARTG>227881</ARTG><ARTG>232428</ARTG></ARTGs><MinimumBenefit>1931</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI353</BillingCode><Name>Allofit Cup</Name><Description>Titanium, macro texture, non HA</Description><Size>46 - 68mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112596</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>210092</ARTG></ARTGs><MinimumBenefit>1931</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL161</BillingCode><Name>Reflection</Name><Description>Acetabular Shell, Beaded, Titanium Alloy</Description><Size>40 to 80mm </Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112597</SubGroupID><ARTGs><ARTG>223522</ARTG><ARTG>223524</ARTG><ARTG>220233</ARTG><ARTG>223823</ARTG><ARTG>247733</ARTG><ARTG>223821</ARTG></ARTGs><MinimumBenefit>1802</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD023</BillingCode><Name>FMP Acetabular Shell</Name><Description>Titanium, non HA, beaded, variable screw holes</Description><Size>42-80mm</Size><SupplierCode>39986</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112597</SubGroupID><ARTGs><ARTG>210540</ARTG><ARTG>210541</ARTG><ARTG>210542</ARTG></ARTGs><MinimumBenefit>1802</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA496</BillingCode><Name>SeleXys Acetabular PC Shell</Name><Description>Uncemented Ti acetabular shell, beaded, non HA</Description><Size>42mm - 72mm in 2mm increments</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112597</SubGroupID><ARTGs><ARTG>274135</ARTG></ARTGs><MinimumBenefit>1802</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SL085</BillingCode><Name>Reflection</Name><Description>Acetabular Cup, Spiked, Beaded, Titanium Alloy</Description><Size>40-68 mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112597</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>218205</ARTG></ARTGs><MinimumBenefit>1802</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY521</BillingCode><Name>Pinnacle Acetabular Shell</Name><Description>Titanium, beaded (Porocoat), not HA, acetabular cups</Description><Size>38 - 80mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112597</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>223026</ARTG><ARTG>221600</ARTG><ARTG>221679</ARTG></ARTGs><MinimumBenefit>1802</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH681</BillingCode><PriorBillingCodes><PriorBillingCode>OO170</PriorBillingCode></PriorBillingCodes><Name>MUTARS RS Cup</Name><Description>Acetabulum reconstruction cup, flange multiple screw holes</Description><Size>46, 50, 54, 58, 62mm
right &amp; left</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112598</SubGroupID><ARTGs><ARTG>238836</ARTG></ARTGs><MinimumBenefit>1897</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI386</BillingCode><Name>Fitmore Cup</Name><Description>Titanium mesh non HA </Description><Size>42 to 68mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112598</SubGroupID><ARTGs><ARTG>223627</ARTG></ARTGs><MinimumBenefit>1897</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF028</BillingCode><Name>Cementless Cup plasma coated</Name><Description>Cementless Cup are availbe with No-Hole and Cluster Hole design options, shells manufactured from titanium (Ti) alloy with plasma coating, sphere and taper inner diameter geometry</Description><Size>Shell: No-Hole shell size 48-68, 2mm increments; Cluster Hole Size 48-68, 2mm increments; Multi-Hole Size 48-56, Multi-Hole with Rim Fixation, Size 56-68</Size><SupplierCode>40413</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112599</SubGroupID><ARTGs><ARTG>266797</ARTG></ARTGs><MinimumBenefit>1856</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM128</BillingCode><Name>POLAR CUP ACETABULAR Cementless Shell</Name><Description>Stainless steel with titanium plasma spray coating that has polished inner surface for dual mobility with constrained UHMWPE liner/head</Description><Size>43-67MM</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112599</SubGroupID><ARTGs><ARTG>260954</ARTG></ARTGs><MinimumBenefit>1856</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB378</BillingCode><Name>Plasmafit Acetabular Cup</Name><Description>Acetabular Shell with Plasmapore Coating</Description><Size>40mm - 70mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112599</SubGroupID><ARTGs><ARTG>297206</ARTG><ARTG>297207</ARTG></ARTGs><MinimumBenefit>1856</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH365</BillingCode><Name>G7 Acetabular Shell</Name><Description>Acetabular Shell, porous plasma, non-HA</Description><Size>42mm to 68mm in 2 mm increments</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112599</SubGroupID><ARTGs><ARTG>231249</ARTG></ARTGs><MinimumBenefit>1856</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC164</BillingCode><Name>Delta TT Acetabular Cup</Name><Description>Delta TT Acetabular Cup Ti6AI4V</Description><Size>44 - 76mm</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112600</SubGroupID><ARTGs><ARTG>210796</ARTG></ARTGs><MinimumBenefit>2812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU140</BillingCode><Name>Mpact Acetabular Shells</Name><Description>Cementless titanium acetabular shell, variable holes</Description><Size>42 to 66</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112600</SubGroupID><ARTGs><ARTG>209485</ARTG></ARTGs><MinimumBenefit>2812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ248</BillingCode><Name>REDAPT Modular Shell</Name><Description>Modular Shell, variable holes</Description><Size>48-80mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112600</SubGroupID><ARTGs><ARTG>325775</ARTG></ARTGs><MinimumBenefit>2812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA012</BillingCode><Name>G7 OsseoTi Acetabular Shell</Name><Description>Acetabular shell, porous Ti alloy</Description><Size>42-80mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112600</SubGroupID><ARTGs><ARTG>287801</ARTG><ARTG>278984</ARTG></ARTGs><MinimumBenefit>2812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW786</BillingCode><Name>Trident II Tritanium Acetabular System</Name><Description>Acetabular Shell, tritanium</Description><Size>Size A-J Diameter (mm) 42-72</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112600</SubGroupID><ARTGs><ARTG>320142</ARTG></ARTGs><MinimumBenefit>2812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI125</BillingCode><Name>Austral Acetabular Shell</Name><Description>Titanium Cup with sintered titanium coating</Description><Size>44 - 68mm</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112600</SubGroupID><ARTGs><ARTG>386911</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>2812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT004</BillingCode><Name>Fixa Ti-Por Cup</Name><Description>Porous Matrix Titanium, Screw Holes with Plugs, Hemispherical Acetabular Cup</Description><Size>42-66mm</Size><SupplierCode>40232</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112600</SubGroupID><ARTGs><ARTG>207934</ARTG></ARTGs><MinimumBenefit>2812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WN009</BillingCode><Name>Jump System Traser Cup</Name><Description>Uncemented Acetabular Cup</Description><Size>44mm to 70mm</Size><SupplierCode>40384</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112600</SubGroupID><ARTGs><ARTG>381044</ARTG></ARTGs><MinimumBenefit>2812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC200</BillingCode><PriorBillingCodes><PriorBillingCode>LC165</PriorBillingCode></PriorBillingCodes><Name>Delta ONE TT cup</Name><Description>Delta One TT Acetabular Cup Ti6AI4V</Description><Size>Diameter (mm) 44 - 66mm</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112600</SubGroupID><ARTGs><ARTG>216036</ARTG></ARTGs><MinimumBenefit>2812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI325</BillingCode><Name>Trabecular Metal Modular Acetabular System</Name><Description>Titanium, porous tantalum </Description><Size>38-80mm diameter; Cluster, Multiholed, No Holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112600</SubGroupID><ARTGs><ARTG>208903</ARTG></ARTGs><MinimumBenefit>2812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW637</BillingCode><Name>RAS Restoration Anatomical Shell</Name><Description>Cementless Tritanium Acetabular Cup. Multihole screw fixation.</Description><Size>54-80 L and R</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112600</SubGroupID><ARTGs><ARTG>285188</ARTG></ARTGs><MinimumBenefit>2812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI617</BillingCode><Name>Continuum Acetabular Shell</Name><Description>Trabecular Metal Acetabular Shell</Description><Size>40-80mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112600</SubGroupID><ARTGs><ARTG>289083</ARTG><ARTG>289084</ARTG></ARTGs><MinimumBenefit>2812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI099</BillingCode><Name>C2 Acetabular Shell</Name><Description>titanium Cup with sintered titanium coating</Description><Size>48 - 68mm</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112600</SubGroupID><ARTGs><ARTG>227893</ARTG></ARTGs><MinimumBenefit>2812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI123</BillingCode><Name>C2 Acetabular Cup</Name><Description>Uncemented Acetabular Cup with Titanium Porous Coating</Description><Size>48mm to 68mm</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112600</SubGroupID><ARTGs><ARTG>379310</ARTG></ARTGs><MinimumBenefit>2812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU141</BillingCode><Name>Mpact Revision Acetabular Shells</Name><Description>Cementless titanium acetabular shell, variable holes</Description><Size>42 to 76</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112600</SubGroupID><ARTGs><ARTG>229108</ARTG></ARTGs><MinimumBenefit>2812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK428</BillingCode><Name>Trident Tritanium Acetabular Shells</Name><Description>Acetabular Shell, tritanium</Description><Size>44mm - 72mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112600</SubGroupID><ARTGs><ARTG>218018</ARTG><ARTG>221598</ARTG></ARTGs><MinimumBenefit>2812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF144</BillingCode><Name>Logical G Shell</Name><Description>titanium Cup with sintered titanium coating</Description><Size>44 - 70mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112600</SubGroupID><ARTGs><ARTG>276894</ARTG></ARTGs><MinimumBenefit>2812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC199</BillingCode><PriorBillingCodes><PriorBillingCode>LC165</PriorBillingCode></PriorBillingCodes><Name>Delta Multihole TT Cup</Name><Description>Delta Multihole TT Acetabular Cup (Ti6AI4V)</Description><Size>Diameter (mm) 44 to 76</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112600</SubGroupID><ARTGs><ARTG>292687</ARTG></ARTGs><MinimumBenefit>2812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ653</BillingCode><Name>Pinnacle Hip System - Gription Cup</Name><Description>Porous metal acetabular cup</Description><Size>38 - 80mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108617</GroupID><SubGroupID>112600</SubGroupID><ARTGs><ARTG>224540</ARTG><ARTG>222606</ARTG><ARTG>224199</ARTG><ARTG>236733</ARTG></ARTGs><MinimumBenefit>2812</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST548</BillingCode><Name>Trident acetabular component system </Name><Description>Titanium, arc deposited,  with HA</Description><Size>40-82mm OD</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112601</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>145591</ARTG><ARTG>145592</ARTG><ARTG>145590</ARTG><ARTG>152442</ARTG><ARTG>152396</ARTG></ARTGs><MinimumBenefit>2191</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK092</BillingCode><Name>Stryker Hydroxyapatite coated cup with ceramic liner</Name><Description>Shell with Biolox forte ceramic liner</Description><Size>52-54mm OD</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112601</SubGroupID><Suffix>Shell &amp; Insert</Suffix><ARTGs><ARTG>205394</ARTG></ARTGs><MinimumBenefit>2760</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO032</BillingCode><Name>Link acetabular cup system</Name><Description>Titanium, grit blast, HA</Description><Size>40 - 68mm  Small, medium, large</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112601</SubGroupID><ARTGs><ARTG>212232</ARTG><ARTG>212117</ARTG></ARTGs><MinimumBenefit>2191</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW015</BillingCode><Name>ABG 11Cup with Hydroxyapatite</Name><Description>Titanium, grit blast and HA for ceramic insert</Description><Size>Sizes 44mm to 66mm OD in 2mm increments</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112601</SubGroupID><ARTGs><ARTG>205384</ARTG></ARTGs><MinimumBenefit>2191</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF010</BillingCode><Name>Atlas Acetabular Cup System</Name><Description>Titanium, grit blast &amp; HA</Description><Size>Atlas Cup 40-74mm</Size><SupplierCode>40106</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112601</SubGroupID><ARTGs><ARTG>141168</ARTG></ARTGs><MinimumBenefit>2191</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV033</BillingCode><Name>Procotyl L  Acetabular Cup</Name><Description>Beaded, Titanium HA coated cup</Description><Size>42 - 68mm
A-G</Size><SupplierCode>40177</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112602</SubGroupID><ARTGs><ARTG>285236</ARTG></ARTGs><MinimumBenefit>2398</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN286</BillingCode><Name>Reflection</Name><Description>Acetabular Cup HA Coated Titanium Alloy, beaded</Description><Size>40-80mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112602</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>223523</ARTG><ARTG>212782</ARTG></ARTGs><MinimumBenefit>2398</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY520</BillingCode><Name>Pinnacle Acetabular Shell</Name><Description>Titanium. Beaded with HA (Duofix) acetabular cup</Description><Size>48 - 66 mm  </Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112602</SubGroupID><ARTGs><ARTG>221677</ARTG><ARTG>221678</ARTG></ARTGs><MinimumBenefit>2398</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI035</BillingCode><Name>Trilogy Acetabular Cup</Name><Description>Titanium mesh (fibre metal) with HA for UHMPE insert</Description><Size>36 - 80</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112603</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>213174</ARTG><ARTG>267446</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>2210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WN002</BillingCode><PriorBillingCodes><PriorBillingCode>RL007</PriorBillingCode></PriorBillingCodes><Name>Permedica JUMP System Acetabular Cup HaX-Pore - Acetabular Shell</Name><Description>This acetabular component is for un-cemented applications and is coated with a titanium plasma spray and hydroxyapatite coating.  Anchorage of the device to the bone is by press-fit insertion which can be augmented with cancellous bone screws and the screw holes can be sealed with special plugs.  The acetabular shell is a hemispherical shape with polar deflection and is used in combination with an articular liner, a femoral ball head and a femoral stem.</Description><Size>44mm - 70mm in 2mm increments</Size><SupplierCode>40384</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112604</SubGroupID><ARTGs><ARTG>234000</ARTG></ARTGs><MinimumBenefit>2079</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TG022</BillingCode><Name>JRI CSF Plus Cup</Name><Description>Titanium, plasma, HA for modified poly insert</Description><Size>44mm - 70mm O/D</Size><SupplierCode>40373</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112604</SubGroupID><ARTGs><ARTG>302542</ARTG></ARTGs><MinimumBenefit>2079</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH436</BillingCode><Name>Samo Acetabular Cup</Name><Description>Acetabular cup</Description><Size>40 - 70</Size><SupplierCode>40113</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112604</SubGroupID><ARTGs><ARTG>165470</ARTG></ARTGs><MinimumBenefit>2079</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI061</BillingCode><Name>Saturne Press Fit Dual Mobility Acetabular Cup</Name><Description>A cementless, stippled and peripherally expanded, acetabular cup.  Flattened pole and an elevated rim to help prevent dislocation.</Description><Size>Sizes: 44 - 64 in 2mm increments</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112604</SubGroupID><ARTGs><ARTG>216969</ARTG></ARTGs><MinimumBenefit>2079</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM024</BillingCode><Name>EP Fit Acetabular Shell</Name><Description>Titanium, plasma spray,  and HA, with variable number of holes for UHMWPE,ceramic &amp; metal inserts</Description><Size>40 - 68mm Dia</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112604</SubGroupID><ARTGs><ARTG>223820</ARTG></ARTGs><MinimumBenefit>2079</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU022</BillingCode><Name>Versafitcup Dual Mobility Acetabular Shell</Name><Description>Stainless steel, with titanium plasma coating and HA, and polished inner surface for dual articulation</Description><Size>from diameter 46mm to 64mm in 2mm increments</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112604</SubGroupID><ARTGs><ARTG>208323</ARTG></ARTGs><MinimumBenefit>2079</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TG027</BillingCode><Name>JRI CSF Plus Cup</Name><Description>Titanium, plasma, HA for ceramic insert</Description><Size>44mm - 70mm O/D</Size><SupplierCode>40373</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112604</SubGroupID><ARTGs><ARTG>302741</ARTG></ARTGs><MinimumBenefit>2079</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UK028</BillingCode><PriorBillingCodes><PriorBillingCode>GO233</PriorBillingCode></PriorBillingCodes><Name>Novae Dual Mobility Cup</Name><Description>A cementless metal acetabular dual mobility cup designed to be used with a polyethylene liner.</Description><Size>41mm to 73mm diameter in 2mm increments</Size><SupplierCode>40267</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112604</SubGroupID><ARTGs><ARTG>296620</ARTG><ARTG>296615</ARTG><ARTG>296616</ARTG></ARTGs><MinimumBenefit>2079</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR242</BillingCode><Name>Dual Mobility Cup, shell uncemented</Name><Description>Acetabular shell titanium Plasma spray + HA, flanges and/or hook.</Description><Size>42 to 68mm</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112604</SubGroupID><Suffix>Flange</Suffix><ARTGs><ARTG>210208</ARTG><ARTG>210209</ARTG><ARTG>210210</ARTG></ARTGs><MinimumBenefit>2600</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM131</BillingCode><Name>POLAR CUP ACETABULAR Cementless Shell</Name><Description>Stainless steel with titanium plasma spray coating and HA and pegs &amp; flanges, that has polished inner surface for dual mobility with constrained UHMWPE liner/head</Description><Size>43-67MM</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112604</SubGroupID><Suffix>Flange</Suffix><ARTGs><ARTG>148672</ARTG></ARTGs><MinimumBenefit>2600</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC167</BillingCode><Name>Met Acetabular Cup</Name><Description>Met Acetabular Cup CoCrMo + Poro + HA</Description><Size>42 - 64mm OD x 38 - 58mm ID</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112604</SubGroupID><ARTGs><ARTG>222644</ARTG></ARTGs><MinimumBenefit>2079</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU008</BillingCode><Name>Versafitcup Acetabular Shell</Name><Description>Titanium, plasma spray, with HA, variable holes</Description><Size>40 to 64</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112604</SubGroupID><ARTGs><ARTG>209003</ARTG><ARTG>215938</ARTG><ARTG>215939</ARTG></ARTGs><MinimumBenefit>2079</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB243</BillingCode><Name>Plasmacup</Name><Description>Titanium, plasma, HA</Description><Size>44mm-68mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112604</SubGroupID><ARTGs><ARTG>297211</ARTG></ARTGs><MinimumBenefit>2079</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK500</BillingCode><Name>Restoration ADM Cup (Anatomic Dual Mobility) Cup</Name><Description>Chobalt-Chome; HA Coated; Anatomic Dual Mobility Cup</Description><Size>48-64mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112604</SubGroupID><ARTGs><ARTG>205438</ARTG></ARTGs><MinimumBenefit>2079</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR165</BillingCode><Name>Trinity Acetabular Cup</Name><Description>Tri-liner hemispherical shell. Titanium (Ti6A14V) material with Titanium and HA coated plasma spray</Description><Size>44 - 68 mm in 2mm increments</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112604</SubGroupID><ARTGs><ARTG>106747</ARTG></ARTGs><MinimumBenefit>2079</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI987</BillingCode><Name>G7 Acetabular Shell</Name><Description>Acetabular Shell, porous plasma, HA</Description><Size>42-68mm in 2mm increments</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112604</SubGroupID><ARTGs><ARTG>231250</ARTG></ARTGs><MinimumBenefit>2079</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC166</BillingCode><Name>Delta PF Acetabular Cup</Name><Description>Delta PF Acetabular Cup Ti6AI4V + Poro + HA</Description><Size>44 - 76mm</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112604</SubGroupID><ARTGs><ARTG>210795</ARTG></ARTGs><MinimumBenefit>2079</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GG001</BillingCode><Name>Fin II Acetabular Shell</Name><Description>titanium, Plasma sprayed, HA, with variable screw options</Description><Size>44 to 72mm</Size><SupplierCode>40371</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112604</SubGroupID><ARTGs><ARTG>279500</ARTG></ARTGs><MinimumBenefit>2079</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF038</BillingCode><Name>Logical ™ Acetabular Shell</Name><Description>Titanium, plasma spray, HA with variable number of holes</Description><Size>42-72mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112604</SubGroupID><ARTGs><ARTG>266797</ARTG></ARTGs><MinimumBenefit>2079</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN347</BillingCode><Name>BI-MENTUM Dual Mobility System</Name><Description>Press-Fit cementless metal acetabular dual mobility cup, designed to be used with a polyethylene liner.</Description><Size>43mm to 69mm diameter in 2mm increments</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108618</GroupID><SubGroupID>112604</SubGroupID><ARTGs><ARTG>363113</ARTG></ARTGs><MinimumBenefit>2079</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB237</BillingCode><Name>Plasmacup PE insert</Name><Description>UMHPE unmodified liner</Description><Size>44mm-68mm diameters, 22.2mm-32mm articulations</Size><SupplierCode>40020</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112606</SubGroupID><ARTGs><ARTG>296146</ARTG></ARTGs><MinimumBenefit>688</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF011</BillingCode><Name>Atlas Acetabular Cup System</Name><Description>liner polyethylene liner, Titanium &amp; HA</Description><Size>Atlas Poly Insert Std. Dia 28 and 32mm</Size><SupplierCode>40106</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112606</SubGroupID><ARTGs><ARTG>141168</ARTG></ARTGs><MinimumBenefit>688</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR228</BillingCode><Name>Dual Mobility Cup, Liner</Name><Description>Acetabular Liner UHMWPE</Description><Size>Head 22.2mm or 28mm, Diameter 42 mm to 68mm</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112606</SubGroupID><ARTGs><ARTG>312410</ARTG><ARTG>383312</ARTG></ARTGs><MinimumBenefit>688</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA419</BillingCode><Name>SeleXys Acetabular UHMWPE Liner</Name><Description>UHMWPE</Description><Size>44mm-72mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112606</SubGroupID><ARTGs><ARTG>274137</ARTG></ARTGs><MinimumBenefit>688</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST561</BillingCode><Name>Strker Omnifit/SecurFit Acetabular Insert</Name><Description>Series I and II inserts, UHMPE</Description><Size>22 - 36mm ID for cups 40 - 80mm OD</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112606</SubGroupID><ARTGs><ARTG>225228</ARTG></ARTGs><MinimumBenefit>688</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH435</BillingCode><Name>Samo acetabular cup poly insert</Name><Description>X linked poly insert</Description><Size>22 - 36</Size><SupplierCode>40113</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112606</SubGroupID><ARTGs><ARTG>165470</ARTG></ARTGs><MinimumBenefit>688</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF187</BillingCode><Name>SignaSure Dual Mobility Poly</Name><Description>The SignaSure DM Poly is the mobile polyethylene UHMWPE liner  used with SignaSure Cemented/Cementless Cups as well as the other cementless shells (i.e., Logical G-Series) when used in conjunction with the SignaSure Dual Mobility Metal Inserts.  </Description><Size>Available in size range of 37 – 41 mm (outer diameter) for use with 22 mm Femoral Heads and 39 – 59 mm (outer diameter) for use with 28 mm Femoral Heads</Size><SupplierCode>40413</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112606</SubGroupID><ARTGs><ARTG>277875</ARTG></ARTGs><MinimumBenefit>688</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU010</BillingCode><Name>Medacta UHMWPE Liner</Name><Description>UHMWPE</Description><Size>Internal diameter 22,28,32 mm, hooded &amp; neutral, hooded &amp; neutral</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112606</SubGroupID><ARTGs><ARTG>211169</ARTG><ARTG>132458</ARTG></ARTGs><MinimumBenefit>688</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO033</BillingCode><Name>Link acetabular Insert</Name><Description>UHMWPE Insert, Cross-linked</Description><Size>28mm - 36mm  Small, medium, large</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112606</SubGroupID><ARTGs><ARTG>212120</ARTG></ARTGs><MinimumBenefit>688</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO152</BillingCode><Name>BetaCup Cementless Acetabular Cup System</Name><Description>UHMWPE Insert</Description><Size>26mm&gt;</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112606</SubGroupID><ARTGs><ARTG>140650</ARTG></ARTGs><MinimumBenefit>688</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN291</BillingCode><Name>Reflection/ Reflection3 (R3)</Name><Description>Acetabular Liner XLPE modified UHMPE</Description><Size>22 - 44mm inner diameter, 42 - 80mm outer diameter</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>230903</ARTG><ARTG>218151</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY210</BillingCode><Name>Pinnacle Acetabular Cross Linked UHMWPE Insert</Name><Description>UHMWPE, highly cross linked insert</Description><Size>22-48mm ID</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>225791</ARTG><ARTG>232174</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC171</BillingCode><Name>SPH Constrained Poly Liner</Name><Description>SPH Constrained Poly Liner UHMWPE protruded 20*</Description><Size>Protruded Liners
ID 28mm X Size XXA, A, B, C, D, E
ID 32mm x Size B, C, D, E

Neutral Liners
ID 28mm X Size XXA, A, B, C, D, E
ID 32mm x Size B, C, D, E</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>222629</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF039</BillingCode><Name>Logical™ Acetabular Liner</Name><Description>HCLA (highly Cross-Linked and Annealed) Acetabular Insert</Description><Size>28mm, 32mm, 36mm, 40mm diameter; Neutral, 10 and 20 degree; Size range 44mm to 72mm, including laterialised liners</Size><SupplierCode>40413</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>277875</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV026</BillingCode><Name>Procotyl L System /poly liner</Name><Description>Rim-Lock
A-Class Crosslinked Liners
Standard, Lipped</Description><Size>28-36mm
B-G</Size><SupplierCode>40177</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>265521</ARTG><ARTG>265522</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN348</BillingCode><Name>BI-MENTUM Dual Mobility System</Name><Description>Polyethylene liner </Description><Size>22.2mm heads: 41 - 69mm diameter in 2mm increments,   28mm heads: 47 - 69mm diameter in 2mm increments</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>363212</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GG008</BillingCode><Name>FIN XLPE Liner</Name><Description>A cup liner made from Cross-linked UHMWPE (Ultra High Molecular Weight Polyethylene) for use in hip prostheses systems.</Description><Size>Inner 28mm-5°, DIA 44/46
Inner 32mm-5°, DIA 48/50
Inner 32mm-5°, DIA 52/54
Inner 32mm-5°, DIA 56/58 
Inner 36mm-5°, DIA 52/54
Inner 36mm-5°, DIA 56/58
Inner 36mm-5°, DIA 60/72 
Inner 40mm-5°, DIA 60/72 
Inner 28mm-0°, DIA 44/46 
Inner 32mm-0°, DIA 48/50
Inner 32mm-0°, DIA 52/54 
Inner 32mm-0°, DIA 56/58
Inner 36mm-0°, DIA 52/54
Inner 36mm-0°, DIA 56/58
Inner 36mm-0°, DIA 60/72
Inner 40mm-0°, DIA 60/72</Size><SupplierCode>40371</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>308933</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TG025</BillingCode><Name>JRI CSF Plus Cup Insert </Name><Description>UHMWPE modified </Description><Size>10 degree liners 28mm, 32mm, 36mm</Size><SupplierCode>40373</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>132477</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC170</BillingCode><Name>Delta Non Constrained Liner</Name><Description>Delta Non Constrained Liner UHMWPE X Lima Ti6AI4V Neutral and Protruded</Description><Size>Diameter (mm) 28 to 40  Size Small to Extra Large  Shape Neutral  Shape Protruded</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>218819</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF027</BillingCode><Name>Cross Linked Acetabular Liner</Name><Description>Highly Cross linked Acetabular Liner</Description><Size>Liner Neutral: Group 1: 28mm ID, Group 2: 28mm IS, 32mm ID, Group 3: 32mm ID, 36mm ID; Group 4: 32mm, 36mm, Group 5: 32mm, 36mm, Liner "Lipped": Group 1: 28mm, Group2: 28mm, 32mm, Group 3: 36mm, Group 4: 32mm, 36mm, Group 5: 36mm, Liner "+5 Lateralised" G</Size><SupplierCode>40413</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>277875</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT005</BillingCode><PriorBillingCodes><PriorBillingCode>TZ007</PriorBillingCode></PriorBillingCodes><Name>Adler PE Acetabular Liners</Name><Description>XLPE Liners - for Fixa Cups</Description><Size>Neutral, 15 degree, in 22,28,32,36mm ID,   </Size><SupplierCode>40232</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>208840</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WN003</BillingCode><PriorBillingCodes><PriorBillingCode>RL008</PriorBillingCode></PriorBillingCodes><Name>Vital-XE Acetabular Liner</Name><Description>Crosslinked UHWMPE with Vitamin E</Description><Size>28mm, 32mm, 36mm, 40mm,   Angles 0, 10, 20 degrees.</Size><SupplierCode>40384</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>382990</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DD044</BillingCode><Name>FMP Acetabular System - Acetabular Cup Insert UHMWPE</Name><Description>Acetabular cup inserts, UHMWPE compression moulded and cross-linked.  28-44mm Internal Diameters available in 0-degree (neutral), 10-degree hooded and 20-degree hooded options and +5mm offset options</Description><Size>ID of 28mm - 44mm to suit Acetabular shells of OD 40mm-80mm
0,10,20-degree hooded and non-hooded.
+5mm Offset</Size><SupplierCode>39986</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>209548</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU019</BillingCode><Name>Medacta Highly Crosslinked UHMWPE Liner</Name><Description>Highly Crosslinked UHMWPE</Description><Size>Internal diameter 22, 28,32,36, 40 mm neutral &amp; hooded, 4mm offset, face changing 10 degrees</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>209250</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ314</BillingCode><Name>G7 Vivacit E Liners</Name><Description>Highly cross linked PE liner with Vit E</Description><Size>28 mm to 44 mm in 4mm increments</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>430900</ARTG></ARTGs><ChangeExplanation>New listing</ChangeExplanation><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Insert</ActionFlag><CycleStartDate>2024-08-08</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM029</BillingCode><Name>EP Fit &amp; MPF Highly cross linked UHMWPE Insert</Name><Description>Modified UHMWPE</Description><Size>40-68mm Dia, all head sizes</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>222566</ARTG><ARTG>222567</ARTG><ARTG>342565</ARTG><ARTG>342564</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI126</BillingCode><Name>Austral XL Polyethylene Liner</Name><Description>XL Polyethylene Liner</Description><Size>Neutral and Hooded  44/28mm - 52/28mm; 48/32mm - 64/32mm; 52/36mm - 68/36mm</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>386912</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH697</BillingCode><PriorBillingCodes><PriorBillingCode>OO149</PriorBillingCode></PriorBillingCodes><Name>Implacross PE liner</Name><Description>PE Liner for LUMiC acetabula reconstruction system</Description><Size>0,15 and 15 with 4mm offset. 39 - 52 external diameter</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>277989</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI097</BillingCode><Name>C2 XL2 Polyethylene Liner</Name><Description>XL2 Polyethylene Liner</Description><Size>32-48mm, 32-50mm, 32-52mm, 32-54mm, 32-56mm, 32-58mm, 32-60mm, 32-62mm, 32-64mm, 32-66mm, 36-68mm, 36-52mm, 36-54mm, 36-56mm, 36-58mm, 36-60mm, 36-62mm, 36-64mm, 36-66mm, 36-68mm.</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>229459</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI124</BillingCode><Name>C2 Cross-Linked PE Liner</Name><Description>Neutral and Hooded Cross-Linked PE Liner</Description><Size>ID 32mm and 36mm  Sizes 48mm to 68mm (Neutral and Hooded)</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>379311</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB377</BillingCode><Name>Vitelene PE Cup Insert</Name><Description>Highly cross-linked polyethylene liner stabilised with vitamin E</Description><Size>22.2mm - 40mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>297205</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI972</BillingCode><Name>E-Poly HXLPE Liner</Name><Description>Highly cross linked PE liner, stabilised with Vit E</Description><Size>28mm to 44mm in 4mm increments</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>98098</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI969</BillingCode><Name>Vivacit-E  Highly Crossed Linked Polyethylene Liner</Name><Description>Highly Crossed Linked Polyethylene Liner</Description><Size>22-40mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>273105</ARTG><ARTG>273104</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR216</BillingCode><Name>Trinity ECiMA Liner</Name><Description>Cross linked polyethylene with vitamin E</Description><Size>Size 1-5, 28mm, 32mm, 36mm, 40mm</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>210774</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR267</BillingCode><Name>Dual Mobility Cup (MobiliT), Liner</Name><Description>Acetabular Liner ECiMa</Description><Size>Head 22.2mm or 28mm, Diameter 42 mm to 68mm</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>383768</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA006</BillingCode><Name>Xonit X-PE Acetabular Liner</Name><Description>Highly Cross-Linked Acetabular Insert</Description><Size>Standard/Dysplasia:
39-52mm/28mm
39-52mm/32mm
44-52mm/36mm
48-52mm/40mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>285483</ARTG><ARTG>285959</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST549</BillingCode><Name>Trident acetabular component system</Name><Description>Trident polyethlene liner, enhanced polyethlene</Description><Size>22, 26, 28, 32mm dia</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>219397</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI357</BillingCode><Name>Alpha Durasul Insert</Name><Description>UHMPE modified </Description><Size>22mm x 42 to 28mm x 68</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>230651</ARTG><ARTG>226717</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA067</BillingCode><PriorBillingCodes><PriorBillingCode>ZI045</PriorBillingCode><PriorBillingCode>ZI046</PriorBillingCode><PriorBillingCode>ZI047</PriorBillingCode><PriorBillingCode>ZI048</PriorBillingCode></PriorBillingCodes><Name>Longevity XLPE Acetabular liner</Name><Description>XLPE Acetabular liner</Description><Size>35-80mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><Suffix>SCP</Suffix><ARTGs><ARTG>240575</ARTG><ARTG>284918</ARTG><ARTG>231596</ARTG><ARTG>230853</ARTG><ARTG>226197</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST546</BillingCode><Name>Stryker Acetabular Crossfire Insert</Name><Description>Modified UHMPE</Description><Size>22 -36mm  ID</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>290924</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR163</BillingCode><Name>Trinity polyethylene liner</Name><Description>Highly cross linked Polyethylene liner in neutral +4mm offset +4mm oblique and 4mm elevated wall variants for use with the Trinity acetabular multi-bearing shell</Description><Size>28mm, 32mm, 36mm, 40mm</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>106747</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA503</BillingCode><Name>Selexys Acetabular Cup Liner</Name><Description>Insert / Liner, modified polyethylene.  Highly crossed link polyethylene, stabilised with Vit E.</Description><Size>Articulation 28, 32, 36mm; Cup size AA to LL (42 to 70mm)</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>274134</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST931</BillingCode><Name>Stryker Acetabular Insert</Name><Description>Enhanced Polyethylene insert</Description><Size>22 - 36mm ID</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>205393</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK318</BillingCode><Name>X3 Trident Acetabular Inserts</Name><Description>Modified UHMPE</Description><Size>Inner diameters: 22mm, 26mm, 28mm 32mm, 36mm, 38 - 64mm.  For outer diameter shells 40mm - 80mm.</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>220404</ARTG><ARTG>230931</ARTG><ARTG>219398</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI620</BillingCode><Name>Continuum Acetabular System</Name><Description>HXPE Liner (Highly Cross Linked) - Neutral, Elevated, Offset and Oblique</Description><Size>28mm Neutral - EE to QU; 32mm Neutral GG to VV; 36mm Neutral II to W; 40mm Neutral KK to VV; 22mm Elevated - CC to FF; 28mm Elevated EE to QU; 32mm Elevated GG to VV; 36mm Elevated II to VV; 28mm 7 mm Offset CC28 to QU28; 32mm 7mm Offset EE32 to QU32; 36m</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112607</SubGroupID><ARTGs><ARTG>231319</ARTG><ARTG>231010</ARTG><ARTG>231320</ARTG></ARTGs><MinimumBenefit>930</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF009</BillingCode><Name>Atlas Acetabular Cup System</Name><Description>liner - ceramic and poly 'Titanium &amp; HA</Description><Size>Atlas Alumina Insert Dia 28mmort</Size><SupplierCode>40106</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112608</SubGroupID><Suffix>Sandwich</Suffix><ARTGs><ARTG>141168</ARTG></ARTGs><MinimumBenefit>1636</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO151</BillingCode><Name>Link Acetabular Cup System</Name><Description>Ceramic Insert</Description><Size>32mm -40mm  Small, medium, large</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112608</SubGroupID><ARTGs><ARTG>212119</ARTG></ARTGs><MinimumBenefit>1636</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TG011</BillingCode><Name>JRI CSF Plus Cup ceramic Insert</Name><Description>CSF Plus Cup Liner, Delta Liner </Description><Size>28mm, 32mm, 36mm, 40mm</Size><SupplierCode>40373</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112608</SubGroupID><ARTGs><ARTG>302539</ARTG></ARTGs><MinimumBenefit>1636</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH688</BillingCode><PriorBillingCodes><PriorBillingCode>OO139</PriorBillingCode></PriorBillingCodes><Name>Implantcast delta ceramic liner</Name><Description>Biolox delta cup liner</Description><Size>32/39, 32/44,36/44, 32/48,36/48,32/52, 36/52, 40/48, 40/52</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112608</SubGroupID><ARTGs><ARTG>233781</ARTG></ARTGs><MinimumBenefit>1636</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI076</BillingCode><Name>Horizon II Delta Ceramic Insert</Name><Description>Ceramic Insert, Biolox Delta</Description><Size>9 sizes for 28, 32 and 36mm heads</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112608</SubGroupID><ARTGs><ARTG>223258</ARTG></ARTGs><MinimumBenefit>1636</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH437</BillingCode><Name>Samo acetabular cup ceramic insert</Name><Description>Ceramic insert</Description><Size>28 - 40</Size><SupplierCode>40113</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112608</SubGroupID><ARTGs><ARTG>165470</ARTG></ARTGs><MinimumBenefit>1636</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT006</BillingCode><PriorBillingCodes><PriorBillingCode>TZ008</PriorBillingCode></PriorBillingCodes><Name>Adler Ceramic Acetabular Liners</Name><Description>Ceramic Liners - for Fixa Cups</Description><Size>Delta, 28,32,36 &amp; 40 mm ID</Size><SupplierCode>40232</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112608</SubGroupID><ARTGs><ARTG>206130</ARTG></ARTGs><MinimumBenefit>1636</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI073</BillingCode><Name>Modular Ceramic System</Name><Description>Acetabular Ceramic/ Polyethylene Liner, UHMWPE</Description><Size>28mm to 44mm in 4mm increments</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112608</SubGroupID><ARTGs><ARTG>98098</ARTG></ARTGs><MinimumBenefit>1636</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST565</BillingCode><Name>Alumina acetabular inserts</Name><Description>Ceramic insert, alumina</Description><Size>28, 32 &amp; 36mm dia</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112608</SubGroupID><ARTGs><ARTG>217830</ARTG></ARTGs><MinimumBenefit>1636</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH682</BillingCode><PriorBillingCodes><PriorBillingCode>OO171</PriorBillingCode></PriorBillingCodes><Name>ACCIS Insert (15 degrees)</Name><Description>ACCIS liner (15 degrees) for use with MUTARS RS and LUMIC Cup</Description><Size>38/39, 42/44, 46/48, 50/52mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112609</SubGroupID><Suffix>Revision/Tumour</Suffix><ARTGs><ARTG>281539</ARTG></ARTGs><MinimumBenefit>2140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR164</BillingCode><Name>Trinity Metal Liner</Name><Description>Metal liner for use with the Trinity acetabular shell</Description><Size>35mm,40mm,42.5mm, 45mm</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112609</SubGroupID><ARTGs><ARTG>312411</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC012</BillingCode><Name>Lima Cup </Name><Description>Metal Liner</Description><Size>28mm, 32mm and 36mm</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112609</SubGroupID><ARTGs><ARTG>216035</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF186</BillingCode><Name>SignaSure Dual Mobility Insert</Name><Description>SignaSure Dual Mobility CoCr Metal Insert is used with Logical-G  Series Shell and SignaSure Poly Cup to create a modular Dual Mobility Acetabular Assembly for use with Metal or Ceramic Femoral heads for use during for Total Hip Replacement.    </Description><Size>A - 34 /for Logical Shell 44-46mm  B - 38 /for Logical Shell 48-50mm  C - 41 /for Logical Shell 52-54mm  D - 45 /for Logical Shell 56-58mm  E - 48 /for Logical Shell 60-70mm  </Size><SupplierCode>40413</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112609</SubGroupID><ARTGs><ARTG>277875</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW485</BillingCode><Name>MDM CoCr Liner</Name><Description>Modular Dual Mobility (MDM) CoCr Liner</Description><Size>The MDM CoCr Liner comes in a range of inner diameters of 36mm - 58mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112609</SubGroupID><ARTGs><ARTG>217674</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA077</BillingCode><Name>G7 Dual Mobility CoCr Liner</Name><Description>CoCr Liner</Description><Size>32-60mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112609</SubGroupID><ARTGs><ARTG>285123</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UK029</BillingCode><PriorBillingCodes><PriorBillingCode>GO234</PriorBillingCode></PriorBillingCodes><Name>Novae Double Mobility Cup Insert</Name><Description>A cementless metal acetabular dual mobility cup designed to be used with a polyethylene liner.</Description><Size>22mm x 43 - 69mm diameter in 2mm increments  28mm x 47 - 69mm diameter in 2mm increments</Size><SupplierCode>40267</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112609</SubGroupID><ARTGs><ARTG>282775</ARTG></ARTGs><MinimumBenefit>1762</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI045</BillingCode><Name>Saturne acetabular liner</Name><Description>Polyethylene liner for double mobility cup</Description><Size>42/22- 66/22 (13 sizes)  48/28- 66/28 (10 sizes)</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112610</SubGroupID><ARTGs><ARTG>217778</ARTG></ARTGs><MinimumBenefit>1540</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU024</BillingCode><Name>Versafitcup UHMWPE  Constrained Liner</Name><Description>UHMWPE Constrained Liner for Versafitcup Dual Mobility Acetabular Shell</Description><Size>For head diameter 22mm sizes 42 - 64mm. For head diameter 28mm sizes 48 - 64mm.</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112610</SubGroupID><ARTGs><ARTG>208308</ARTG></ARTGs><MinimumBenefit>1540</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM135</BillingCode><Name>POLAR Dual Mobility Constrained Highly Cross Linked Liner</Name><Description>Modified UHMWPE</Description><Size>FOR '22.2-28MM Head sizes and 43-72MM diameter shells</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112610</SubGroupID><ARTGs><ARTG>231322</ARTG></ARTGs><MinimumBenefit>1540</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU098</BillingCode><Name>Versafitcup HX UHMWPE Constrained Liner</Name><Description>HighCross UHMWPE Constrained Liner for Versafitcup Dual Mobility Acetabular Shell</Description><Size>From Ø 42 to Ø 64mm for head Ø 22mm. From Ø 48 to Ø 64mm for head Ø 28mm.</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112610</SubGroupID><ARTGs><ARTG>208705</ARTG></ARTGs><MinimumBenefit>1540</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN689</BillingCode><Name>Reflection</Name><Description>Constrained Acetabular Liner unmodified UHMWPE</Description><Size>22 - 32mm, 42 - 76mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112610</SubGroupID><ARTGs><ARTG>218152</ARTG></ARTGs><MinimumBenefit>1540</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF037</BillingCode><Name>Logical™ Constrained Acetabular Liner</Name><Description>highly cross linked and annealed constrained liner</Description><Size>28mm, 32mm  36mm Diameter Neutral, 10 degree and 20 degree size range 44mm to 72mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112610</SubGroupID><ARTGs><ARTG>297186</ARTG></ARTGs><MinimumBenefit>1540</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN856</BillingCode><Name>R3 Acetabular System</Name><Description>XLPE Constrained Acetabular liner</Description><Size>40-78mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112610</SubGroupID><ARTGs><ARTG>260953</ARTG></ARTGs><MinimumBenefit>1540</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI561</BillingCode><Name>Trabecular Metal Acetabular Revision System</Name><Description>Cemented Constrained Liner</Description><Size>50x28mm; 52x28mm; 54x32mm; 56x32mm; 58x36mm; 60x36mm; 66/68/70x36mm; 72/74x36mm; 76/78/80x36mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112610</SubGroupID><ARTGs><ARTG>231529</ARTG></ARTGs><MinimumBenefit>1540</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI092</BillingCode><Name>Mallory Head Hip System</Name><Description>Acetabular Liner,  Constrained, Ringloc, UHMWPE</Description><Size>28-38mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112610</SubGroupID><ARTGs><ARTG>98097</ARTG></ARTGs><MinimumBenefit>1540</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI878</BillingCode><Name>Freedom Constrained Liner</Name><Description>Constrained Acetabular Liner - UHMWPE, Ti</Description><Size>23mm to 62mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112610</SubGroupID><ARTGs><ARTG>231253</ARTG><ARTG>223315</ARTG><ARTG>225460</ARTG></ARTGs><MinimumBenefit>1540</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH041</BillingCode><Name>Avantage Dual Mobility Acetabular Cup Inlay</Name><Description>UHMWPE Dual Mobility Liner</Description><Size>OD: 44 – 66mm and ID: 22.25mm and 28mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112610</SubGroupID><ARTGs><ARTG>230317</ARTG><ARTG>230318</ARTG><ARTG>294052</ARTG></ARTGs><MinimumBenefit>1540</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST539</BillingCode><Name>Constrained acetabular insert </Name><Description>UHMPE &amp; cobalt chrome bipolar constrained insert</Description><Size>22, 26, 28, 32mm dia</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112610</SubGroupID><ARTGs><ARTG>217730</ARTG></ARTGs><MinimumBenefit>1540</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI737</BillingCode><Name>LONGEVITY CONSTRAINED LINER</Name><Description>Longevity HXPE constrained Liner with Titanium Alloy Locking Ring</Description><Size>Inner Diameter: 28mm, 32mm and 36mm head size.  Outer Diameter 50mm to 80mm shell size in 2mm increments.</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112610</SubGroupID><Suffix>Cup &amp; Ring</Suffix><ARTGs><ARTG>230336</ARTG></ARTGs><MinimumBenefit>1540</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP014</BillingCode><Name>Pinnacle Constrained Inserts</Name><Description>UHMWPE, constrained liner with titanium alloy locking ring</Description><Size>Inner diameter 28-44mm, 36-76mm outer diameter</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112610</SubGroupID><Suffix>Cup &amp; Ring</Suffix><ARTGs><ARTG>222179</ARTG></ARTGs><MinimumBenefit>1540</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST932</BillingCode><Name>Stryker Trident Constrained Acetabular Insert</Name><Description>Two pre assembled components: Outer insert component and a captured UHR (Universal Head) component.  Composition - Cobalt chrome alloy and UHMWPE (ultra high molecular weight polyethylene) with a Titanium 6A1-4V ELI alloy retaining ring</Description><Size>Sizing 22 - 32mm in 0 degrees &amp; 10 degrees</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112610</SubGroupID><Suffix>Cup &amp; Ring</Suffix><ARTGs><ARTG>235283</ARTG></ARTGs><MinimumBenefit>1540</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH623</BillingCode><PriorBillingCodes><PriorBillingCode>OO036</PriorBillingCode></PriorBillingCodes><Name>IC Polaric head</Name><Description>IC Polaric head</Description><Size>38, 40, 42, 44, 46, 48, 50, 52, 54, 56, 58</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112610</SubGroupID><ARTGs><ARTG>281540</ARTG></ARTGs><MinimumBenefit>1540</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI568</BillingCode><Name>Trilogy Acetabular System</Name><Description>Longevity Constrained Liner</Description><Size>50/52/54mmODx28mmID; 56mmODx32mmID; 58mmODx32mmID; 60mmODx36mmID; 62mmODx36mmID; 64mmODx36mmID; 66mmODx36ID; 68mmODx36mmID; 70mmODx36mmID; 72mmODx36mmID; 74mmODx36mmID; 76mmODx36mmID; 78mmODx36mmID; 80mmODx36mmID</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112610</SubGroupID><ARTGs><ARTG>218867</ARTG></ARTGs><MinimumBenefit>1540</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR067</BillingCode><Name>Anatomic X3 Liners</Name><Description>Anatomic X3 Liner with constraint</Description><Size>36mm, 40mm, 44mm, 48mm and 52mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112610</SubGroupID><ARTGs><ARTG>219398</ARTG><ARTG>230931</ARTG><ARTG>220404</ARTG></ARTGs><MinimumBenefit>1540</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK501</BillingCode><Name>Restoration Anatomic Dual Mobility Polyethylene Insert</Name><Description>The polyethylene insert for the Restoration ADM component articulates with the highly polished inner surface of the Restoration ADM cup and is articul;ated with a standard cobalt-chrome or ceramic 28mm diameter femoral head</Description><Size>Outer Diameter 36mm - 64mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112610</SubGroupID><ARTGs><ARTG>211464</ARTG><ARTG>205711</ARTG></ARTGs><MinimumBenefit>1540</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ327</BillingCode><Name>Vivacit E Dual Mobility Liners</Name><Description>Vitamin E UHMWPE Dual Mobility Liner  </Description><Size>ID: 22.2mm to 28mm, OD: 32mm to 60mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112610</SubGroupID><ARTGs><ARTG>430899</ARTG></ARTGs><ChangeExplanation>New listing</ChangeExplanation><MinimumBenefit>1540</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Insert</ActionFlag><CycleStartDate>2024-08-08</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN855</BillingCode><Name>R3 Acetabular system</Name><Description>Delta Ceramic Liner</Description><Size>40-78mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112611</SubGroupID><Suffix>Ring</Suffix><ARTGs><ARTG>218185</ARTG></ARTGs><MinimumBenefit>1690</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY512</BillingCode><Name>Pinnacle Acetabular Cup System</Name><Description>Pinnacle ceramic liner</Description><Size>44 - 66mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112611</SubGroupID><ARTGs><ARTG>223381</ARTG></ARTGs><MinimumBenefit>1690</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SM143</BillingCode><Name>EP fit &amp; MPF Delta Ceramic Insert</Name><Description>Ceramic Delta Acetabular Liners</Description><Size>44mm-72mm *28mm - 44mm</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112611</SubGroupID><ARTGs><ARTG>222565</ARTG></ARTGs><MinimumBenefit>1690</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GG004</BillingCode><Name>Contile Fin II Acetabular Biolox Delta Ceramic Liners</Name><Description>Contile Fin II Acetabular Biolox Delta Ceramic Liner inserts 28mm,32mm, 36mm &amp; 46mm</Description><Size>Inserts 28mm 44mm to 46mm, Inserts 32mm 48mm to 66mm, Inserts 36mm 52mm to 66mm, Inserts 40mm 56mm to 66mm</Size><SupplierCode>40371</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112611</SubGroupID><ARTGs><ARTG>281318</ARTG></ARTGs><MinimumBenefit>1690</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC168</BillingCode><Name>Delta Ceramic Liner Biolox Delta</Name><Description>Delta Ceramic Liner Biolox Delta</Description><Size>28 - 40mm ID x Small to Large</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112611</SubGroupID><ARTGs><ARTG>210724</ARTG></ARTGs><MinimumBenefit>1690</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF031</BillingCode><Name>Biolox Delta Acetabular Liner</Name><Description>Biolox Delta ceramic acetabular liner</Description><Size>28mm, 32mm, 36mm, 40mm, 44mm, 48mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112611</SubGroupID><ARTGs><ARTG>276016</ARTG></ARTGs><MinimumBenefit>1690</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU013</BillingCode><Name>Delta Ceramic Liners</Name><Description>Ceramic, Delta</Description><Size>28mm (A to G), 32mm (C to G), 36mm (E to G), 40mm (F to G)</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112611</SubGroupID><ARTGs><ARTG>140177</ARTG><ARTG>205457</ARTG></ARTGs><MinimumBenefit>1690</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WN006</BillingCode><PriorBillingCodes><PriorBillingCode>RL003</PriorBillingCode></PriorBillingCodes><Name>MAC Surgical Delta Ceramic Liner</Name><Description>Biolox delta ceramic liner</Description><Size>Available in 10 different sizes (4 diameters for the articulating surface)</Size><SupplierCode>40384</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112611</SubGroupID><ARTGs><ARTG>230838</ARTG></ARTGs><MinimumBenefit>1690</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BV029</BillingCode><Name>Procotyl L Delta Ceramic Liner</Name><Description>Rim-Lock Biolox
Delta Ceramic Liners</Description><Size>28-40mm
A-G</Size><SupplierCode>40177</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112611</SubGroupID><ARTGs><ARTG>273669</ARTG></ARTGs><MinimumBenefit>1690</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QG010</BillingCode><Name>Acetabular Liner Ceramic</Name><Description>Ceramic Acetabular Liner</Description><Size>28/35G, 32/39G, 32/44G, 36/44G,  32/48G, 36/48G, 32/52G, 36/52G</Size><SupplierCode>39928</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112611</SubGroupID><ARTGs><ARTG>326320</ARTG></ARTGs><MinimumBenefit>1690</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB235</BillingCode><Name>Biolox Delta Ceramic Liner</Name><Description>Biolox Delta Liner</Description><Size>28, 32, 36 &amp; 40mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112611</SubGroupID><ARTGs><ARTG>296141</ARTG><ARTG>296145</ARTG></ARTGs><MinimumBenefit>1690</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FA005</BillingCode><Name>Biolox Delta Acetabular Liner</Name><Description>Biolox Delta ceramic acetabular liner</Description><Size>28mm, 32mm, 36mm, 40mm</Size><SupplierCode>40074</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112611</SubGroupID><ARTGs><ARTG>285506</ARTG></ARTGs><MinimumBenefit>1690</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CR158</BillingCode><Name>Biolox Delta Acetabular Liner</Name><Description>Biolox Delta ceramic acetabular liner</Description><Size>28mm, 32mm, 36mm, 40mm</Size><SupplierCode>39996</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112611</SubGroupID><ARTGs><ARTG>157687</ARTG></ARTGs><MinimumBenefit>1690</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA486</BillingCode><Name>SeleXys Acetabular Ceramys Ceramic Liner</Name><Description>Ceramys ceramic (zirconia &amp; alumina combination)</Description><Size>28/AA, 28/BB, 28/CC, 28/DD, 32/CC, 32DD, 32/EE, 32/FF,36/EE, 36/FF, 36/GG, 386HH,36/II, 36/JJ, 36/KK, /36/LL</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112611</SubGroupID><ARTGs><ARTG>274136</ARTG></ARTGs><MinimumBenefit>1690</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI621</BillingCode><Name>Continuum Acetabular System</Name><Description>Biolox Delta Taper Ceramic Liner</Description><Size>28mm: EE28 to HH28; 32mm: GG32 to JJ32; 36mm: II36 to TT36; 40mm: KK40 to VV40</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108619</GroupID><SubGroupID>112611</SubGroupID><ARTGs><ARTG>209626</ARTG></ARTGs><MinimumBenefit>1690</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA513</BillingCode><Name>RM Acetabular Cup, Polyethylene</Name><Description>Titanium bonded UHMWPE Cup, with and without lugs</Description><Size>46 to 64mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108620</GroupID><SubGroupID>112612</SubGroupID><ARTGs><ARTG>209312</ARTG><ARTG>212649</ARTG><ARTG>212648</ARTG></ARTGs><MinimumBenefit>2517</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA502</BillingCode><Name>RM Pressfit Acetabular Cup</Name><Description>Acetabular component - Bonded Shell / Liner - polyethylene modified. Ti coated monoblock, bearing surface is Vit E stabilised highly cross linked polyethylene</Description><Size>28, 32, 36mm (Articulation); 42 to 70mm (Cup size)</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108620</GroupID><SubGroupID>112613</SubGroupID><ARTGs><ARTG>274133</ARTG></ARTGs><MinimumBenefit>2854</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HT007</BillingCode><PriorBillingCodes><PriorBillingCode>TZ018</PriorBillingCode></PriorBillingCodes><Name>Agilis Tipor</Name><Description>AGILIS Ti-POR is an uncemented monoblock hemispherical acetabulum cup designed to articulate with ceramic heads of large diameter.</Description><Size>42 – 66 mm diameter</Size><SupplierCode>40232</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108620</GroupID><SubGroupID>112616</SubGroupID><ARTGs><ARTG>292345</ARTG></ARTGs><MinimumBenefit>4381</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MJ003</BillingCode><Name>Adept MoM Acetabular Component - Extra Fixation Cup</Name><Description>Porocast beaded Shell , Co Cr, HA coated, dysplasia flange </Description><Size>46-66mm Outer diameter going up in 4mm increments</Size><SupplierCode>40173</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108622</GroupID><SubGroupID>112618</SubGroupID><Suffix>Flange</Suffix><ARTGs><ARTG>192534</ARTG><ARTG>192533</ARTG></ARTGs><MinimumBenefit>5874</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN742</BillingCode><Name>Birmingham Hip Resurfacing Prostheses - Acetabular Cup</Name><Description>Cobal Chrome, beaded, HA</Description><Size>44 - 66 mm cups</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108622</GroupID><SubGroupID>112618</SubGroupID><ARTGs><ARTG>274334</ARTG></ARTGs><MinimumBenefit>4322</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MJ002</BillingCode><Name>Adept MoM Acetabular Component</Name><Description>Porocast beaded Shell , Co Cr, HA coated size 44-66mm</Description><Size>44-66mm Outer diameter going up in 2mm increments</Size><SupplierCode>40173</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108622</GroupID><SubGroupID>112618</SubGroupID><ARTGs><ARTG>192533</ARTG><ARTG>192534</ARTG></ARTGs><MinimumBenefit>4322</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH694</BillingCode><PriorBillingCodes><PriorBillingCode>OO146</PriorBillingCode></PriorBillingCodes><Name>MUTARS LUMiC Cup</Name><Description>Modular partial pelvic replacement and acetabular reconstruction device in case of large bone defects</Description><Size>50, 54 and 60mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108623</GroupID><SubGroupID>112620</SubGroupID><Suffix>Tumour</Suffix><ARTGs><ARTG>227162</ARTG><ARTG>284582</ARTG></ARTGs><MinimumBenefit>8351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW586</BillingCode><Name>METS Coned Hemi-Pelvis Shell</Name><Description>METS Coned Hemi-Pelvis Shell</Description><Size>Diameters: 9,10,12,16</Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108623</GroupID><SubGroupID>112620</SubGroupID><Suffix>Tumour</Suffix><ARTGs><ARTG>277434</ARTG></ARTGs><MinimumBenefit>8351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO013</BillingCode><Name>Link Acetabular Reconstruction Cup System</Name><Description>Acetabular reconstruction shell</Description><Size>45 - 66 mm  Small, Medium, Large</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108623</GroupID><SubGroupID>112620</SubGroupID><ARTGs><ARTG>212118</ARTG><ARTG>212130</ARTG><ARTG>212102</ARTG></ARTGs><MinimumBenefit>2658</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC022</BillingCode><Name>Delta Revision TT Acetabular Cup</Name><Description>Delta Revision TT Acetabular Cup Ti</Description><Size>50 - 66mm</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108623</GroupID><SubGroupID>112620</SubGroupID><ARTGs><ARTG>210779</ARTG></ARTGs><MinimumBenefit>2658</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI249</BillingCode><Name>Trabecular Metal Reconstruction Shell</Name><Description>Porous tantalum, reconstruction shell</Description><Size>OD: 48 – 80mm and ID: 22.25 mm and 28mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108623</GroupID><SubGroupID>112620</SubGroupID><ARTGs><ARTG>216639</ARTG></ARTGs><MinimumBenefit>2658</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LI046</BillingCode><Name>Saturne reconstruction cup</Name><Description>Dual coated, mobile, cementless reconstruction cup</Description><Size>Sizes: 50 - 66mm</Size><SupplierCode>40041</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108623</GroupID><SubGroupID>112620</SubGroupID><ARTGs><ARTG>216970</ARTG></ARTGs><MinimumBenefit>2658</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SN265</BillingCode><Name>Contour</Name><Description>Acetabular  Reinforcement cage</Description><Size>44 - 74mm OD</Size><SupplierCode>40406</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108623</GroupID><SubGroupID>112621</SubGroupID><ARTGs><ARTG>141017</ARTG></ARTGs><MinimumBenefit>1197</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI540</BillingCode><Name>Trabecular metal acetabular revision system modular cup-cage</Name><Description>Modular cup-cage titanium alloy</Description><Size>56-80 Long &amp; short flanged left &amp; right</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108623</GroupID><SubGroupID>112621</SubGroupID><ARTGs><ARTG>117219</ARTG></ARTGs><MinimumBenefit>1197</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI392</BillingCode><Name>Burch-Schneider Reinforcement Cage</Name><Description>Reinforcement Cages</Description><Size>46-68mm outer diameter</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108623</GroupID><SubGroupID>112621</SubGroupID><ARTGs><ARTG>274914</ARTG></ARTGs><MinimumBenefit>1197</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MA024</BillingCode><Name>CCE Acetabular Reinforcing Ring</Name><Description>Titanium, grit blast, acetabular reconstruction cage with proximal rim</Description><Size>Dia 42 - 58mm</Size><SupplierCode>40172</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108623</GroupID><SubGroupID>112621</SubGroupID><ARTGs><ARTG>211196</ARTG></ARTGs><MinimumBenefit>1197</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH625</BillingCode><PriorBillingCodes><PriorBillingCode>OO038</PriorBillingCode></PriorBillingCodes><Name>IC titanium ring</Name><Description>Acetabular recontrusction ring</Description><Size>42mm, 44mm, 46mm, 48mm, 50mm, 52mm, 54mm, 56mm, 58mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108623</GroupID><SubGroupID>112621</SubGroupID><ARTGs><ARTG>169691</ARTG></ARTGs><MinimumBenefit>1197</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH624</BillingCode><PriorBillingCodes><PriorBillingCode>OO037</PriorBillingCode></PriorBillingCodes><Name>IC Reinforcement cage</Name><Description>Acetabular Reinforcement cage</Description><Size>Left and Right. 44mm, 50mm, 56mm, 62mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108623</GroupID><SubGroupID>112621</SubGroupID><ARTGs><ARTG>169691</ARTG></ARTGs><MinimumBenefit>1197</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI391</BillingCode><Name>Acetabular Reinforcement</Name><Description>Roof Ring with Hook - Ti alloy</Description><Size>36/23 to 64/23mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108623</GroupID><SubGroupID>112621</SubGroupID><ARTGs><ARTG>274914</ARTG></ARTGs><MinimumBenefit>1197</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST557</BillingCode><Name>Restoration  gap cup II acetabular cage</Name><Description>Acetabular reconstruction cage with extended plates </Description><Size>48-72mm OD in 2mm increments </Size><SupplierCode>40329</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108623</GroupID><SubGroupID>112621</SubGroupID><ARTGs><ARTG>242314</ARTG></ARTGs><MinimumBenefit>1197</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LC021</BillingCode><Name>Acetabular Plate</Name><Description>Acetabular Reconstruction Plate Ti</Description><Size>50 - 66mm x Standard or Long</Size><SupplierCode>40191</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108623</GroupID><SubGroupID>112621</SubGroupID><ARTGs><ARTG>210762</ARTG></ARTGs><MinimumBenefit>1197</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LO029</BillingCode><Name>LINK Partial Pelvis Replacement</Name><Description>Acetabular reconstruction cage with inferior flange</Description><Size>48-67mm</Size><SupplierCode>40190</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108623</GroupID><SubGroupID>112621</SubGroupID><ARTGs><ARTG>237076</ARTG></ARTGs><MinimumBenefit>1197</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH431</BillingCode><Name>Samo Revision Hip System acetabular</Name><Description>Acetabular reinforcement ring with hook</Description><Size>44 - 64 mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108623</GroupID><SubGroupID>112621</SubGroupID><ARTGs><ARTG>165470</ARTG></ARTGs><MinimumBenefit>1197</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH432</BillingCode><Name>Samo Revision Hip System acetabular</Name><Description>Acetabular reinforcement ring</Description><Size>44 - 64 mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108623</GroupID><SubGroupID>112621</SubGroupID><ARTGs><ARTG>165470</ARTG></ARTGs><MinimumBenefit>1197</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU139</BillingCode><Name>Reinforcement Cages</Name><Description>Acetabular Reinforcement Cage</Description><Size>Internal diameter from 40 to 62 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107562</CategoryID><SubCategoryID>107680</SubCategoryID><GroupID>108623</GroupID><SubGroupID>112621</SubGroupID><ARTGs><ARTG>237104</ARTG></ARTGs><MinimumBenefit>1197</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB051</BillingCode><Name>ELLIPSE Occipito Cervico Thoracic Stabilization System</Name><Description>T-Connector and Locking Nut</Description><Size>21mm - 63mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV111</BillingCode><Name>Reline (Fixed Cross Connector)</Name><Description>Fixed Cross Connector</Description><Size>11-80mm length; to fit 4.5-6.5 mm rod diameter</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ652</BillingCode><Name>Cross Connector - Expedium Anterior Spine System</Name><Description>Drop and Lock One Piece Connector-Titanium</Description><Size>13 to 20mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>97391</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI458</BillingCode><Name>PASS LP System - Crosslinks</Name><Description>Crosslinks</Description><Size>Diameter: 5.5mm - 6.0mm Length: 10mm - 72mm; small and medium</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>316001</ARTG><ARTG>295277</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Description, Size</ChangeExplanation><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KB006</BillingCode><PriorBillingCodes><PriorBillingCode>SV064</PriorBillingCode></PriorBillingCodes><Name>STERISPINE™ Cross Connector System (transverse rod to rod fixed)</Name><Description>STERISPINE™ Cross Connector System (tranverse rod to rod, fixed)</Description><Size>20-36 mm  34-50 mm  48 -64 mm</Size><SupplierCode>40247</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>273286</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER450</BillingCode><Name>LnK Spinal Fixation System/OpenLoc-L Spinal Fixation System-Connector, transverse</Name><Description>LnK Spinal Fixation System/OpenLoc-L Spinal Fixation System-Connector, crosslink rod to rod; fixed</Description><Size>dia (5.2-6.5mm) x length (15-83mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>286123</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM445</BillingCode><PriorBillingCodes><PriorBillingCode>NK060</PriorBillingCode></PriorBillingCodes><Name>Excella System Connectors</Name><Description>Excella Cross Connectors - Fixed</Description><Size>20 to 35 mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>295225</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW754</BillingCode><PriorBillingCodes><PriorBillingCode>ER200</PriorBillingCode></PriorBillingCodes><Name>K2M Spinal Systems – Fixed Cross Connector</Name><Description>Fixed Cross Connector</Description><Size>14-60mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>154442</ARTG><ARTG>159828</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI474</BillingCode><PriorBillingCodes><PriorBillingCode>NK089</PriorBillingCode></PriorBillingCodes><Name>Crosslinks</Name><Description>Crosslinks</Description><Size>All sizes</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>295277</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ046</BillingCode><Name>Invictus Cross Connector </Name><Description>(Head to Head) or (Rod To Rod) Fixation Style, Adjustable, Ti Alloy</Description><Size>(9-101)mm  width  +/-  3mm travel </Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>398576</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI250</BillingCode><Name>CD Horizon</Name><Description>Crosslink Plates - Fixed</Description><Size>10 to 200mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV100</BillingCode><Name>Vuepoint (Adjustable Cross Connector)</Name><Description>The VuePoint OCT System is intended to promote fusion of the cervical spine and occipito-thoracic junction (Occiput-T3), and is indicated for; 1: Degenerative disc disease (as defined by back pain of discogenic origin with degeneration of the disc confimred by patient history and radiographic studies), 2: Degenerative spondylolisthesis with objective evidence of neurologic impairment, 3: Fractur/Dislocation, 4: Spinal Stenosis, 5: Atlantaxial fracture with instability, 6; Occipitocervical dislocation, 7: Spinal tumor and/or 8: revision of previous cervical spine surgery</Description><Size>One size only</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB228</BillingCode><Name>Aesculap Spinal System</Name><Description>Cross Connector</Description><Size>All Sizes</Size><SupplierCode>40020</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>134538</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB011</BillingCode><Name>DPS Spine System - Transconnector Fixed</Name><Description>Fixed transconnector for spinal fixation system.</Description><Size>Diameter 5.5/6.0mm; Length 50 - 80mm.</Size><SupplierCode>40026</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>214788</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER140</BillingCode><Name>Signus Pedical Screw System-Cross Link</Name><Description>Cross Link-as part of Signus Pedicle Screw System Construct</Description><Size>MP 0150-0038-38 mm; MP-0150-0042-42 mm;MP-0150-0050-50 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>216751</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY545</BillingCode><Name>Monarch Spinal System</Name><Description>Threaded Connector</Description><Size>One size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>97391</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI012</BillingCode><Name>Streamline TL- Fixed Crosslink</Name><Description>Fixed Transverse connector (Titanium Alloy)</Description><Size>Lengths ranging from 16mm-40mm in 3mm increments</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>233599</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV020</BillingCode><Name>VuePoint Fixed Cross Connector</Name><Description>Fixed cross connector</Description><Size>26mm-50mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>209198</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN261</BillingCode><Name>SYMPHONY OCT System</Name><Description>Head to head cross connectors</Description><Size>20-70mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>178040</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY043</BillingCode><PriorBillingCodes><PriorBillingCode>DE553</PriorBillingCode></PriorBillingCodes><Name>Jazz Claw Posterior Fixation System - Connector</Name><Description>Connector with dual locking screws for Jazz Claw Connector</Description><Size>One size</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>200830</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ171</BillingCode><Name>Coral Fixed Cross Connector</Name><Description>The Coral Spinal System offers a full range of implants for adaptation to most surgical needs. Coral Spinal System is a spinal fixation device intended for use as a posterior pedicle screw fixation system, a posterior non-pedicle screw fixation system, or as an anterolateral fixation system. Cross-links allow for greater strength of construct.</Description><Size>10mm-40mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB170</BillingCode><Name>REVERE Anterior Staple System - Cross Connector</Name><Description>Top Tightening Cross Connector</Description><Size>13mm -20mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU024</BillingCode><Name>Romeo 2 Posterior Thoraco-lumbar Fixation System - Straight Cross Connector</Name><Description>Straight cross connector</Description><Size>Length: 18mm, 21mm, 24mm, 27mm, 30mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>198720</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER665</BillingCode><Name>LnK AccelFix Spinal Fixation System-Connector, lateral, fixed</Name><Description>AccelFix Spinal Fixation System-Connector, lateral, fixed, Ti, sterile</Description><Size>Diameter: 5.2-6.5 mm  Length: 16-83 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>384815</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM459</BillingCode><PriorBillingCodes><PriorBillingCode>NK011</PriorBillingCode></PriorBillingCodes><Name>Capless LI  Pedicle screw system - X Link cross connector - Fixed</Name><Description>Titanium, lowprofile transverse crossconnector</Description><Size>low profile, multiple sizes, 25-35mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>159605</ARTG><ARTG>160750</ARTG><ARTG>170220</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK227</BillingCode><Name>Oasys-Occipito Cervico Thoracic System</Name><Description>Connector - Transverse; Offset; Cross; Rod to Rod; Axial</Description><Size>For rod diameters from 3.5mm to 6mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>279144</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW783</BillingCode><PriorBillingCodes><PriorBillingCode>ER555</PriorBillingCode></PriorBillingCodes><Name>Yukon Head to Head Connectors</Name><Description>Head to Head transverse connector</Description><Size>Small, Medium, Large and Extra Large</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>159828</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER182</BillingCode><Name>SIGNUS DIPLOMAT DEFORMITY System– Transverse connector</Name><Description>DIPLOMAT DEFORMITY System – transverse connector comprising a cross bar and 2 cross bar clamps with grub screws.</Description><Size>4.0x50 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>216751</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK241</BillingCode><Name>Xia Spinal System</Name><Description>Titanium or Stainless Steel Cross Connector</Description><Size>15-20mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>279160</ARTG><ARTG>279150</ARTG><ARTG>279151</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF108</BillingCode><Name>Freedom Crosslink Connector</Name><Description>Crosslink Connectors</Description><Size>Small, medium, large, x-large</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>203838</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER516</BillingCode><PriorBillingCodes><PriorBillingCode>EU004</PriorBillingCode></PriorBillingCodes><Name>e.Spine Transverse Link</Name><Description>Titanium spine transverse link</Description><Size>Lengths 35, 46, 60, 70, 80 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>171952</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY044</BillingCode><PriorBillingCodes><PriorBillingCode>DE586</PriorBillingCode></PriorBillingCodes><Name>Jazz Frame T-Bar</Name><Description>Fixed transverse rod-to-rod connector</Description><Size>25mm, 30mm, 35mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>200830</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV063</BillingCode><Name>Armada (Fixed cross connector)</Name><Description>Fixed cross connector</Description><Size>5.5mm x 20-60mm
5.5mm, 5.5mm-6.35mm
5.5, 15mm-40mm x 200mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH746</BillingCode><PriorBillingCodes><PriorBillingCode>LM499</PriorBillingCode></PriorBillingCodes><Name>Inline Connectors</Name><Description>Inline Connectors</Description><Size>7.5 to 17 mm </Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>362890</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU159</BillingCode><Name>MUST MINI  Cross Connector</Name><Description>Cross Connector</Description><Size>15-70 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>291175</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH054</BillingCode><Name>Crosslink</Name><Description>Crosslink Adjustable Connector</Description><Size>28-52mm Length</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW026</BillingCode><PriorBillingCodes><PriorBillingCode>ZI908</PriorBillingCode></PriorBillingCodes><Name>Virage Rod to Rod Transverse Connector</Name><Description>Rod to Rod Transverse Connector</Description><Size>XS, S, M, L, XL</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>111775</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW021</BillingCode><Name>WEGO Spinal Systems </Name><Description>Plates</Description><Size>All sizes &amp;lt;55 mm</Size><SupplierCode>40252</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>330363</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW025</BillingCode><PriorBillingCodes><PriorBillingCode>ZA001</PriorBillingCode></PriorBillingCodes><Name>Vitality Spine System - Fixed Cross Connector</Name><Description>Fixed length cross connector, titanium</Description><Size>21mm X 5.5mm - 31mm X 5.5mm &amp; 21mm Wide X 6.0mm - 31mm Wide X 6.0mm</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>287242</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU053</BillingCode><Name>Perla TL Posterior thoraco-lumbar fixation system - cross connector (fixed)</Name><Description>Cross connector monobloc</Description><Size>Length: 18, 21, 24, 27, 30mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU064</BillingCode><Name>Perla Posterior Cervico-Thoracic Fixation System - Cross Connector</Name><Description>Head-to-head cross connectors  </Description><Size>Length: 20-25mm, 25-30mm, 30-35mm, 35-40mm, 40-45mm, 45-50mm  </Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER554</BillingCode><Name>Biedermann Motech MOSS Spinal Fixation System-Ti Cross Connector  </Name><Description>Adjustable Cross Connector, compatible with dia 5.5 mm and 6.0 mm MOSS Rods  </Description><Size>70mm - 110mm  </Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112629</SubGroupID><ARTGs><ARTG>337238</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI018</BillingCode><Name>Streamline TL- Variable Crosslink</Name><Description>Transverse rod to rod connector, Adjustable (Titanium Alloy)</Description><Size>Small, medium,and large sizes, with lengths ranging from 37mm-85mm.</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>233599</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ063</BillingCode><Name>Centaur Spinal System</Name><Description>Cross Connector - rod to rod - adjustable</Description><Size>26mm-82mm</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>407189</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY011</BillingCode><Name>Reform POCT Cross Connector</Name><Description>Cross Connector</Description><Size>Diameter 3.5mm</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>287906</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER657</BillingCode><Name>Biedermann Motech MOSS Spinal Fixation System-Ti Cross Connector-adjustable    </Name><Description>Biedermann Motech MOSS Spinal Fixation System-Ti Cross Connector-adjustable, compatible with dia 5.5 mm and 6.0 mm MOSS Rods   </Description><Size>35-100 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>337238</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW390</BillingCode><Name>XIA Spine System</Name><Description>Cross Link</Description><Size>Length 20mm - 99mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>279150</ARTG><ARTG>279160</ARTG><ARTG>279151</ARTG><ARTG>279159</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM406</BillingCode><PriorBillingCodes><PriorBillingCode>NK012</PriorBillingCode></PriorBillingCodes><Name>Capless LI  Pedicle screw system - X Link cross connector - Variable</Name><Description>Titanium, lowprofile transverse dual articulation crossconnector</Description><Size>Low profile, Multiple sizes, 37-80mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>159605</ARTG><ARTG>160750</ARTG><ARTG>170220</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER337</BillingCode><Name>Ulrich Pedicle Screw System-Transverse connectors, adjustable</Name><Description>Ulrich Pedicle Screw System (uCentum,flamenco)-crosslink connectors, adjustable, with or without hook</Description><Size>closed (35-92) mm x open (43-107 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>279706</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY007</BillingCode><Name>Reform Crosslinks</Name><Description>Crosslinks Adjustable</Description><Size>Length 20mm to 100mm</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>287905</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW728</BillingCode><PriorBillingCodes><PriorBillingCode>ER019</PriorBillingCode></PriorBillingCodes><Name>K2M Spinal Systems</Name><Description>Transverse Connector</Description><Size>3.5 – 5.5mm rod /rail diameter 14 - 93mm width</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>159828</ARTG><ARTG>154442</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM419</BillingCode><PriorBillingCodes><PriorBillingCode>NK040</PriorBillingCode></PriorBillingCodes><Name>Certex Spinal Implant System Connector Adjustable</Name><Description>Connector Adjustable</Description><Size>3.5mm x 28-33mm to 42-58mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>160750</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER666</BillingCode><Name>LnK AccelFix Spinal Fixation System-connector, lateral, adjustable</Name><Description>AccelFix Spinal Fixation System-connector, lateral, adjustable</Description><Size>Diameter: 5.2-6.5 mm  Lentgth: Adjustable from (28-35) mm to (52-83) mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>384815</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER584</BillingCode><PriorBillingCodes><PriorBillingCode>OF025</PriorBillingCode></PriorBillingCodes><Name>Spinal Fixation System</Name><Description>Multi Axial Cross Connector Assembly – Titanium/Lateral Offset</Description><Size>5.5mm-80mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>195012</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER632</BillingCode><PriorBillingCodes><PriorBillingCode>OF065</PriorBillingCode></PriorBillingCodes><Name>Centurion Cross Connectors</Name><Description>Adjustable Cross Connector</Description><Size>20mm – 50mm in 5mm increments</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>195012</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB216</BillingCode><Name>CREO® Cross Connector</Name><Description>Cross Connector</Description><Size>20-78mm to 22-91mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GW050</BillingCode><Name>WEGO Spinal Systems</Name><Description>Connectors</Description><Size>All Sizes</Size><SupplierCode>40252</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>330363</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU204</BillingCode><Name>M.U.S.T. Mini Cross Connectors</Name><Description>Top Loading Cross Connectors</Description><Size>21-68 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>404164</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW027</BillingCode><PriorBillingCodes><PriorBillingCode>ZI909</PriorBillingCode></PriorBillingCodes><Name>Virage Head to Head Transverse Connector</Name><Description>Transverse Connector Adjustable</Description><Size>XS, S, M, L, XL</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>111775</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY250</BillingCode><Name>Universal Spine System</Name><Description>Low Profile Transconnector</Description><Size>18-83mm length</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>133401</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI291</BillingCode><PriorBillingCodes><PriorBillingCode>MI247</PriorBillingCode><PriorBillingCode>MI249</PriorBillingCode></PriorBillingCodes><Name>CD Horizon</Name><Description>Crosslink Plates - Adjustable</Description><Size>10 to 200mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VB009</BillingCode><Name>Lunfix Cross Connector</Name><Description>Adjustable Cross Connector</Description><Size>(20-80) minimum sie to (25-98)mm expanded size </Size><SupplierCode>40229</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>327225</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER328</BillingCode><Name>SIGNUS Diplomat Pedicle Screw System – Transverse Connector, adjustable</Name><Description>SIGNUS Diplomat Pedicle Screw System – Cross Connector, adjustable</Description><Size>small 35-45mm  medium 41-58mm  large 54-82mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>216751</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM446</BillingCode><PriorBillingCodes><PriorBillingCode>NK061</PriorBillingCode></PriorBillingCodes><Name>Excella System Connectors</Name><Description>Pedicle Screw System Rod Connectors - Transverse adjustable</Description><Size>Fits 5.5 or 6mm rods  Various sizes from 39 to 81 mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>295225</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ027</BillingCode><Name>Centaur Cross Connector, Centaur Screw System</Name><Description>Cross Connector - rod to rod - Adjustable</Description><Size>10mm - 90mm</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>217033</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER451</BillingCode><Name>LnK Spinal Fixation System/OpenLoc-L Spinal Fixation System-Connector, transverse, adjustable</Name><Description>LnK Spinal Fixation System/OpenLoc-L Spinal Fixation System-Connector, transverse, adjustable</Description><Size>closed 30-50mm; extended 34-74 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>286123</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER316</BillingCode><Name>Ulrich posterior OCT System (neon3)-Connector, transverse</Name><Description>Ulrich posterior OCT System (neon3)- Crosslink, adjustable, screw to screw and rod to rod</Description><Size>length adjustable within range of 34-50 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>279706</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB012</BillingCode><Name>DPS Spine System - Transconnector Adjustable</Name><Description>Adjustable transconnector for spinal fixation system.</Description><Size>Diameter 5.5/6.0mm; Adjustable lengths: 34-39mm, 38-49mm, 48-68mm.</Size><SupplierCode>40026</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>214788</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB229</BillingCode><Name>Aesculap Spinal System</Name><Description>Cross, Domino, Axial, Lateral Connector</Description><Size>All Sizes</Size><SupplierCode>40020</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>134538</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH578</BillingCode><Name>Pine Adjustable Cross Link</Name><Description>Rod - Rod Connector</Description><Size>30-80mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>274913</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV047</BillingCode><Name>Armada</Name><Description>Arch, adjustable transverse connector</Description><Size>20-70mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB186</BillingCode><Name>CREO DLX Cross Connector</Name><Description>Adjustable Cross Connectors</Description><Size>20mm-78mm to 22mm-91mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY079</BillingCode><PriorBillingCodes><PriorBillingCode>DR009</PriorBillingCode></PriorBillingCodes><Name>Life Spine Pedicle Screw System - Transverse Connectors, Adjustable</Name><Description>Life Spine Pedicle Screw System - Transverse Connectors, Adjustable. Arched or Straight</Description><Size>Closed (25-90)mm x Open (32-100)mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>321122</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY018</BillingCode><Name>Katana Connector</Name><Description>Adjustable</Description><Size>Extra Small to Large, 22-44 x 28-60</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>396083</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB057</BillingCode><Name>ELLIPSE Stabilization System, Top Loading T-Connector</Name><Description>T-Connector</Description><Size>21mm - 56mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB159</BillingCode><Name>QUARTEX T-Connectors</Name><Description>Rod to Rod and Head to Head T-Connectors</Description><Size>21mm to 57mm - 27mm to 63mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW028</BillingCode><PriorBillingCodes><PriorBillingCode>ZI999</PriorBillingCode></PriorBillingCodes><Name>Vitality Spine System - Multi-Span Cross Connector</Name><Description>Adjustable length cross connector, titanium</Description><Size>33-36mm Wide X 5.5mm - 70-90mm Wide X 6.0mm</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>287242</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH061</BillingCode><Name>Crosslink</Name><Description>Crosslink Connector</Description><Size>20-80mm Length</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH091</BillingCode><Name>Crosslink </Name><Description>Crosslink </Description><Size>Diameter : 5.5 mm &amp; 6.0 mm   Length : 32 mm - 75 mm </Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>380418</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IB002</BillingCode><Name>Vertefix ll Locking screw</Name><Description>Transverse connector rod system</Description><Size>One size only</Size><SupplierCode>40009</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>188902</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ096</BillingCode><Name>RESPONSE Spine System – Cross Connector</Name><Description>Cross Connector</Description><Size>XS - XL
20-80mm</Size><SupplierCode>40325</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>233454</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU124</BillingCode><Name>M.U.S.T LINK - Cross Connector</Name><Description>Cross Connector</Description><Size>19-100mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>222457</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE668</BillingCode><Name>Mariner CrossBar</Name><Description>Adjustable Cross link</Description><Size>Small 33-41mm  Medium  39-52mm  Large 50-75mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE768</BillingCode><Name>NorthStar OCT</Name><Description>NorthStar OCT Crossbar - Screw to Screw,  Screw to Rod Connector, Rod to Rod</Description><Size>3.5 &amp; 4mm  SM: 21-26mm  MD: 24-32mm  LG: 34-44mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT014</BillingCode><Name>SOLFIX2 Cross Links</Name><Description>Cross links</Description><Size>29mm - 63mm</Size><SupplierCode>40227</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>320880</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY020</BillingCode><PriorBillingCodes><PriorBillingCode>EV044</PriorBillingCode></PriorBillingCodes><Name>BA Posterior Screw Head to Head Connector</Name><Description>BA Posterior Screw Head to Head Connector</Description><Size>25-66mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>329318</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI266</BillingCode><Name>Infinity Spinal System</Name><Description>Crosslink Connector</Description><Size>Small, medium, large</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF180</BillingCode><Name>Freedom Posterior Screw Head to Head Connector</Name><Description>Freedom Posterior Screw Head to Head Connector</Description><Size>25-66mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>203838</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC590</BillingCode><Name>Vertex Reconstruction System</Name><Description>Crosslink/Bar</Description><Size>Extra small to  large</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ767</BillingCode><Name>Expedium SFX Cross Connector System</Name><Description>Variable Length Cross Connector</Description><Size>26mm - 100 mm Length, 4.5, 5.5, 6.35mm rod diameter</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>97391</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF179</BillingCode><Name>Freedom Posterior Screw Rod to Rod Connector</Name><Description>Rod to Rod Connector</Description><Size>25-66mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>203838</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE672</BillingCode><Name>icotec Pedicle System Cross Link</Name><Description>Adjustable cross link</Description><Size>30-34mm  33-42mm  40-53mm  50-70mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>283854</ARTG><ARTG>283853</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU023</BillingCode><Name>Romeo 2 Posterior Thoraco-lumbar Fixation System - Multiaxial Cross Connector</Name><Description>Multiaxial cross connector, Multiaxial pre-bent cross connector</Description><Size>Length: 33 - 36mm, 36-43mm, 43-55mm, 55-80mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>198720</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI475</BillingCode><PriorBillingCodes><PriorBillingCode>NK090</PriorBillingCode></PriorBillingCodes><Name>Adjustable Crosslinks</Name><Description>Adjustable Crosslinks</Description><Size>All sizes</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>295277</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU005</BillingCode><Name>Perla Posterior Cervico-Thoracic Fixation System - Cross Connector</Name><Description>Adjustable rod-to-rod cross connectors</Description><Size>RTR - Length: 21-23mm, 23-26mm, 26-32mm, 32-44mm, 44-45mm  </Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY069</BillingCode><PriorBillingCodes><PriorBillingCode>DR051</PriorBillingCode></PriorBillingCodes><Name>Ulrich Medical Pedicle Screw System - Crosslinks</Name><Description>Ulrich Medical Pedicle Screw System - Crosslinks</Description><Size>XXS-XL</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>365230</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY019</BillingCode><PriorBillingCodes><PriorBillingCode>EV043</PriorBillingCode></PriorBillingCodes><Name>BA Posterior Screw Rod to Rod Connector</Name><Description>Rod to Rod Connector</Description><Size>25-66mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>329318</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY569</BillingCode><Name>Spinal Fixation System</Name><Description>Matrix Snap-on Transconnector</Description><Size>21mm - 90mm Length</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>293275</ARTG><ARTG>293276</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB086</BillingCode><Name>CREO Stabilization System Cross Connector</Name><Description>The CREO Stabilization System implants are non-cervical spinal fixation intended for posterior pedicle screw fixation, posterior hook fixation or anterolateral fixation.</Description><Size>4.75 and 5.5, 30-91mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB030</BillingCode><Name>REVERE H-LINK</Name><Description>Transverse Connector with integral Rods</Description><Size>5.5mm - 6.35mm Rod with 38mm - 71mm transverse connector and 40 - 45mm rod</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU049</BillingCode><Name>Perla TL Posterior thoraco-lumbar fixation system - cross connector (adjustable)</Name><Description>Multiaxial cross connector - straight or pre-bent</Description><Size>Length: 30-31mm, 31-33mm, 33-36mm, 36-43mm, 43-55mm, 55-80 mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF015</BillingCode><Name>Centaur Cross Connector, Centaur Screw System</Name><Description>Cross Connector - rod to rod - Adjustable</Description><Size>10mm - 90mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>203838</ARTG><ARTG>166153</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DP412</BillingCode><Name>Moss Miami (Titanium)</Name><Description>Transverse Connector - Complete</Description><Size>One size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>142432</ARTG><ARTG>145010</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN259</BillingCode><Name>SYMPHONY OCT System</Name><Description>Rod to rod cross connectors</Description><Size>20-64mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>178040</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY398</BillingCode><Name>Axon Spinal System - Transconnector</Name><Description>Axon Transconnector</Description><Size>60mm - 75mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>133401</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB026</BillingCode><Name>REVERE Cross Connectors</Name><Description>Cross Connectors</Description><Size>4.5mm 20mm-78mm
5.5mm 29mm-91mm
6.35mm 29-90mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER527</BillingCode><Name>LnK Posterior Cervical Fixation System/CastleLoc-S Posterior Cervical Fixation System-Crosslink</Name><Description>LnK Posterior Cervical Fixation System/CastleLoc-S Posterior Cervical Fixation System-Crosslink Plate Type, Bar type, Hybrid Type, non-sterile or sterile</Description><Size>closed 29-42 mm; extended 34-58 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>286122</ARTG><ARTG>384816</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV118</BillingCode><Name>Reline (Adjustable Cross Connector)</Name><Description>Adjustable Cross Connector</Description><Size>20-100mm length; to fit 4.5-6mm rod diameter</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>209199</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BF007</BillingCode><Name>Smartloc Spinal Fixation System/Transverse Link</Name><Description>Cross link for Smartloc Spinal Fixation System</Description><Size>Telescopes to 70mm</Size><SupplierCode>40171</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107665</SubCategoryID><GroupID>108565</GroupID><SubGroupID>112630</SubGroupID><ARTGs><ARTG>150778</ARTG></ARTGs><MinimumBenefit>1136</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW408</BillingCode><Name>Aviator Anterior Cervical Plating System - Plate</Name><Description>Anterior Cervical Plate - Integral Locking</Description><Size>One, two and three level up to 55mm in length</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>278368</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ136</BillingCode><Name>Evolution Spine EMERGE Plate System- Plates</Name><Description>Evolution Spine EMERGE Plate System- Plates, Level 1-4</Description><Size>18-55 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>445230</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB038</BillingCode><Name>XTEND Anterior Cervical Plate</Name><Description>Anterior Cervical Plate</Description><Size>10mm - 54mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>190070</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC346</BillingCode><Name>Venture Anterior Cervical Plate</Name><Description>Single or multi level plate, titanium alloy and Nitinol</Description><Size>20mm - 50mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF158</BillingCode><Name>Alias ACDF Plate</Name><Description>Anterior Cervical Plate</Description><Size>1 Level 12-30mm, 2 Level 30-44mm, 3 Level 42-66mm, 4 Level 64-76mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>208160</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC863</BillingCode><Name>Zephir Anterior Cervical Plate</Name><Description>Anterior Cervical Plate</Description><Size>22.5mm - 55mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB015</BillingCode><Name>VIP Anterior Cervical Plate</Name><Description>Anterior Cervical Plate</Description><Size>13mm - 46mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>190972</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DY524</BillingCode><Name>Uniplate Spinal System</Name><Description>Titanium Anterior Cervical Plate</Description><Size>13-55mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>148371</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY022</BillingCode><PriorBillingCodes><PriorBillingCode>EV009</PriorBillingCode></PriorBillingCodes><Name>Evolution ACDF Plate</Name><Description>Anterior Cervical Plate</Description><Size>1 level Plate (20mm-32mm), 2 level plate (34mm – 50mm)</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>247573</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR085</BillingCode><Name>Reflex Anterior Cervical Plate System</Name><Description>Plate</Description><Size>≤55mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>278368</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI152</BillingCode><Name>ZEVO Anterior Cervical Plate System</Name><Description>Anterior Cervical Plate</Description><Size>15mm - 55mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC419</BillingCode><Name>Atlantis Anterior Cervical Plate</Name><Description>Anterior Cervical Plate</Description><Size>50mm - 55mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY019</BillingCode><Name>Slimplicity HP Plates</Name><Description>Plates</Description><Size>10mm - 105mm</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>287906</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM407</BillingCode><PriorBillingCodes><PriorBillingCode>NK013</PriorBillingCode></PriorBillingCodes><Name>Spider Cervical Plating System - Spider Plate</Name><Description>Titanium, Anterior Cervical Plate System -</Description><Size>22-54mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>159605</ARTG><ARTG>170220</ARTG><ARTG>160750</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB040</BillingCode><Name>XTEND Anterior Cervical Extender Plate</Name><Description>Anterior Cervical Extender Plate</Description><Size>10mm - 46mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>190070</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW767</BillingCode><PriorBillingCodes><PriorBillingCode>ER289</PriorBillingCode></PriorBillingCodes><Name>Pyrenees Segmental Plate</Name><Description>Single level fusion plate with shelf.</Description><Size>5-10mm shelf</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>290395</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ030</BillingCode><Name>Aquila Plate System</Name><Description>Anterior Cervical Plate</Description><Size>1 level and 2 level plates (21 - 55mm Length)</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>217032</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER524</BillingCode><Name>CastleLoc-P Anterior Cervical Plate</Name><Description>CastleLoc-P Anterior Cervical Plate, Plate level 1-3, ≤55 mm</Description><Size>length 19-54 mm; width 17 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>286127</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI157</BillingCode><Name>Divergence Anterior Cervical Fusion Mini-plate System</Name><Description>Divergence anterior cervical fusion mini-plate</Description><Size>15.5mm - 22.5mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER588</BillingCode><PriorBillingCodes><PriorBillingCode>OF003</PriorBillingCode></PriorBillingCodes><Name>Azure Anterior Cervical Plate</Name><Description>Anterior Cervical Plate &lt;55mm</Description><Size>18-54mm length</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>195018</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU013</BillingCode><Name>Tryptik 2 Anterior Cervical Plate</Name><Description>Anterior cervical plate</Description><Size>Length: 20mm, 22mm, 24mm, 26mm, 28mm, 30mm, 32mm, 34mm, 36mm, 38mm, 40mm, 43mm, 46mm, 49mm, 52mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>166151</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC706</BillingCode><Name>Venture Anterior Cervical Plate</Name><Description>Single or multi level plate, titanium alloy and Nitinol</Description><Size>52.5mm - 55mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB110</BillingCode><Name>ASSURE® Anterior Cervical Plate System – Plate</Name><Description>Titanium Alloy Anterior Cervical Plate</Description><Size>1.8 mm depth, 16mm width, 14- 54mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>190070</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY023</BillingCode><PriorBillingCodes><PriorBillingCode>EV021</PriorBillingCode></PriorBillingCodes><Name>Revolution ACDF Plate</Name><Description>Anterior Cervical Plate</Description><Size>Double and Mini Plates, 18 - 50mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>273279</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI480</BillingCode><PriorBillingCodes><PriorBillingCode>NK106</PriorBillingCode></PriorBillingCodes><Name>Intervertebral Fusion Staple</Name><Description>Intervertebral Fusion Staple</Description><Size>Multiple sizes to suit patient anatomy</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>295270</ARTG></ARTGs><Note>For single level ACDF (Anterior cervical discectomy and fusion) ONLY.</Note><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY520</BillingCode><Name>Vectra Anterior Spinal System</Name><Description>Cervical Plate</Description><Size>≤55</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>155808</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB003</BillingCode><Name>Delta Plate</Name><Description>Anterior cervical plate</Description><Size>Length: 16-22mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>214788</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW763</BillingCode><PriorBillingCodes><PriorBillingCode>ER241</PriorBillingCode></PriorBillingCodes><Name>Pyrenees Cervical Plate System-Monoplate, Short</Name><Description>Pyrenees MonoPlate, Short</Description><Size>18-55mm length</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>290395</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV108</BillingCode><Name>Archon (Plate 18-55mm)</Name><Description>Anterior Cervical Plate</Description><Size>18-55mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>209196</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW779</BillingCode><PriorBillingCodes><PriorBillingCode>ER493</PriorBillingCode></PriorBillingCodes><Name>Ozark Plate Level 1-5, ≤55 mm</Name><Description>Plate level 1 -5, ≤55 mm</Description><Size>16-55 mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>290395</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB114</BillingCode><Name>Unify Dynamic Anterior Cervical Plate System – Plate</Name><Description>Titanium Alloy Dynamic Anterior Cervical Plate</Description><Size>Depth - 2.8mm
Width – 16.6mm
Length – 10- 55 mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>190070</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV069</BillingCode><Name>Helix-Revolution (plate 56-110mm)</Name><Description>Anterior Cervical Plate</Description><Size>56-110mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>133466</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB016</BillingCode><Name>Anterior Cervical Plate System</Name><Description>Anterior cervical plate. Various size plates, Titanium</Description><Size>&gt;55mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>214788</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV092</BillingCode><Name>Helix-T (Plate 56 - 110mm)</Name><Description>Anterior cervical plate</Description><Size>56-110mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV091</BillingCode><Name>Helix-T (Plate 20-54mm)</Name><Description>Anterior cervical plate</Description><Size>20-54mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV109</BillingCode><Name>Archon (Plate 56-110mm)</Name><Description>Anterior Cervical Plate</Description><Size>56-110mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>209196</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE679</BillingCode><Name>icotec Anterior Cervical Plate</Name><Description>Cervical Plate</Description><Size>18mm Width, 58mm - 94mm Length</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>283853</ARTG></ARTGs><Note>Only to be reimbursed when used in patients with spinal tumours requiring regular magnetic resonance imaging (MRI) and/or computerised tomography (CT) imaging and or adjuvant radiotherapy and/or proton therapy.</Note><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW030</BillingCode><PriorBillingCodes><PriorBillingCode>ZA015</PriorBillingCode></PriorBillingCodes><Name>MaxAn Anterior Cervical Plating System</Name><Description>Titanium plate for anterior cervical spine</Description><Size>&gt;55mm</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>287243</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC859</BillingCode><Name>Venture Anterior Cervical Plate</Name><Description>Single or multi level plate, titanium alloy and Nitinol</Description><Size>57.5mm - 150mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER590</BillingCode><PriorBillingCodes><PriorBillingCode>OF077</PriorBillingCode></PriorBillingCodes><Name>Cetra Anterior Cervical Plate</Name><Description>Low profile anterior cervical plate</Description><Size>16mm-54mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>195018</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC002</BillingCode><Name>WeCover Cervical System - Plate</Name><Description>Cervical Plate</Description><Size>One Level Plate - 22,24,26,28,30,32, 34mm
Two Level Plate - 36, 38, 40, 42, 44, 46, 48, 50mm
Three Level Plate - 52mm
Width of all plates are 18mm and the plate profile is 1.9mm.</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>221268</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE680</BillingCode><Name>icotec Anterior Cervical Plate</Name><Description>Cervical Plate</Description><Size>18mm width, 21mm - 55mm length</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>283853</ARTG></ARTGs><Note>Only to be reimbursed when used in patients with spinal tumours requiring regular magnetic resonance imaging (MRI and/or computerised tomography (CT) imaging and or adjuvant radiotherapy and/or proton therapy.</Note><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JA017</BillingCode><PriorBillingCodes><PriorBillingCode>OH540</PriorBillingCode></PriorBillingCodes><Name>Spinal Plate - Cervical</Name><Description>Anterior Cervical Plate</Description><Size>20mm - 53mm</Size><SupplierCode>40213</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>289731</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV068</BillingCode><Name>Helix-Revolution (Plate 20-54mm)</Name><Description>Anterior Cervical Plate</Description><Size>20-54mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>133466</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC418</BillingCode><Name>Atlantis Anterior Cervical Plate</Name><Description>Plate</Description><Size>19.0mm -  47.5mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI162</BillingCode><Name>ZEVO Anterior Cervical Plate System</Name><Description>Anterior Cervical Plate</Description><Size>57 - 108mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB111</BillingCode><Name>ASSURE® Anterior Plate System – Plate</Name><Description>Titanium Alloy Anterior Cervical Plate</Description><Size>1.8 mm depth, 16mm width, 57-100mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>190070</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB015</BillingCode><Name>Anterior Cervical Plate System</Name><Description>Anterior cervical plate. Various size plates, Titanium</Description><Size>20-55mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>214788</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC858</BillingCode><Name>Atlantis Anterior Cervical Plate</Name><Description>Anterior Cervical Plate</Description><Size>57.5mm - 110mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER586</BillingCode><PriorBillingCodes><PriorBillingCode>OF031</PriorBillingCode></PriorBillingCodes><Name>Blackstone Medical ACP - 3 and 4 Level</Name><Description>Titanium Alloy Anterior Cervical Plate - 3 and 4 Level</Description><Size>56mm - 122mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>195018</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER589</BillingCode><PriorBillingCodes><PriorBillingCode>OF029</PriorBillingCode></PriorBillingCodes><Name>Blackstone Medical ACP - Level 1 &amp; 2</Name><Description>Titanium Alloy ACP L1-L2</Description><Size>20mm - 54mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>195018</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW736</BillingCode><PriorBillingCodes><PriorBillingCode>ER030</PriorBillingCode></PriorBillingCodes><Name>Pyrenees Cervical Plate System</Name><Description>Cervical Plate</Description><Size>18mm to 54mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>290395</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER207</BillingCode><Name>SIGNUS  Cervical Plating Implant System-Plate</Name><Description>SIGNUS Cervical Plating Implant System-Plate</Description><Size>20-54 mm, in 2-3 mm increments</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>216749</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW762</BillingCode><PriorBillingCodes><PriorBillingCode>ER240</PriorBillingCode></PriorBillingCodes><Name>Pyrenees Cervical Plate System-MonoPlate, Long</Name><Description>Pyrenees Cervical Plate System-MonoPlate, Long</Description><Size>Length 56-78 mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>290395</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR084</BillingCode><Name>Reflex Anterior Cervical Plate System</Name><Description>Plate</Description><Size>&gt;55mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>278368</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW746</BillingCode><PriorBillingCodes><PriorBillingCode>ER052</PriorBillingCode></PriorBillingCodes><Name>Blue Ridge Hybrid Cervical Plate System - Plate</Name><Description>Low profile, anterior cervical plate. Locking,  titanium.</Description><Size>56-92mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>290395</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM408</BillingCode><PriorBillingCodes><PriorBillingCode>NK014</PriorBillingCode></PriorBillingCodes><Name>Spider Cervical Plating System - Spider Plate</Name><Description>Titanium, anterior cervical plate system</Description><Size>56-77mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>160750</ARTG><ARTG>170220</ARTG><ARTG>159605</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER585</BillingCode><PriorBillingCodes><PriorBillingCode>OF004</PriorBillingCode></PriorBillingCodes><Name>Azure Anterior Cervical Plate System</Name><Description>Anterior Cervical Plate &gt; 55mm</Description><Size>56-120mm length</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>195018</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER208</BillingCode><Name>SIGNUS  Cervical Plating Implant System-Plate (&gt;55 mm)</Name><Description>SIGNUS  Cervical Plating Implant System-Plate (&gt;55 mm)</Description><Size>56-100 mm, in 3-5 mm increments</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>216749</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER587</BillingCode><PriorBillingCodes><PriorBillingCode>OF078</PriorBillingCode></PriorBillingCodes><Name>Cetra Anterior Cervical Plate &gt; 55mm</Name><Description>Low profile anterior cervical plate</Description><Size>56mm-94mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>195018</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW780</BillingCode><PriorBillingCodes><PriorBillingCode>ER494</PriorBillingCode></PriorBillingCodes><Name>Ozark Plate Level 1-5 , &gt;55mm</Name><Description>Plate Level 1-5 , &gt;55mm</Description><Size>56-110 mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>290395</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER525</BillingCode><Name>CastleLoc-P Anterior Cervical Plate, &gt;55mm</Name><Description>CastleLoc-P Anterior Cervical Plate, &gt;55mm, 3-4 levels</Description><Size>length 55-97 mm, width 17 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>286127</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB115</BillingCode><Name>Unify Dynamic Anterior Cervical Plate System – Plate</Name><Description>Titanium Alloy Dynamic Anterior Cervical Plate</Description><Size>Depth - 2.8mm
Width – 16.6mm
Length – 58 -70 mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>190070</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB039</BillingCode><Name>XTEND Anterior Cervical Plate &gt;55mm</Name><Description>Anterior Cervical Plate &gt;55mm</Description><Size>57mm - 104mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>190070</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU014</BillingCode><Name>Tryptik 2 Anterior Cervical Plate</Name><Description>Anterior cervical plate</Description><Size>Length: 55mm, 58mm, 61mm, 64mm, 68mm, 72mm, 76mm, 80mm, 84mm, 88mm, 92mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>166151</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JA018</BillingCode><PriorBillingCodes><PriorBillingCode>OH541</PriorBillingCode></PriorBillingCodes><Name>Spinal Plate - Cervical 55mm+</Name><Description>Anterior Cervical Plate 55mm+</Description><Size>56 - 92mm</Size><SupplierCode>40213</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>289731</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW737</BillingCode><PriorBillingCodes><PriorBillingCode>ER031</PriorBillingCode></PriorBillingCodes><Name>Pyrenees Cervical Plate System</Name><Description>Cervical Plate</Description><Size>57mm to 110mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>290395</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW407</BillingCode><Name>Aviator Anterior Cervical Plating System - Plate longer than 55mm</Name><Description>Anterior Cervical Plate - Integral Locking</Description><Size>Three and four level greater than 55mm in length</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>278368</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ031</BillingCode><Name>Aquila Plate System</Name><Description>Anterior Cervical Plate</Description><Size>2, 3 and 4 level cervical plates (55m - 109mm length)</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>217032</ARTG></ARTGs><MinimumBenefit>1419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HC013</BillingCode><Name>Origin System</Name><Description>Cervical Plate</Description><Size>L:22-72mm</Size><SupplierCode>40349</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>369730</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW031</BillingCode><PriorBillingCodes><PriorBillingCode>ZA014</PriorBillingCode></PriorBillingCodes><Name>MaxAn Anterior Cervical Plating System</Name><Description>Titanium plate for anterior cervical spine</Description><Size>≤55mm</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112631</SubGroupID><ARTGs><ARTG>287243</ARTG></ARTGs><MinimumBenefit>1297</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC010</BillingCode><PriorBillingCodes><PriorBillingCode>SF149</PriorBillingCode></PriorBillingCodes><Name>XM Plate</Name><Description>Lumbar Fusion Plate</Description><Size>17-27mm, in 2mm increments.</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>208160</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER635</BillingCode><PriorBillingCodes><PriorBillingCode>OF069</PriorBillingCode></PriorBillingCodes><Name>SKYHAWK Lateral Plate</Name><Description>Low profile Lateral Plate</Description><Size>6mm, 8mm, 10mm, 12mm, 14mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>206571</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF020</BillingCode><Name>Aurora SPINE System</Name><Description>Thoracolumbar plate</Description><Size>15mm-51mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>208160</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ032</BillingCode><Name>Aurora SPINE System</Name><Description>Thoracolumbar plate</Description><Size>15mm-51mm</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>217032</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER186</BillingCode><Name>SIGNUS Contact Thoracolumbar Plating System-Frame Plate</Name><Description>Signus Contact Thoracolumbar Plating System-Frame Plate</Description><Size>40-70 mm, in 5 mm increments (straight); 70-120 mm in 5 mm increments (10 deg angled)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>216749</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV155</BillingCode><Name>XLIF Modular Plate</Name><Description>Lateral plate</Description><Size>Small (8mm), Medium (10mm), Large (12mm)</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>209200</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV105</BillingCode><Name>Decade Lateral Plate System (plate)</Name><Description>The NuVasive Decade Plate System is indicated for use in the treatment of lumbar and lumbarsacral (L1-S1) spine instability.</Description><Size>2-4 Hole Static, 2-4 Hole Translating, Lengths 6-20</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>209200</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV157</BillingCode><Name>Halo Buttress Plate</Name><Description>Titanium Buttress Plate</Description><Size>21mm-25mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>209200</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW572</BillingCode><Name>LITe Plate System - Plate</Name><Description>Anterior and Lateral Lumbar Locking Plates</Description><Size>Buttress1Size, Universal and Sacral Length 21mm-37mm, Lateral Length 16mm- 28mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>277947</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC610</BillingCode><Name>Vantage</Name><Description>Vantage plates and Screws; Thoracic Plate</Description><Size>3.5 - 8cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI171</BillingCode><Name>Divergence-L Anterior/Oblique Lumbar Fusion System </Name><Description>Lumbar Plates </Description><Size>10-20mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW733</BillingCode><PriorBillingCodes><PriorBillingCode>ER024</PriorBillingCode></PriorBillingCodes><Name>Cayman Thoracolumbar Plate System / Plate</Name><Description>Thoracolumbar Plate, Titanium</Description><Size>21mm to 109mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>290395</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB106</BillingCode><Name>InterContinental Plate</Name><Description>Lateral Plate</Description><Size>20mm x 8mm - 21mm.</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>190063</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB012</BillingCode><Name>CITADEL® Anterior Lumbar Plate</Name><Description>Anterior Lumbar plate</Description><Size>20mm - 99mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>190969</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB009</BillingCode><Name>TRUSS® Thoracolumbar Plate</Name><Description>Thoracolumbar plate</Description><Size>22mm - 55mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>190063</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC612</BillingCode><Name>Vantage</Name><Description>Vantage Plates and Screws; ATL Plate</Description><Size>4 - 10cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB008</BillingCode><Name>TRUSS® Thoracolumbar Plate with slider</Name><Description>Thoracolumbar plate</Description><Size>45mm-99.5mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>190063</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ518</BillingCode><Name>AEGIS ALP</Name><Description>Curved anterior lumbar plate</Description><Size>4-25mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>148371</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI187</BillingCode><Name>PIVOX Oblique Lateral Spinal System</Name><Description>Plate</Description><Size>Small, Large</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF149</BillingCode><Name>XM Plate</Name><Description>Lumbar Fusion Plate</Description><Size>17-27mm, in 2mm increments.</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>208160</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB095</BillingCode><Name>PLYMOUTH Thoracolumbar Plate System Plate</Name><Description>Thoracolumbar Plate</Description><Size>15 - 24mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>190063</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY139</BillingCode><Name>Spinal Plate/Plate System AO/ASIF Spinal Implants</Name><Description>Anterior thoracolumbar plate - locking</Description><Size>40mm - 109mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>155808</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC819</BillingCode><Name>Pyramid +4</Name><Description>Anterior Plate</Description><Size>Height: 33mm - 45mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW776</BillingCode><PriorBillingCodes><PriorBillingCode>ER489</PriorBillingCode></PriorBillingCodes><Name>Cayman United Plate</Name><Description>Thoracolumbar Plate</Description><Size>16-24</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>293886</ARTG></ARTGs><Note>“To be reimbursed only when used with posterior supplemental fixation with other implants.”</Note><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER591</BillingCode><PriorBillingCodes><PriorBillingCode>OF032</PriorBillingCode></PriorBillingCodes><Name>Unity Lumbar Plate</Name><Description>Unity Plate</Description><Size>17-28mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>195018</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT019</BillingCode><Name>Unity+ Plates</Name><Description>Thoracolumbar plate</Description><Size>Depth: 22mm;  Length: 8mm, 9mm, 11mm, 13mm, 15mm, 24mm, 27,5mm, 30.5mm.</Size><SupplierCode>40227</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108567</GroupID><SubGroupID>112632</SubGroupID><ARTGs><ARTG>320879</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV164</BillingCode><Name>ACP Plate</Name><Description>Anterior Cervical Plates 1, 2, and 3 levels</Description><Size>16mm to 54mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><ARTGs><ARTG>209196</ARTG></ARTGs><MinimumBenefit>1179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV040</BillingCode><Name>Helix Mini Plate</Name><Description>Anterior cervical plate</Description><Size>20mm-50mm (2mm increments)</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><ARTGs><ARTG>133401</ARTG></ARTGs><MinimumBenefit>1179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BF009</BillingCode><Name>WinLoc Cervical Plate System - plate</Name><Description>Titanium anterior cervical plate</Description><Size>1-Level: 25mm, 27mm, 30mm, 33mm, 36mm
2-Level: 39mm, 42mm, 45mm, 48mm, 51mm, 54mm</Size><SupplierCode>40171</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><ARTGs><ARTG>218438</ARTG></ARTGs><MinimumBenefit>1179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB119</BillingCode><Name>Assure-X Anterior Cervical Plate System - Plates</Name><Description>Titanium Alloy Anterior Cervical Plate</Description><Size>1.8 mm profile, 16mm width, 10-54mm in length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><ARTGs><ARTG>190070</ARTG></ARTGs><MinimumBenefit>1179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI036</BillingCode><Name>Shark CP Locking Plate </Name><Description>Plate, titanium alloy</Description><Size>55mm length  or less </Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><ARTGs><ARTG>345367</ARTG></ARTGs><MinimumBenefit>1179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER457</BillingCode><Name>LnK Anterior Cervical Plate System/CastleLoc-P Anterior Cervical Plate System-Plate</Name><Description>LnK Anterior Cervical Plate System/CastleLoc-P Anterior Cervical Plate System-Plate, 1-3 levels</Description><Size>width 17mm x length (13-54mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><ARTGs><ARTG>286127</ARTG></ARTGs><MinimumBenefit>1179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM533</BillingCode><Name>Oryx Cervical Plate System </Name><Description>Titanium Cervical Plate System </Description><Size>57-85mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><ARTGs><ARTG>375676</ARTG></ARTGs><MinimumBenefit>1179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT007</BillingCode><Name>AXIS2 Anterior Cervical Plate</Name><Description>Anterior cervical plate</Description><Size>19.5mm - 53mm</Size><SupplierCode>40227</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><ARTGs><ARTG>320878</ARTG><ARTG>320879</ARTG></ARTGs><MinimumBenefit>1179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM530</BillingCode><Name>Cervical Plate 55mm or less</Name><Description>Cervical Plate 55mm or less</Description><Size>55 mm and smaller</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><ARTGs><ARTG>375676</ARTG></ARTGs><MinimumBenefit>1179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ059</BillingCode><Name>Aquila Spinal System</Name><Description>Anterior Cervical Plate</Description><Size>12mm-55mm length</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><ARTGs><ARTG>398970</ARTG></ARTGs><MinimumBenefit>1179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU129</BillingCode><Name>Mecta C Plates</Name><Description>Cervical Plates</Description><Size>L 3 to 4; 58 to 92 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>222455</ARTG></ARTGs><MinimumBenefit>908</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH086</BillingCode><Name>Ceplate Anterior Cervical Plate</Name><Description>Anterior Cervical Plate &gt;55mm</Description><Size>57.5 mm - 110 mm</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>366091</ARTG></ARTGs><MinimumBenefit>908</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH616</BillingCode><Name>HumanTech - Hero Cervical Plate System, Plate Lge</Name><Description>Cervical Plate Large</Description><Size>L: 57 - 97mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>316053</ARTG></ARTGs><MinimumBenefit>908</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH082</BillingCode><Name>Katia Anterior Cervical Plate - Long </Name><Description>Anterior Cervical Plate &gt; 55 mm</Description><Size>56 mm - 110 mm </Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>908</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM534</BillingCode><Name>Oryx Cervical Plate System </Name><Description>Titanium Cervical Plate </Description><Size>8-54mm </Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><ARTGs><ARTG>375676</ARTG></ARTGs><MinimumBenefit>1179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ119</BillingCode><PriorBillingCodes><PriorBillingCode>DZ084</PriorBillingCode></PriorBillingCodes><Name>CanAce Anterior Cervical Plating System</Name><Description>Spinal Fixation System</Description><Size>&gt;55mm</Size><SupplierCode>40393</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>346450</ARTG><ARTG>346439</ARTG><ARTG>346438</ARTG></ARTGs><MinimumBenefit>908</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER458</BillingCode><Name>LnK Anterior Cervical Plate System/CastleLoc-P Anterior Cervical Plate System-Plate, &gt;55mm</Name><Description>LnK Anterior Cervical Plate System/CastleLoc-P Anterior Cervical Plate System-Plate, &gt;55mm, 3-4 levels</Description><Size>width 17mm x length (57-97 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>286127</ARTG></ARTGs><MinimumBenefit>908</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BF010</BillingCode><Name>WinLoc Cervical Plate System - plate</Name><Description>Titanium anterior cervical plate</Description><Size>3-Level: 58mm, 62mm, 66mm, 70mm, 74mm, 78mm, 82mm
4-Level: 86mm, 90mm</Size><SupplierCode>40171</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>218438</ARTG></ARTGs><MinimumBenefit>908</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM529</BillingCode><Name>Cervical Plate &gt;55mm</Name><Description>Cervical Plate &gt;55mm</Description><Size>&gt;55mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>375676</ARTG></ARTGs><MinimumBenefit>908</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB194</BillingCode><Name>PROVIDENCE Anterior Cervical Plates</Name><Description>Low profile anterior cervical plates</Description><Size>10mm to 54mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><ARTGs><ARTG>190070</ARTG></ARTGs><MinimumBenefit>1179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ060</BillingCode><Name>Aquila Spinal System</Name><Description>Anterior Cervical Plate</Description><Size>56mm-97mm Length</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>398970</ARTG></ARTGs><MinimumBenefit>908</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER167</BillingCode><Name>Signus Anterior Cervical Plate - L3-L4</Name><Description>Pre-contoured titanium plate, secured onto the spinal vertebrae by either fixed or variable angle colour coded screws.</Description><Size>56mm - 100mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>122274</ARTG></ARTGs><MinimumBenefit>908</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT008</BillingCode><Name>AXIS2 Anterior Cervical Plate</Name><Description>Anterior cervical plate</Description><Size>57mm - 83mm</Size><SupplierCode>40227</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>320879</ARTG></ARTGs><MinimumBenefit>908</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY029</BillingCode><Name>Slim HP Plates</Name><Description>Plates</Description><Size>55 -105mm</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>287906</ARTG></ARTGs><MinimumBenefit>908</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB374</BillingCode><Name>Aesculap Cervical Systen</Name><Description>Titanium Alloy</Description><Size>All Sizes &lt; 55 mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><ARTGs><ARTG>134538</ARTG></ARTGs><MinimumBenefit>1179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ800</BillingCode><Name>Skyline Cervical Plate System</Name><Description>Skyline anterior cervical plate. Various size plates, Titanium</Description><Size>12-55mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><ARTGs><ARTG>194058</ARTG></ARTGs><MinimumBenefit>1179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY086</BillingCode><PriorBillingCodes><PriorBillingCode>DR029</PriorBillingCode></PriorBillingCodes><Name>Choice Spine Cervical Plate</Name><Description>Anterior Cervical Fusion Plate</Description><Size>Plate Lenths 10mm to 54mm (One, Two &amp; Three Level Plates)</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><ARTGs><ARTG>330080</ARTG></ARTGs><MinimumBenefit>1179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU130</BillingCode><Name>Mecta C Plates</Name><Description>Cervical Plates</Description><Size>L 1 to 3; 20 to 55 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><ARTGs><ARTG>222455</ARTG></ARTGs><MinimumBenefit>1179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ137</BillingCode><Name>Evolution Spine EMERGE Plate System- Plates-&gt;55mm</Name><Description>Evolution Spine EMERGE Plate System- Plates-&gt;55mm, Level 2-5</Description><Size>56-110 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>445230</ARTG></ARTGs><MinimumBenefit>908</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE791</BillingCode><Name>Admiral Cervical Plate</Name><Description>Admiral Cervical Plate &lt;55mm</Description><Size>7mm-54mm Length</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><ARTGs><ARTG>275780</ARTG></ARTGs><MinimumBenefit>1179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH088</BillingCode><Name>Ceplate Anterior Cervical Plate </Name><Description>Anterior Cervical Plate - Single or Multi level plate </Description><Size>22.5 mm - 55 mm </Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><ARTGs><ARTG>366091</ARTG></ARTGs><MinimumBenefit>1179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH084</BillingCode><Name>Katia Anterior Cervical Plate </Name><Description>Anterior Cervical Plate - Single or Multi level </Description><Size>20 mm - 53.5 mm</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><ARTGs><ARTG>312520</ARTG></ARTGs><MinimumBenefit>1179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ020</BillingCode><Name>Insignia Anterior Cervical Plating System </Name><Description>Plate, 3 - 5 level, Ti Alloy</Description><Size>&gt; 55mm length</Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>398575</ARTG></ARTGs><MinimumBenefit>908</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HC023</BillingCode><Name>Butterfly Plate</Name><Description>Cervical Plate</Description><Size>L:55-86mm</Size><SupplierCode>40349</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>201492</ARTG></ARTGs><MinimumBenefit>908</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE792</BillingCode><Name>Admiral Cervical Plate</Name><Description>Admiral Cervical Plate &gt;55mm</Description><Size>57mm-100mm Lengths</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>275780</ARTG></ARTGs><MinimumBenefit>908</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HC021</BillingCode><Name>Butterfly Plate</Name><Description>Cervical Plate</Description><Size>L : 21-55mm</Size><SupplierCode>40349</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><ARTGs><ARTG>201492</ARTG></ARTGs><MinimumBenefit>1179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ120</BillingCode><PriorBillingCodes><PriorBillingCode>DZ086</PriorBillingCode></PriorBillingCodes><Name>CanAce Anterior Cervical Plating System</Name><Description>Spinal Fixation System</Description><Size>≤55mm</Size><SupplierCode>40393</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><ARTGs><ARTG>346439</ARTG><ARTG>346450</ARTG><ARTG>346438</ARTG></ARTGs><MinimumBenefit>1179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ019</BillingCode><Name>Insignia Anterior Cervical Plating System </Name><Description>Plate, 1-3 level, Ti Alloy</Description><Size>16 - 54mm length </Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><ARTGs><ARTG>398575</ARTG></ARTGs><MinimumBenefit>1179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV165</BillingCode><Name>ACP Plate &gt; 55mm</Name><Description>Anterior cervical plate 3, 4 and 5 levels</Description><Size>56mm to 110mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>209196</ARTG></ARTGs><MinimumBenefit>908</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI037</BillingCode><Name>Shark CP Locking Plate</Name><Description>Plate, titanium alloy. </Description><Size>greater than 55mm length </Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>345367</ARTG></ARTGs><MinimumBenefit>908</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB140</BillingCode><Name>Aesculap Cervical System</Name><Description>Titanium Alloy</Description><Size>All Sizes &gt;55mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>134538</ARTG></ARTGs><MinimumBenefit>908</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB120</BillingCode><Name>Assure-X Anterior Cervical Plate System - Plates &gt; 55mm</Name><Description>Titanium Alloy Anterior Cervical Plate</Description><Size>1.8mm profile, 16mm width, 57-100 mm in length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>190070</ARTG></ARTGs><MinimumBenefit>908</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB195</BillingCode><Name>PROVIDENCE Anterior Cervical Plates &gt; 55mm</Name><Description>Low profile anterior cervical plates</Description><Size>57mm to 104mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>190070</ARTG></ARTGs><MinimumBenefit>908</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ801</BillingCode><Name>Skyline Cervical Plate System</Name><Description>Skyline anterior cervical plate. Various size plates. Titanium</Description><Size>56-105mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>194058</ARTG></ARTGs><MinimumBenefit>908</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH615</BillingCode><Name>HumanTech - Hero Cervical Plate System - Plates</Name><Description>Cervical Plate</Description><Size>L: 21 - 53mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><ARTGs><ARTG>316053</ARTG></ARTGs><MinimumBenefit>1179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE659</BillingCode><Name>Shoreline ACS TruProfile Cervical Plate</Name><Description>Anterior cervical plating system</Description><Size>Holes: 2, 3 and 4 
Length: 5-12mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><ARTGs><ARTG>298002</ARTG></ARTGs><MinimumBenefit>1179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC034</BillingCode><Name>Ulrich Anterior Cervical Plate &gt;55mm</Name><Description>Ulrich Anterior Cervical Plating System - Plate 55mm+</Description><Size>57-84mm</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>377912</ARTG></ARTGs><MinimumBenefit>908</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY085</BillingCode><PriorBillingCodes><PriorBillingCode>DR028</PriorBillingCode></PriorBillingCodes><Name>Choice Spine Cervical Plate 55+</Name><Description>Anterior Cervical Fusion Plate</Description><Size>Plate Lengths 57mm to 105mm (Three, Four and Five Level Plates)</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><Suffix>&gt;55mm</Suffix><ARTGs><ARTG>330080</ARTG></ARTGs><MinimumBenefit>908</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC033</BillingCode><Name>Ulrich Anterior Cervical Plate  </Name><Description>Ulrich Anterior Cervical Plating System - Plate</Description><Size>12mm - 54mm</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112633</SubGroupID><ARTGs><ARTG>377912</ARTG></ARTGs><MinimumBenefit>1179</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV033</BillingCode><Name>Traverse Plate</Name><Description>Plate</Description><Size>Fixed Plate - Size 15/20/25/30/35/40/45/50/55/60/65/70/80/90mm
Compression Plate - Size 45/50/55/60/65/70/75/80/85/95/105mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112634</SubGroupID><ARTGs><ARTG>132467</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV095</BillingCode><Name>Brigade Anterior Plate</Name><Description>Anterior plate</Description><Size>26-42mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112634</SubGroupID><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW045</BillingCode><PriorBillingCodes><PriorBillingCode>ZI951</PriorBillingCode></PriorBillingCodes><Name>Timberline Lateral Fusion System</Name><Description>Lateral Plate</Description><Size>6-16mm</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112634</SubGroupID><ARTGs><ARTG>287242</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE798</BillingCode><Name>Meridian ALIF Plate</Name><Description>Titanium ALIF Plate </Description><Size>2 &amp; 4 Hole, Size 10mm-20mm </Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112634</SubGroupID><ARTGs><ARTG>298002</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU043</BillingCode><Name>Juliet Ti LL plate</Name><Description>Titanium lateral plate</Description><Size>2 holes or 4 holes  Width: 13mm, 17mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112634</SubGroupID><ARTGs><ARTG>338461</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM526</BillingCode><Name>Buttress Plates </Name><Description>Buttress Plates used to stabilise the allograft or autograft at on level (L1-S1). </Description><Size>Plates 20, 24, 28 mm  Screws 5.5 &amp; 6.5 mm diameter, 20 - 30mm long</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112634</SubGroupID><ARTGs><ARTG>375812</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ057</BillingCode><Name>Aurora Spinal System</Name><Description>Thoracolumbar Plate</Description><Size>17-27mm</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112634</SubGroupID><ARTGs><ARTG>335884</ARTG></ARTGs><MinimumBenefit>2039</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE771</BillingCode><Name>NorthStar OCT  </Name><Description>NorthStar OCT Occipital Plate</Description><Size>Extra Small - Small - Large</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112635</SubGroupID><ARTGs><ARTG>275794</ARTG></ARTGs><MinimumBenefit>1728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ048</BillingCode><Name>Invictus Occiptal Plate </Name><Description>Occipital Plate ,Ti Alloy</Description><Size>48 - 66 mm</Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112635</SubGroupID><ARTGs><ARTG>398576</ARTG></ARTGs><MinimumBenefit>1728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW032</BillingCode><PriorBillingCodes><PriorBillingCode>ZI913</PriorBillingCode></PriorBillingCodes><Name>Virage Occiptial Plates</Name><Description>Modular adjustable occipital plates</Description><Size>small, medium, large</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112635</SubGroupID><ARTGs><ARTG>111775</ARTG></ARTGs><MinimumBenefit>1728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU166</BillingCode><Name>MUST Mini Occipital Plate</Name><Description>Occipital Plate</Description><Size>Small to Large. X, Y and T Shape.</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112635</SubGroupID><ARTGs><ARTG>291175</ARTG></ARTGs><MinimumBenefit>1728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI476</BillingCode><PriorBillingCodes><PriorBillingCode>NK091</PriorBillingCode></PriorBillingCodes><Name>Occipital plates</Name><Description>Occipital plates</Description><Size>All sizes</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112635</SubGroupID><ARTGs><ARTG>295277</ARTG></ARTGs><MinimumBenefit>1728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC293</BillingCode><Name>Vertex Spinal System</Name><Description>Occipital Plate</Description><Size>24 - 40 mm length</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112635</SubGroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>1728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI268</BillingCode><Name>Infinity Spinal System</Name><Description>Occipital Plate</Description><Size>Small, standard</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112635</SubGroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>1728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU061</BillingCode><Name>Perla Posterior Occipito-Cervico-Thoracic fixation system - occipital plate</Name><Description>Occipital plate</Description><Size>31 - 45 mm, Small, medium, large</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112635</SubGroupID><ARTGs><ARTG>338498</ARTG></ARTGs><MinimumBenefit>1728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY380</BillingCode><Name>Occipito-Cervical Fusion System</Name><Description>Occipital Plate Medial / Lateral, Pure titanium</Description><Size>50mm / 60mm width, 3 or 4 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112635</SubGroupID><ARTGs><ARTG>293275</ARTG></ARTGs><MinimumBenefit>1728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV027</BillingCode><Name>VuePoint Keel Plate (occipital)</Name><Description>Plate (occipital)</Description><Size>35/40/45mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112635</SubGroupID><ARTGs><ARTG>209198</ARTG></ARTGs><MinimumBenefit>1728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER637</BillingCode><PriorBillingCodes><PriorBillingCode>OF067</PriorBillingCode></PriorBillingCodes><Name>Centurion Occipital Plate</Name><Description>Occipital Plate</Description><Size>20-30mm Rod Spacing  30- 40mm Rod Spacing  40-50mm Rod Spacing</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112635</SubGroupID><ARTGs><ARTG>195012</ARTG></ARTGs><MinimumBenefit>1728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER322</BillingCode><Name>Ulrich posterior OCT System (neon3)-Plate</Name><Description>Ulrich posterior OCT System (neon3)-Plate, occipital, midline for occipital and standard rod (4 mm).</Description><Size>47,57 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112635</SubGroupID><ARTGs><ARTG>279706</ARTG></ARTGs><MinimumBenefit>1728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW740</BillingCode><PriorBillingCodes><PriorBillingCode>ER034</PriorBillingCode></PriorBillingCodes><Name>K2M Spinal Systems- Occipital Plate</Name><Description>Occipital Plate for posterior occipital/cervical/thoracic fixation</Description><Size>24-50mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112635</SubGroupID><ARTGs><ARTG>159828</ARTG></ARTGs><MinimumBenefit>1728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY038</BillingCode><Name>Reform POCT Occipital Plate</Name><Description>Occipital Plate</Description><Size>25mm to 50mm</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112635</SubGroupID><ARTGs><ARTG>287906</ARTG></ARTGs><MinimumBenefit>1728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM426</BillingCode><PriorBillingCodes><PriorBillingCode>NK102</PriorBillingCode></PriorBillingCodes><Name>Occipital Plate</Name><Description>Occipital Plate</Description><Size>Multiple sizes to suit patient anatomy</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112635</SubGroupID><ARTGs><ARTG>159605</ARTG></ARTGs><MinimumBenefit>1728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK226</BillingCode><Name>Oasys-Occipito Cervico Thoracic System</Name><Description>Occipital Plate</Description><Size>Mini, SML, MED, LGE, LGE Long, 100 deg, 130 deg</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112635</SubGroupID><ARTGs><ARTG>94635</ARTG></ARTGs><MinimumBenefit>1728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB161</BillingCode><Name>QUARTEX Occipital Plate</Name><Description>Occipital Plate</Description><Size>Small to Large</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112635</SubGroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>1728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB050</BillingCode><Name>ELLIPSE® Stabilization System Occipital Plate</Name><Description>Occipital Plate</Description><Size>Small to Large</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112635</SubGroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>1728</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB174</BillingCode><Name>Haven Dual Plates</Name><Description>Dual Laminoplasty plates</Description><Size>32mm - 39mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112637</SubGroupID><Suffix>Bilateral laminoplasty plate</Suffix><ARTGs><ARTG>219536</ARTG></ARTGs><MinimumBenefit>832</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB046</BillingCode><Name>Laminoplasty Mini Plate</Name><Description>Laminoplasty Plate</Description><Size>10/12/14mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112637</SubGroupID><ARTGs><ARTG>214788</ARTG></ARTGs><MinimumBenefit>660</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH707</BillingCode><Name>Ultio Laminoplasty Plate</Name><Description>Plate</Description><Size>Small - 25,7mm  Med - 27,1mm  Lge - 28,9mm  X-Large - 30,3mm  Standard support plate - 15,35mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112637</SubGroupID><ARTGs><ARTG>330538</ARTG></ARTGs><MinimumBenefit>660</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI174</BillingCode><Name>Centerpiece</Name><Description>TiMesh LP</Description><Size>Various</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112637</SubGroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>660</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV054</BillingCode><Name>Leverage LFS (Traditional Plate)</Name><Description>Laminoplasty plate</Description><Size>8/9.5/11/12.5mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112637</SubGroupID><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>660</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB092</BillingCode><Name>CANOPY Laminoplasty System Plate</Name><Description>Laminoplasty Plate</Description><Size>5 - 13mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112637</SubGroupID><ARTGs><ARTG>219536</ARTG></ARTGs><MinimumBenefit>660</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB149</BillingCode><Name>Canopy Radiolucent Spacer</Name><Description>Slide-on PEEK spacer with graft packing chamber</Description><Size>5-13mm in 2mm increments</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107667</SubCategoryID><GroupID>108568</GroupID><SubGroupID>112637</SubGroupID><ARTGs><ARTG>219536</ARTG></ARTGs><MinimumBenefit>660</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB078</BillingCode><Name>REVERE Rods, Dual Unit</Name><Description>Scoliosis Rods</Description><Size>5.5mm - 6.35mm 450mm - 500mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108574</GroupID><SubGroupID>112639</SubGroupID><ARTGs><ARTG>190039</ARTG></ARTGs><MinimumBenefit>1352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY026</BillingCode><Name>Katana Unit Rods</Name><Description>Katana Unit Rods</Description><Size>200 - 500mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108574</GroupID><SubGroupID>112639</SubGroupID><ARTGs><ARTG>396083</ARTG></ARTGs><MinimumBenefit>1352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY384</BillingCode><Name>Speciality Rods</Name><Description>Unit Rod, Titanium / Stainless Steel</Description><Size>5mm, 6mm diameter
250mm - 500mm length</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108574</GroupID><SubGroupID>112639</SubGroupID><ARTGs><ARTG>133401</ARTG></ARTGs><MinimumBenefit>1352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC537</BillingCode><Name>Danek Unit Rod System</Name><Description>Scoliosis Rods</Description><Size>5.5mm to 6.35mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108574</GroupID><SubGroupID>112639</SubGroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>1352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV101</BillingCode><Name>Vuepoint (Hinged Rod)</Name><Description>The VuePoint OCT System is intended to promote fusion of the cervical spine and occipito-thoracic junction (Occiput-T3), and is indicated for; 1: Degenerative disc disease (as defined by back pain of discogenic origin with degeneration of the disc confimred by patient history and radiographic studies), 2: Degenerative spondylolisthesis with objective evidence of neurologic impairment, 3: Fractur/Dislocation, 4: Spinal Stenosis, 5: Atlantaxial fracture with instability, 6; Occipitocervical dislocation, 7: Spinal tumor and/or 8: revision of previous cervical spine surgery</Description><Size>one size only</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108574</GroupID><SubGroupID>112640</SubGroupID><ARTGs><ARTG>132466</ARTG></ARTGs><MinimumBenefit>1350</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ034</BillingCode><Name>Invictus Hinged Rod</Name><Description>Hinged Rod. Ti Alloy</Description><Size>Cranial: (3.5, 4.0) mm diameter x 90mm length   Caudal, (3.5, 4.0)mm diameter  x 210mm length </Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108574</GroupID><SubGroupID>112640</SubGroupID><ARTGs><ARTG>398576</ARTG></ARTGs><MinimumBenefit>1350</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM428</BillingCode><PriorBillingCodes><PriorBillingCode>NK104</PriorBillingCode></PriorBillingCodes><Name>Pre-Bent rods</Name><Description>Pre-Bent rods</Description><Size>3.5mm diameter rods</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108574</GroupID><SubGroupID>112640</SubGroupID><ARTGs><ARTG>159605</ARTG></ARTGs><MinimumBenefit>1350</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER318</BillingCode><Name>Ulrich posterior OCT System (neon3)-Rods, occipital</Name><Description>Ulrich posterior OCT System (neon3)-Rods, occipital, various shapes</Description><Size>dia 4 mm x length (240-300 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108574</GroupID><SubGroupID>112640</SubGroupID><ARTGs><ARTG>279706</ARTG></ARTGs><MinimumBenefit>1350</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB163</BillingCode><Name>QUARTEX Occipital Jointed Rod</Name><Description>Occipital Jointed Rods</Description><Size>Left and Right, 4mm -Left and Right</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108574</GroupID><SubGroupID>112640</SubGroupID><ARTGs><ARTG>190061</ARTG></ARTGs><MinimumBenefit>1350</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI271</BillingCode><Name>Infinity Spinal System</Name><Description>Occipital Hinged Rod</Description><Size>Length 100 - 200mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108574</GroupID><SubGroupID>112640</SubGroupID><ARTGs><ARTG>169514</ARTG></ARTGs><MinimumBenefit>1350</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HC019</BillingCode><Name>KM Occipital Plate</Name><Description>Occipital Plate Rod</Description><Size>3-5mm</Size><SupplierCode>40349</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108574</GroupID><SubGroupID>112640</SubGroupID><ARTGs><ARTG>201492</ARTG></ARTGs><MinimumBenefit>1350</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW036</BillingCode><PriorBillingCodes><PriorBillingCode>ZI915</PriorBillingCode></PriorBillingCodes><Name>Virage Occipital Rod</Name><Description>Occipital Hinged Rod</Description><Size>One size</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107668</SubCategoryID><GroupID>108574</GroupID><SubGroupID>112640</SubGroupID><ARTGs><ARTG>111775</ARTG></ARTGs><MinimumBenefit>1350</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC022</BillingCode><PriorBillingCodes><PriorBillingCode>JA031</PriorBillingCode></PriorBillingCodes><Name>Stalif  with required screws</Name><Description>Cervical Interbody Fusion Cage - Lordotic(Tapered)/Anatomic(Domed) and screws</Description><Size>Depth 12 - 16mm, Height 5.5 - 11.5mm</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>196068</ARTG></ARTGs><ChangeExplanation>Change to Product name, Product Group, ARTG, Description</ChangeExplanation><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC020</BillingCode><PriorBillingCodes><PriorBillingCode>JA027</PriorBillingCode></PriorBillingCodes><Name>Stalif C cage with the required screws</Name><Description>Interbody Fusion Cage - Domed and screws</Description><Size>5.5 - 9.5</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>196068</ARTG></ARTGs><ChangeExplanation>Change to Product name, Product Group, ARTG, Description</ChangeExplanation><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH762</BillingCode><PriorBillingCodes><PriorBillingCode>LM411</PriorBillingCode></PriorBillingCodes><Name>IRIX - C Implants</Name><Description>Cervical intergrated fusion system</Description><Size>18 x 14mm and 16 x 13mm; Heights 5 - 12mm; Shape - Lordotic and parallel</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>160750</ARTG></ARTGs><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ326</BillingCode><Name>Hexanium ACIF</Name><Description>Integrated ACDF Cage with screws for Integral Fixation</Description><Size>Cage Height 5mm-12mm, Small, Medium, Large Screw Length 10-16mm</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>421975</ARTG></ARTGs><ChangeExplanation>New listing</ChangeExplanation><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Insert</ActionFlag><CycleStartDate>2024-08-08</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV103</BillingCode><Name>CoRoent Small Interlock Cage with screws</Name><Description>The CoRoent Small Interlock System is a stand-alone anterior cervical interbody fusion system indicated for use in skeletally mature patients with degenerative disc disease (DDD) at one level from C2-T1.</Description><Size>Width 14-18mm x length 10-14mm x Height 5-16mm x Lordosis 0-20˚</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>339170</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG</ChangeExplanation><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH587</BillingCode><Name>Cervical Spine Truss System - Stand Alone Cage and screw</Name><Description>Stand alone Cervical Interbody Fusion Device</Description><Size>12-14 x 15-17 x 5-12mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>252733</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Description, Size</ChangeExplanation><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC013</BillingCode><PriorBillingCodes><PriorBillingCode>BF022</PriorBillingCode></PriorBillingCodes><Name>Redmond Cervical Cage  with screws</Name><Description>Stand-alone cervical interbody fusion cage with locking screws</Description><Size>14mm L x 15mm W; 5mm - 12mm H  15mm L x 15mm W; 5mm - 12mm H  15mm L x 17mm W; 5mm - 12mm H</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>211536</ARTG></ARTGs><ChangeExplanation>Change to Product name, Product Group, ARTG, Description</ChangeExplanation><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IB001</BillingCode><Name>STACC Cervical Cage</Name><Description>PEEK Stand alone interbody fusion cage</Description><Size>5.5, 6.5, 7.5, 8.5 (Height) x 14mm (Width)</Size><SupplierCode>40009</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>188902</ARTG></ARTGs><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB065</BillingCode><Name>COALITION Spacer</Name><Description>ACDF Spacer</Description><Size>12mm x 14mm, 14mm x 16mm and 15mm x 18mm ,5mm - 12mm height</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>190040</ARTG></ARTGs><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU066</BillingCode><Name>Tryptik MC cage/plate/screw</Name><Description>Integrated titanium anterior fixation plate with screws and PEEK cage</Description><Size>Cage: Height: 5mm, 6mm, 7mm.  Depth: 12mm, 14mm.    Screws: Dia.: 4 and 4.5 mm. Length: 12 to 18 mm.</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>166194</ARTG></ARTGs><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY029</BillingCode><PriorBillingCodes><PriorBillingCode>EV033</PriorBillingCode></PriorBillingCodes><Name>HRCc Cervical Locking Cage</Name><Description>Cervical Locking Cage</Description><Size>Size 4 to 9  Standard and Large</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>322672</ARTG></ARTGs><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JP009</BillingCode><PriorBillingCodes><PriorBillingCode>JA030</PriorBillingCode></PriorBillingCodes><Name>Stalif C cage with the required screws</Name><Description>Interbody Fusion Cage - Tapered and screws</Description><Size>5.5 – 9.5</Size><SupplierCode>39934</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>196068</ARTG></ARTGs><ChangeExplanation>Change to Product name, Product Group, ARTG, Description</ChangeExplanation><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB207</BillingCode><Name>HEDRON IC</Name><Description>3D Printed Integrated ACDF Plate-Spacer including screws</Description><Size>Footprint: 12X14, 14X16, 15X18mm  Height: 5-12mm  Screws 3.6-4.2mm, 12-20mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>353400</ARTG></ARTGs><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI154</BillingCode><Name>Divergence Anterior Cervical Fusion Standalone System</Name><Description>Divergence anterior cervical fusion Standalone interbody device</Description><Size>5-10mm height</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI327</BillingCode><PriorBillingCodes><PriorBillingCode>ER470</PriorBillingCode></PriorBillingCodes><Name>Endoskeleton TCS</Name><Description>Titanium Stand Alone ADCF Cage, sterile or non-sterile also with Nanolock™ surface technology, sterile</Description><Size>12-16mm Length, 14-18mm Width, 5-12mm Heights</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>285244</ARTG><ARTG>315580</ARTG></ARTGs><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ084</BillingCode><PriorBillingCodes><PriorBillingCode>JQ058</PriorBillingCode></PriorBillingCodes><Name>IdentiTi Cervical SA Spacer</Name><Description>Integral Fixation Spacer including two Fixation Screws. Ti Alloy</Description><Size>Cage: (5 - 10)mm x (14 - 18)mm footprint  x (12 -  16)mm height,  (7- 15) degrees lordosis   Screws: (3.5 - 4)mm diameter x (12-18)mm length self tapping or self drillling, single or dual lead </Size><SupplierCode>40401</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>397510</ARTG></ARTGs><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC021</BillingCode><PriorBillingCodes><PriorBillingCode>JA030</PriorBillingCode></PriorBillingCodes><Name>Stalif C cage with the required screws</Name><Description>Interbody Fusion Cage - Tapered and screws</Description><Size>5.5 – 9.5</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>196068</ARTG></ARTGs><ChangeExplanation>Change to Product name, Product Group, ARTG, Description</ChangeExplanation><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE662</BillingCode><Name>Shoreline ACS NoProfile Cage</Name><Description>Cervical cage with no anterior profile</Description><Size>Footprints: 16 x 14mm and 18 x 15mm
Heights: 6 -12 mm
7 Degrees Lordosis</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>298002</ARTG></ARTGs><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GK001</BillingCode><Name>3D fusion ACDF</Name><Description>Stand-alone anterior cervical discectomy and fusion (ACDF) fixation system: cage, screws and locking cap.    The 3DMorphic ACDF integral screw fixation device (cage) is intended to immobilize, stabilize and maintain the height between instrumented segments and support loading in the cervical spine until fusion occurs. The 3DMorphic ACDF device has a trapezoidal, ring shaped footprint with a central graft window that can receive bone graft. The superior and inferior surfaces of the device are made to fit the patient’s vertebral endplate anatomy and feature serrated teeth to resist expulsion from the interbody space. The anterior surface of the device features screw holes and a threaded locking cap hole as the device is designed for use with integral fixation screws and a locking cap. The device is offered in a variety of footprints, heights, lordotic and scoliotic angles according to the patient’s anatomy and surgeon’s specifications. </Description><Size>Footprints: 10mm to 23mm L x 08mm to 30mm W. Minimum anterior height is 6mm.         L = Anterior-posterior depth (DD in the catalogue), W = width (WW in the catalogue), height and angle vary according to surgeon request as the devices are custom-made.     Please refer to attached catalogue for full size range.     </Size><SupplierCode>40226</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>406173</ARTG></ARTGs><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY034</BillingCode><Name>Dakota ACDF System</Name><Description>Dakota ACDF System comprising of ACDF cage, ACDF plate, locking screw, bone screw</Description><Size>5mm to 12mm heights</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>317596</ARTG></ARTGs><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW518</BillingCode><Name>AVS Anchor C Cervical Cage System</Name><Description>Cervical Cage with integrated screws</Description><Size>Cages: 12 x 14mm, 14 x 16mm, height range ; 6mm-12 mm.) 0, 4 and 8 degree angulation, Screws: Diameter 3.5-4mm Length 8-14mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>315081</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Description, Size</ChangeExplanation><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JP006</BillingCode><PriorBillingCodes><PriorBillingCode>JA027</PriorBillingCode></PriorBillingCodes><Name>Stalif C cage with the required screws</Name><Description>Interbody Fusion Cage - Domed and screws</Description><Size>5.5 - 9.5</Size><SupplierCode>39934</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>196068</ARTG></ARTGs><ChangeExplanation>Change to Product name, Product Group, ARTG, Description</ChangeExplanation><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY052</BillingCode><Name>Mako ACDF Cage</Name><Description>ACDF Locking Cage</Description><Size>Small, Medium, Large, Extra-Large 6 and 9 degrees 5mm to 10mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>393044</ARTG></ARTGs><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY110</BillingCode><PriorBillingCodes><PriorBillingCode>EV013</PriorBillingCode></PriorBillingCodes><Name>Cato ACDF Standalone Cage with screws</Name><Description>Interbody Fusion Cages are used to restore disc height and support loading during intervertebral body fusion.</Description><Size>Medium, Large – 6°, 9° and 12°, height 4-10mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>248234</ARTG></ARTGs><ChangeExplanation>Change to Product name, Product Group, ARTG</ChangeExplanation><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BF022</BillingCode><Name>Redmond Cervical Cage</Name><Description>Stand-alone cervical interbody fusion cage with locking cap</Description><Size>14mm L x 15mm W; 5mm - 12mm H
15mm L x 15mm W; 5mm - 12mm H
15mm L x 17mm W; 5mm - 12mm H</Size><SupplierCode>40171</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>211536</ARTG></ARTGs><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB006</BillingCode><Name>DCS System</Name><Description>Anterior cervical interbody fusion system</Description><Size>Cage Height: 5/6/7/8/9/10/11/12 mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>214788</ARTG></ARTGs><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC005</BillingCode><Name>Alias Cage with screws</Name><Description>PEEK Fusion Cage with Plasma coating  with screws</Description><Size>5-9mm, 4, 8 and 12 degree, Flat and contoured options</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>268893</ARTG></ARTGs><ChangeExplanation>Change to Product name, Product Group, ARTG, Description</ChangeExplanation><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW039</BillingCode><PriorBillingCodes><PriorBillingCode>ZA052</PriorBillingCode></PriorBillingCodes><Name>ROI-C Cervical Cage</Name><Description>A cervical cage for anterior approaches to cervical spine</Description><Size>Footprints 12x14, 12x15.5, 14x14, 14x15.5; 14x17mm; Heights 4.5mm to 10mm; Anchors: Short, Long</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>188175</ARTG><ARTG>188176</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU177</BillingCode><Name>Mecta-C Stand Alone System</Name><Description>TiPEEK Anterior cervical cages + screws</Description><Size>Height: from 5 mm to 12 mm in 1 mm increments  15 mm x 13 mm, 16 mm x 14 mm, 18 mm x 15 mm  7° lordosis</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>222456</ARTG><ARTG>333435</ARTG></ARTGs><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY063</BillingCode><PriorBillingCodes><PriorBillingCode>DR031</PriorBillingCode></PriorBillingCodes><Name>Hygro-C Integrated ACDF with screws</Name><Description>Integrated ACDF Cage with screws for Integral Fixation</Description><Size>14mm-16mm x 16mm-19mm x 4mm-9mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>330365</ARTG></ARTGs><ChangeExplanation>Change to Product name, Product Group, ARTG</ChangeExplanation><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY055</BillingCode><Name>Tesera SC / Tesera-k SC</Name><Description>Integrated Fusion Cage – Construct achieves integral fixation with screws and a locking mechanism</Description><Size>Foot Print (14.5-19mm) Wide x (12.5 - 16mm) Deep x (5-12mm) Height,  2-12 Degrees Lordosis</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>354092</ARTG></ARTGs><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU011</BillingCode><Name>Scarlet AC-T Cervical Cage</Name><Description>Cervical cage - anatomical, lordotic</Description><Size>Height: 5mm, 6mm, 7mm, 8mm, 9mm, 10mm
Footprint: 12 x 15mm (Small); 14 x 17mm (Large)</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>166194</ARTG></ARTGs><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY752</BillingCode><Name>Zero-P</Name><Description>Anterior Cervical Interbody Fusion System with locking screws</Description><Size>5-12mm Height</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>293275</ARTG><ARTG>293276</ARTG><ARTG>231839</ARTG></ARTGs><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI482</BillingCode><PriorBillingCodes><PriorBillingCode>NK152</PriorBillingCode></PriorBillingCodes><Name>Cervical Fusion Cage</Name><Description>Cervical Fusion Cage</Description><Size>Multiple sizes for patient anatomy</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>340293</ARTG></ARTGs><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ046</BillingCode><Name>Borealis Spine System</Name><Description>Anterior Cervical Inerbody Fusion Cage and Screws</Description><Size>Medium - Large</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>217033</ARTG><ARTG>217031</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Description, Size</ChangeExplanation><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER595</BillingCode><PriorBillingCodes><PriorBillingCode>OF054</PriorBillingCode></PriorBillingCodes><Name>Lonestar Cervical Stand Alone System Cage</Name><Description>The Lonestar Cervical Stand Alone device is a stand-alone cervical cage system consisting of cages, screws and a anti-backout cover plate. The Lonestar is manufactured from PEEK and Titanium with Titanium Bone Screws.</Description><Size>Cage: 15-17mm x 13-15mmx6-9 mm; 7 degrees; Cover Plate: 9.9x5.1 mm; Bone Screw: dia 3.6-4.0mmx Length 12-16 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>206571</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT003</BillingCode><Name>SPICCA-S2 Anterior Cervical Fusion Cage and bone fixation screws</Name><Description>Anterior cervical fusion cage; PEEK, Titanium coated PEEK, or 3D printed Titanium including bone fixation screws.</Description><Size>Cage: Footprints: 15mm x 14mm, 17.5mm x 15mm, 19.5mm x 17mm; Height: 4mm - 10mm; Lordosis: 7 or 12 degrees. Screws: Diameter: 3.3 &amp; 3.7mm; Length: 13mm - 21mm.</Size><SupplierCode>40227</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>320878</ARTG><ARTG>322720</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Description, Size</ChangeExplanation><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW771</BillingCode><PriorBillingCodes><PriorBillingCode>ER472</PriorBillingCode></PriorBillingCodes><Name>Chesapeake Cervical PEEK</Name><Description>Cervical fusion cage with integrated fixation</Description><Size>Heights 5-12mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>159146</ARTG></ARTGs><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY028</BillingCode><PriorBillingCodes><PriorBillingCode>EV026</PriorBillingCode></PriorBillingCodes><Name>Revolution Standalone ACDF cage with screws</Name><Description>Interbody Fusion Cages are used to restore disc height and support loading during intervertebral body fusion.</Description><Size>Standard – 6 and 9 degrees, height 4-10mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>236042</ARTG></ARTGs><ChangeExplanation>Change to Product name, Product Group, ARTG</ChangeExplanation><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW747</BillingCode><PriorBillingCodes><PriorBillingCode>ER137</PriorBillingCode></PriorBillingCodes><Name>Chesapeake Cervical</Name><Description>Cage Ti with integral fixation with screws</Description><Size>Cages: Height: 5mm - 10mm, Screws: Diameter: 3.5mm - 3.85mm. Lengths: 12mm to 18mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>159146</ARTG><ARTG>193652</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Description, Size</ChangeExplanation><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JP010</BillingCode><PriorBillingCodes><PriorBillingCode>JA031</PriorBillingCode></PriorBillingCodes><Name>Stalif cage with the required screws</Name><Description>Cervical Interbody Fusion Cage - Lordotic(Tapered)/Anatomic(Domed) and screws</Description><Size>Depth 12 - 16mm, Height 5.5 - 11.5mm</Size><SupplierCode>39934</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112641</SubGroupID><ARTGs><ARTG>196068</ARTG></ARTGs><ChangeExplanation>Change to Product name, Product Group, ARTG, Description</ChangeExplanation><MinimumBenefit>4161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM514</BillingCode><Name>ALIF Cage construct including screws and cover plate for integral fixation</Name><Description>ALIF Cage construct including screws and cover plate for integral fixation</Description><Size>Cage 10 - 20mm (H) x 20, 26, 40mm (W) x 8°, 14°, 20°, 30°  Screws 5.5mm, 20-30  Cover Plate Small, Large</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>367230</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ045</BillingCode><Name>Australis Spine System</Name><Description>Thoracolumbar Cage IF</Description><Size>extra small - extra large</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>217031</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER597</BillingCode><PriorBillingCodes><PriorBillingCode>OF075</PriorBillingCode></PriorBillingCodes><Name>PILLAR SA</Name><Description>ALIF Cage constructed of PEEK with titanium cover plate and bone screws</Description><Size>Cage: 33-43mm x 28-32mm x 12.5-18mm, Lordosis - 7 -12 degrees; Cover plate - 33mm-43mm; Bone screw; dia 5-5.5 mm x length 20-35mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>206571</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Description, Size</ChangeExplanation><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW743</BillingCode><PriorBillingCodes><PriorBillingCode>ER046</PriorBillingCode></PriorBillingCodes><Name>Chesapeake Thoracolumbar Spinal System</Name><Description>Thoracolumbar Peek Cage with Ti Screws</Description><Size>Cages: Footprint: 24mm - 30mm x 30mm - 40mm Height: 11mm - 21mm, Screws: Diameter 5.5mm Lengths: 20-30mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>159146</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Description, Size</ChangeExplanation><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC017</BillingCode><PriorBillingCodes><PriorBillingCode>SF157</PriorBillingCode></PriorBillingCodes><Name>Nik-Alias Cage</Name><Description>Anterior Lumbar Cage with integral fixation (PEEK, HA PEEK, Titanium, Porous Titanium)</Description><Size>Angle 0 - 12 degrees, Length 40 - 60mm, Height 8 - 16mm</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>181030</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC024</BillingCode><PriorBillingCodes><PriorBillingCode>JA029</PriorBillingCode></PriorBillingCodes><Name>Stalif Midline II Ti  cage with the required screws</Name><Description>Interbody Fusion Cage</Description><Size>30-42</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>196068</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG</ChangeExplanation><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ149</BillingCode><Name>Evolution Spine E3D-A Interbody System-Integrated Fusion Cage</Name><Description>E3D-A Interbody-ALIF integrated sterile fusion cage with screws and optional cover plate, non-sterile.</Description><Size>Footprint: (32-40mm) x (24-28mm) Height: 11-21 mm Lordosis: 8-30 degrees</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>445956</ARTG><ARTG>445950</ARTG><ARTG>445955</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY032</BillingCode><PriorBillingCodes><PriorBillingCode>EV030</PriorBillingCode></PriorBillingCodes><Name>Evolution Altus ALIF Cage with screws</Name><Description>ThoracoLumbar ALIF Cage with screws</Description><Size>Small (34x25mm) 8 - 18 degrees, 10 - 18mm  Medium (38x30mm) 8 - 18 degrees, 10 -  18mm  Medium Long (38x34mm) 8 - 18 degrees, 10 -  18mm  Large (42x30mm) 8 - 18 degrees, 10 - 18mm  X Large (42x34mm) 8 - 18 degrees, 10 - 22mm  XX Large (42x38mm) 13 degrees, 12 - 18mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>236042</ARTG></ARTGs><ChangeExplanation>Change to Product name, Product Group, ARTG, Description</ChangeExplanation><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GK002</BillingCode><Name>3D fusion lumbar cage</Name><Description>Stand-alone anterior lumbar interbody fusion (ALIF) fixation system: cage, screws and locking caps.        3DMorphic ALIF integral screw fixation device (cage) is intended to immobilize, stabilize and maintain the space between instrumented segments and support loading in the lumbar spine until fusion occurs. The 3DMorphic ALIF device has a trapezoidal, ring shaped footprint, and features a central graft window that can receive bone graft. The superior and inferior surfaces of the device are adapted to match the patient’s vertebral endplate anatomy and feature serrated teeth to resist expulsion from the interbody space. The anterior surface of the device features screw holes and threaded locking cap holes as the device is designed for use with integral fixation screws and locking caps. The cage is offered in a variety of footprints, heights, lordotic and scoliotic angles according to the patient’s anatomy and surgeon’s specifications.</Description><Size>Footprints: 20mm to 36mm L x 19mm to 58mm W. Minimum anterior height is 10mm.     L = Anterior-posterior depth (DD in the catalogue), W = width (WW in the catalogue), height, angle and number of screws vary according to surgeon request and patient anatomy as the devices are custom-made.    Please see attached catalogue for full list of sizes.</Size><SupplierCode>40226</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>406173</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GK007</BillingCode><Name>3D Fusion integral fixation ATP Cage </Name><Description>Titanium ATP fusion cage with integral fixation</Description><Size>Width: 18-24mm  Length - 35mm-60mm  Height - 3mm-30mm and angle 0-35 as per patient specific requirements for the designed cage.      </Size><SupplierCode>40226</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>406173</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT005</BillingCode><Name>SASCA-2 ALIF Cage and bone fixation screws</Name><Description>Anterior lumber interbody fusion screw cage and screws; PEEK, Titanium coated PEEK, or 3D printed Titanium</Description><Size>Cage: Footprint: 37mm x 27mm, 41mm x 28mm; Height: 8mm - 18mm; Lordosis: 8, 15 or 20 degrees. Screws: Diameter: 5.5 &amp; 6.5mm; Length: 25mm - 40mm</Size><SupplierCode>40227</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>322720</ARTG><ARTG>320878</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Description, Size</ChangeExplanation><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER596</BillingCode><PriorBillingCodes><PriorBillingCode>OF074</PriorBillingCode></PriorBillingCodes><Name>PILLAR SA PTC</Name><Description>ALIF Cage constructed of PEEK Titanium composite (PTC) with cover plate and bone screws.</Description><Size>Width - 33mm to 43mm Depth/Length - 28mm Height - 12mm to 18 mm, Lordosis - 7 to 12 degrees; Cover Plate - 33mm to 43mm; Bone Screw: dia 5-5.5 mm x length 20-35 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>206571</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Description, Size</ChangeExplanation><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW678</BillingCode><Name>Monterey AL, Cage with integral fixation </Name><Description>ALIF cage with screws for integral fixation</Description><Size>Cage: 10-24mm, Screws: 17.5-30mm Length, 5-6mm Diameter</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>356926</ARTG></ARTGs><Note>This billing code is for Monterey AL Cage but only when it is used with screws to achieve integral fixation.’
It was noted that when the cage is used without screws it should be listed on PL in the grouping 13.10.02.02 Spinal, Fusion cage, interbody, no integral fixation, ThoracoLumbar/Lumbar.</Note><ChangeExplanation>Change to ARTG, Description, Size</ChangeExplanation><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE797</BillingCode><Name>Meridian TruProfile ALIF Cage, Plate, Locking Cover, Screws</Name><Description>Anterior lumbar cage with plate, locking cover and screws</Description><Size>Cage: 31x24, 35x27, 39x30;10-20mm Heights;10, 15, 20 &amp; 25 Degree Lordosis    Plate: 2 &amp; 4 Hole, Size 10mm-20mm   Locking Cover: 10mm-20mm  Screws: 5.5 &amp; 6.0mm, 15mm-35mm  </Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>298002</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW040</BillingCode><PriorBillingCodes><PriorBillingCode>ZA053</PriorBillingCode></PriorBillingCodes><Name>ROI-A ALIF Cage</Name><Description>The ROI-A implant is an ALIF interbody/fusion cage manufactured from PEEK-Optima.  If the surgeon so chooses, additional stability can be added to the construct by inserting optional self-guided, locking anchoring plates into the cage and the adjacent vertebral bodies.</Description><Size>Footprints 23x26mm, 30x33mm, 33x36m, 27x36mm, 30x39mm. Lordosis angles 2, 6, 10, 14 degrees. Heights 9-19mm. 1 cage per pack.</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>188175</ARTG><ARTG>188176</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE796</BillingCode><Name>Meridian No Profile Cage with Locking Plate and Screws</Name><Description>No Profile ALIF cage with titanium faceplate - two or three hole, with Screws</Description><Size>Cage 31x24, 35x27, 39x30      10-20mm Heights      10, 15, 20 &amp; 25 Degree Lordosis    Screws: 5.5 &amp; 6.0mm, 15mm-35mm  Locking cover : one size</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>298002</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC015</BillingCode><PriorBillingCodes><PriorBillingCode>BF013</PriorBillingCode></PriorBillingCodes><Name>Redmond Lumbar Cage System - Fusion Cage  with screws</Name><Description>PEEK titanium ALIF  with screws</Description><Size>Height: 12, 14, 16, 18, 20mm  Width: 28, 34, 36, 39, 43mm  Length: 24, 27, 30, 32mm  Angle: 6º, 12º, 18º</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>211536</ARTG></ARTGs><ChangeExplanation>Change to Product name, Product Group, ARTG, Description</ChangeExplanation><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC023</BillingCode><PriorBillingCodes><PriorBillingCode>JA028</PriorBillingCode></PriorBillingCodes><Name>Stalif cage with the required screws</Name><Description>Lumbar/Thoracolumbar Interbody Fusion Cage and screws</Description><Size>W: 30-42mm H: 11-21mm Lordosis: 8-20°</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>196068</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Description</ChangeExplanation><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU121</BillingCode><Name>MectaLIF Anterior Stand-Alone TiPEEK Cages.</Name><Description>TiPEEK Anterior Interbody cage with integral plate and screws</Description><Size>cages: 24x31, 27x35, 30x35, 30x40, 29x31, 32x35, 35x35, 35x40 mm. Height 10-18 in 2mm increments  plates various designs  screws with diameter: 5 &amp; 5.5mm and length: 25, 30, 35 &amp; 40mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>207288</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC004</BillingCode><Name>Advantage Cage with screws</Name><Description>Plasma Coated PEEK Cage  with screws</Description><Size>Small, medium, Medium Wide, Large, Extra Large</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>268893</ARTG></ARTGs><ChangeExplanation>Change to Product name, Product Group, ARTG, Description</ChangeExplanation><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB001</BillingCode><Name>Independence Spacer</Name><Description>Spacer with integral plate</Description><Size>small (24 X30mm), medium (26 X 34mm), large (29mm X 39mm) 8,15, 20, 25 and 30 deg 11mm – 25mm height</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>190071</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY031</BillingCode><PriorBillingCodes><PriorBillingCode>EV016</PriorBillingCode></PriorBillingCodes><Name>Evolution TM2 Cage</Name><Description>Thoraco Lumbar ALIF cage</Description><Size>standard</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>248234</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JP008</BillingCode><PriorBillingCodes><PriorBillingCode>JA029</PriorBillingCode></PriorBillingCodes><Name>Stalif Midline II Ti  cage with the required screws</Name><Description>Interbody Fusion Cage and screws</Description><Size>30-42</Size><SupplierCode>39934</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>196068</ARTG></ARTGs><ChangeExplanation>Change to Product name, Product Group, ARTG, Description</ChangeExplanation><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM512</BillingCode><Name>Stand-Alone ALIF System including screws for integral fixation</Name><Description>Stand-Alone ALIF System including screws for integral fixation</Description><Size>10-20mm (H) x 30, 36, 40mm (W) x 8°, 14°, 20°, 30° </Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>367230</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER538</BillingCode><Name>Signus BIG ST – Lumbar Cage and fixation screws system</Name><Description>ALIF Lumbar Cage and fixation screws</Description><Size>10 – 20mm : 8 deg 12 deg 16deg &amp; 20deg</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>129772</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV071</BillingCode><Name>Brigade (implant)</Name><Description>Interbody fusion implant with screws</Description><Size>Cage: 4-20mm x 34-42mm x 24-32mm, 0-30 degrees. Screws: 4.5-5.5 x 20-35mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>339170</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Description, Size</ChangeExplanation><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY030</BillingCode><PriorBillingCodes><PriorBillingCode>EV014</PriorBillingCode></PriorBillingCodes><Name>Evolution ALIF Cage with screws</Name><Description>ThoracoLumbar ALIF Cage with screws</Description><Size>Small (34x25mm) 8 - 18 degrees, 10 - 18mm  Medium (38x29mm) 8 - 18 degrees, 10 - 18mm  Medium Long (38x34mm) 8 - 18 degrees, 10 - 18mm  Large (42x30mm) 8 - 18 degrees, 10 - 18mm  X Large (42x34mm) 8 - 18 degrees, 10 - 22mm  XX Large (42x38mm) 13 degrees, 12 - 18mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>248234</ARTG></ARTGs><ChangeExplanation>Change to Product name, Product Group, ARTG, Description</ChangeExplanation><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ082</BillingCode><PriorBillingCodes><PriorBillingCode>JQ057</PriorBillingCode></PriorBillingCodes><Name>IdentiTi ALIF Standalone Interbody System </Name><Description>Integrated Fixation Cage Including 2 Lateral Fixation Screws and 1 (Centre Screw or Cannulated Fixation Bolt), Ti Alloy </Description><Size>Cage: 34 - 38)mm x (24 - 28)mm footprint x (4- 13)mm height , (10-30) degree lordosis   Screw: (5 - 8.5)mm diameter  x (25 - 35) mm length   Bolt: (8.5 - 9) mm diameter x (25 -35)mm length </Size><SupplierCode>40401</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>397510</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY801</BillingCode><Name>SynFix Spinal System</Name><Description>Evolution, Interbody Fusion Spacer with locking screws</Description><Size>Size: Small; Small deep; Medium; Medium Deep; Large; Large Deep.   Height: 10.5 mm - 19 mm   Angle: 6°, 10°, 14°, 18°.  Locking screws: 20, 25, 30 mm; 4.0mm diameter;  Fine tip, Blunt tip</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>231840</ARTG><ARTG>293276</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB206</BillingCode><Name>HEDRON IA</Name><Description>3D Printed Integrated ALIF Spacer including screws/anchor</Description><Size>Spacer  Footprint: 24X30, 26X34, 29X39mm  Height: 11-21mm        Screws/Anchor: Diameter 5.5mm, Length 20-40mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>353398</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU037</BillingCode><Name>Scarlet AL-T Secured Lumbar Cage</Name><Description>Secured Lumbar Cage</Description><Size>Small, Medium and Large Footprint
Height 10-18mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>166194</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY109</BillingCode><PriorBillingCodes><PriorBillingCode>EV036</PriorBillingCode></PriorBillingCodes><Name>Tora Cage and screw</Name><Description>Anterior Lumbar Cage with integral fixation (PEEK, HA PEEK, Titanium, Porous Titanium) and screws</Description><Size>Angle 0 - 12 degrees, Length 40 - 60mm, Height 8 - 16mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>248234</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY062</BillingCode><PriorBillingCodes><PriorBillingCode>DR027</PriorBillingCode></PriorBillingCodes><Name>Hygro-L Stand-alone ALIF with screws</Name><Description>Integrated Titanium ALIF cage with Screws for Integral Fixation</Description><Size>Length (32-38mm) x width (24.5-29mm); heights (12-24mm); lordotic angle (9-27) degrees</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>330365</ARTG></ARTGs><ChangeExplanation>Change to Product name, Product Group, ARTG</ChangeExplanation><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI326</BillingCode><PriorBillingCodes><PriorBillingCode>ER469</PriorBillingCode></PriorBillingCodes><Name>Endoskeleton TAS</Name><Description>Titanium  lumbar cage with integrated fixation, sterile or non-sterile also with  NanoLock™ surface technology, sterile  .</Description><Size>10-17mm Height, 32-40mm x 21-27mm Width, 7˚-24˚ Angles</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>315580</ARTG><ARTG>285244</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC987</BillingCode><Name>Sovereign Spinal System - Interbody Spacer</Name><Description>Sovereign Spinal System - Interbody Spacer with Coverplate</Description><Size>Small - 32mm x 23mm, Medium - 37mm x 27mm, Large - 42mm x 30mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB171</BillingCode><Name>ELSA Expandable Lateral Interbody Fusion Spacer</Name><Description>Expandable lateral interbody fusion spacer with integrated fixation</Description><Size>Height (unexpanded): 7-11mm
Height (expanded): 14-20mm
Length: 40-65mm
Width: 20mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>191535</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JP007</BillingCode><PriorBillingCodes><PriorBillingCode>JA028</PriorBillingCode></PriorBillingCodes><Name>Stalif cage with the required screws</Name><Description>Lumbar/Thoracolumbar Interbody Fusion Cage and screws</Description><Size>W: 30-42mm H: 11-21mm Lordosis: 8-20°</Size><SupplierCode>39934</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>196068</ARTG></ARTGs><ChangeExplanation>Change to Product name, Product Group, ARTG, Description</ChangeExplanation><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI513</BillingCode><Name>Anteralign™ - LS cage</Name><Description>Interbody cage and fixation screws</Description><Size>Height: 10 mm - 20 mm; Width: 32 mm - 42 mm; Length: 25 mm - 32 mm; Lordosis: 6° - 30°</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>422152</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY054</BillingCode><Name>Tesera SA / Tesera-k SA</Name><Description>Integrated Fusion Cage –  Construct achieves integral fixation with screws and locking mechanism</Description><Size>Footprint (30-42mm)x(26-32mm); Height 11-21mm, Lordosis 7-28 Degrees</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>354092</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB346</BillingCode><Name>Arcadius L Stand-Alone Interbody Device</Name><Description>Titanium Coated PEEK ALIF CAGE</Description><Size>4 degree, 9 degree &amp; 14 degree lordosis with width 35mm x Depth 25mm X Height 10/12/14/16/18/20mm.
4 degree, 9 degree &amp; 14 degree lordosis with Width 40mm x Depth 29mm x Height 10/12/14/16/18/20mm.</Size><SupplierCode>40020</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>221528</ARTG><ARTG>122641</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB175</BillingCode><Name>ELSA ATP</Name><Description>Anterior-to-Psoas Expandable Lumbar Spacer</Description><Size>Width: 20mm
Length - 40mm-65mm
Unexpanded Height - 7-10mm
Expanded Height - 14mm-17mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>191535</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY039</BillingCode><Name>Dakota ALIF construct</Name><Description>Anterior lumbar fusion device:  construct containing Dakota ALIF Cage, integrated faceplate and screw</Description><Size>11mm to 19mm</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>317596</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH715</BillingCode><Name>Integrated Anterior Lumbar Spine Truss Cage</Name><Description>Integral fixation ALIF cage with screws</Description><Size>8-20mm heights</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>252733</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Description</ChangeExplanation><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV170</BillingCode><Name>Modulus ALIF</Name><Description>Integrated fixation lumbar fusion cage including bolts.</Description><Size>Cage: 6-12mm X 34-42mm X 24-32mm  Bolt: Diameter 5-6mm, Length 15-30mm        </Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108579</GroupID><SubGroupID>112642</SubGroupID><ARTGs><ARTG>132498</ARTG></ARTGs><MinimumBenefit>5948</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ017</BillingCode><Name>VerteLoc Spine System</Name><Description>Cervical Cage</Description><Size>extra small - extra large</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>217031</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER438</BillingCode><Name>LnK Cervical Interbody Fusion Cage System/CastleLoc-C Cervical Interbody Fusion Cage System</Name><Description>LnK Cervical Interbody Fusion Cage System/CastleLoc-C Cervical Interbody Fusion Cage System, PEEK</Description><Size>width (14-20 mm) x length (12-15 mm) x height (5-10mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>286126</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY028</BillingCode><Name>Osimplant BIA ACDF Implant</Name><Description>ACDF Cage</Description><Size>Small through large footprints</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>333220</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KB008</BillingCode><PriorBillingCodes><PriorBillingCode>SV062</PriorBillingCode></PriorBillingCodes><Name>STERISPINE™ Cervical Cage</Name><Description>Sterile Cervical Interbody Fusion Device</Description><Size>H05- W.14.5 D12  H06- W.14.5 D12  H07- W.14.5 D12  H08- W.14.5 D12  H05- W.16 D14  H06- W.16 D14  H07- W.16 D14  H08- W.16 D14</Size><SupplierCode>40247</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>273290</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER598</BillingCode><PriorBillingCodes><PriorBillingCode>OF001</PriorBillingCode></PriorBillingCodes><Name>Construx Mini PTC</Name><Description>Anterior  cervical cage</Description><Size>12x12mm, 15x12mm, 15x15mm, 5-14mm height, parallel or 5 degree lordotic</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>206571</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST712</BillingCode><Name>Solis Cervical Cage</Name><Description>PEEK Cervical Interbody Cage with or without fixation pegs</Description><Size>Height 4mm to 12mm, Width 12mm – 16mm, Depth 12mm – 14mm, Angulation 0 – 4 degree</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>279146</ARTG><ARTG>279147</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY016</BillingCode><Name>BMD Titanium ACIF Implant</Name><Description>ACIF Cage</Description><Size>Height 4mm height to 10mm</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>323561</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM501</BillingCode><Name>ACDF Fusion Cage</Name><Description>ACDF Fusion Cage</Description><Size>6-12mm H x 12, 14, 16mm L x 14, 16, 19mm W</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>367230</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IT018</BillingCode><Name>Fuse It</Name><Description>Titanium alloy fusion cage - to use in situations such as anterior cervical fusion surgery</Description><Size>6mm x 1cm, 8mm x 1cm, 10mm x 1cm, 12mm x 1cm, 6mm x 1cm, 8mm x 2cm, 10mm x 2cm, 12mm x 2cm</Size><SupplierCode>40220</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>235024</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH075</BillingCode><Name>CARMEN Anterior Cervical Cage </Name><Description>The CARMEN anterior cervical cage component is intended to be used for anterior cervical inter-body fusion procedures in skeletally mature patients with cervical disc disease at one level from the C2-C3 disc to the C7-T1 disc. Cervical disc disease is defined as intractable radiculopathy and/or myelopathy with herniated disc and/or osteophyte formation on posterior vertebral end-plates producing symptomatic nerve root and/or spinal cord compression confirmed by radio-graphic studies. This cage is to be used in patients who have had six weeks of non-operative treatment. The CARMEN cage must be used with supplemental fixation. The Carmen  cage is also required to be used with autogenous bone graft comprised of cancellous and/or corticocancellous bone graft and is to be implanted via an open, anterior approach</Description><Size>Height       4 mm - 7 mm   Footprint :    12 mm x 14 mm ; 14 mm x 14 mm</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>312519</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HC022</BillingCode><Name>PM cage</Name><Description>Cervical cage</Description><Size>L :4-11mm</Size><SupplierCode>40349</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>201493</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE592</BillingCode><Name>Cambria Cervical Interbody Cage</Name><Description>Cambria NanoMetalene Cervical Interbody Cage</Description><Size>13x12mm, 15x13mm &amp;17x13mm footprints  5-12mm height</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>298002</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ153</BillingCode><Name>Cornerstone PSR – Fusion Cage</Name><Description>PEEK cervical fusion cage</Description><Size>Height: 4-13mm Width: 11-14mm Length: 11-14mm Lordosis 4 degrees</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>437270</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM400</BillingCode><PriorBillingCodes><PriorBillingCode>NK001</PriorBillingCode></PriorBillingCodes><Name>Zoe Cervical Cage</Name><Description>The ZOE anterior cervical cage is an implant intended for the surgical treatment of the cervical vertebrae.  It is designed for stabilisation and arthrodesis between the cervical verterbrae by the anterior approach, to optimize bone fusion from C3 to C7 levels.</Description><Size>Length: 12 - 14mm, Width: 14 - 16mm, Height: 4.5 - 10mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>195211</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW636</BillingCode><Name>Tritanium C</Name><Description>Porous Titanium ACDF Cage</Description><Size>H 5mm-9mm, Base 12mm x 14mm to 14mm x 17mm, 6deg to 10deg angle</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>297569</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB001</BillingCode><Name>Anterior Cervical PEEK Cage</Name><Description>Interbody fusion cage</Description><Size>Height: 5 -10 mm in 1 mm increments  Foot Print 13 x 16 mm / 13 x 19 mm / 12.5 x 15 mm / 11 mm x 14 mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>215887</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BF012</BillingCode><Name>Vigor PEEK Cervical Disc Spacer</Name><Description>PEEK cervical spine disc spacer</Description><Size>Height: 5mm, 6mm, 7mm, 8mm, 9mm, 10mm
Width: 12mm, 13mm, 14mm, 15mm, 16mm, 17mm
Length: 12mm, 14mm, 16mm
Angulation: 0°, 5°</Size><SupplierCode>40171</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>211536</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB278</BillingCode><Name>Aesculap Interbody Cage</Name><Description>ACDF Interbody cage</Description><Size>All sizes</Size><SupplierCode>40020</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>122641</ARTG><ARTG>273761</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN250</BillingCode><Name>CONDUIT EIT Cervical Cage</Name><Description>Cervical Cage with Titanium</Description><Size>4-10mm heights</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>319880</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH611</BillingCode><Name>HumanTech - Anterior Cervical Interbody Fusion Cages</Name><Description>Tristan - Anterior Cervical Interbody Fusion Cage</Description><Size>L 12-19mm W: 14-16mm H: 4-10mm A:0-10 </Size><SupplierCode>40113</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>316186</ARTG><ARTG>316185</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ118</BillingCode><PriorBillingCodes><PriorBillingCode>DR025</PriorBillingCode></PriorBillingCodes><Name>Hygro-C ACDF Cage</Name><Description>Hygro-C Titanium ACDF Cage</Description><Size>Length (13.7mm) x Width (16.5-19.1mm) x Height (4-9mm); Lordotic angle 6 Degrees</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>330365</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JA004</BillingCode><PriorBillingCodes><PriorBillingCode>OH543</PriorBillingCode></PriorBillingCodes><Name>C7 Cervical Cage</Name><Description>Cervical Cage</Description><Size>H 3-16mm L 12-16mm W 12-16mm</Size><SupplierCode>40213</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>289247</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU102</BillingCode><Name>Mecta-C</Name><Description>Cervical Interbody Fusion Device made with PEEK</Description><Size>Width: 12,14,and 15mm. Length: 14,16 and 18 mm. Height: from 4 to 9 mm. Flat Dome Shaped versions</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>191090</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY095</BillingCode><PriorBillingCodes><PriorBillingCode>EV025</PriorBillingCode></PriorBillingCodes><Name>Eurospine ACDF Cage</Name><Description>Interbody Fusion Cages are used to restore disc height and support loading during intervertebral body fusion.</Description><Size>Flat or angled 6 - 9 degrees.   Anterior width 17 - 19mm  Posterior width 14 - 15mm  Height 5 - 10mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>273756</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV156</BillingCode><Name>Modulus Cervical Interbody System</Name><Description>Anterior Cervical Cage</Description><Size>5-16mm x 15-19mm x 12-16mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>132498</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV010</BillingCode><Name>CoRoent</Name><Description>Cervical Cage</Description><Size>small</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>132498</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BP004</BillingCode><Name>PEEK Interbody system – Cervical</Name><Description>ACIF Implants; Sterile and Non Sterile</Description><Size>Diameter 14mm; 16mm: 
Height (5mm, - 12mm): 
Lordosis Angle 0 - 7.5 degrees: 
Curevd , Straight</Size><SupplierCode>40061</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>273367</ARTG><ARTG>273374</ARTG><ARTG>273366</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BP008</BillingCode><Name>TiPEEK Interbody system – Cervical</Name><Description>ACIF Implants; Sterile
Commercially Pure Titanium and Polyetheretherketone (PEEK-Optima®)</Description><Size>Size: small, standard, large, extra large
Width 12.5mm – 19mm
Length 11.5mm – 16mm
Height 5-12mm: 
Lordosis Angle 0 - 20°: 
Curved, Straight, Convex</Size><SupplierCode>40061</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>273366</ARTG><ARTG>273374</ARTG><ARTG>273367</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB117</BillingCode><Name>Colonial - TPS ACDF System</Name><Description>ACDF spacer with Titanium Plasma Spray</Description><Size>Height : 5-12mm, Width 12-18mm, Length: 11-15mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>191532</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF175</BillingCode><Name>Wasp ACDF Cage</Name><Description>ACDF Cage (PEEK, PEEK/HA or Titanium)</Description><Size>5-9mm, 4, 8 and 12 degree  </Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>181030</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY103</BillingCode><PriorBillingCodes><PriorBillingCode>JG006</PriorBillingCode></PriorBillingCodes><Name>Capri ACIF Cage</Name><Description>Cervical Interbody Fusion Cage</Description><Size>Angle 0, 5 and 10 degrees      Height 4mm to 9mm      Length 12, 14, 16, 18mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>370516</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB209</BillingCode><Name>HEDRON™ C</Name><Description>3D Printed ACDF Spacer</Description><Size>Footprints: 12X14mm, 14X16mm, 15X18mm  Height 5-12mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>353400</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BF018</BillingCode><Name>Combo Cervical Cage</Name><Description>Combination titanium PEEK cervical cage</Description><Size>Height: 5, 6, 7, 8, 9, 10mm
Width: 12, 13, 14, 15, 16, 17mm
Length: 12, 14mm</Size><SupplierCode>40171</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>211536</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV158</BillingCode><Name>Cohere Cervical Interbody Fusion Device</Name><Description>Spinal intervertebral fusion device manufactured from polyetheretherketone (PEEK)</Description><Size>12-14mm X 14-16mm X 6-10mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>132498</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH530</BillingCode><Name>Cervical Spine Truss System</Name><Description>Cage</Description><Size>5-16mm Height</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>252733</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF159</BillingCode><PriorBillingCodes><PriorBillingCode>EV010</PriorBillingCode></PriorBillingCodes><Name>ACDF Cage</Name><Description>Interbody Fusion Cages are used to restore disc height and support loading during intervertebral body fusion. Interbody Fusion Cages are used to restore disc height and support loading during intervertebral body fusion.</Description><Size>small, large – flat</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>181030</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY838</BillingCode><Name>Bengal System</Name><Description>Cervical Fusion Device</Description><Size>4 to 16mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>200396</ARTG><ARTG>98094</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB034</BillingCode><Name>Colonial Spacers</Name><Description>Anterior Cervical Interbody Cage</Description><Size>12 x 11 mm, 14 x 12mm, 16 x 14mm, 18 x 15mm and 0, 7, 12, 15 and 20 degree lordosis</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>191532</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI042</BillingCode><Name>Fortilink®-SC</Name><Description>Cervical standalone fusion cage</Description><Size>Width: 16-20mm  Length: 12-16mm  Height: 6-12mm</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>346071</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI031</BillingCode><Name>Fortilink®-C</Name><Description>Cervical interbody fusion device</Description><Size>Width 12mm-20mm  Length 10mm-16mm  Height 5mm-12mm</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>346071</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FY004</BillingCode><Name>Novomax Fusion</Name><Description>Cervical Interbody Fusion Device, CaO-SiO2 based  glass ceramic</Description><Size>(15 x 13)mm footprint x (5-10)mm height, 3 degree lordosis</Size><SupplierCode>40259</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>376357</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ122</BillingCode><PriorBillingCodes><PriorBillingCode>DZ087</PriorBillingCode></PriorBillingCodes><Name>CanPEEK-C Anterior Cervical Cage System</Name><Description>Interbody Fusion Cage</Description><Size>5mm - 10mm</Size><SupplierCode>40393</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>346450</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH085</BillingCode><Name>Caro Cervical Cage</Name><Description>Cervical interbody cage, PEEK</Description><Size> 4x14x12    4x14x14    5x14x12    5x14x14    6x14x12    6x14x14    7x14x12    7x14x14    8x14x12    8x14x14   </Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>312519</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE658</BillingCode><Name>Shoreline ACS TruProfile Cage</Name><Description>Cervical ACDF Cage</Description><Size>Footprints: 14 x 13mm, 16 x 14mm, 18 x 15mm and 20 x 15mm  Lordosis: 7, 10 and 15 degrees  Heights: 5,6,7,8,9,10,11 and 12mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>298002</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH095</BillingCode><Name>Reach Cervical Interbody Cage </Name><Description>Reach Cervical Interbody Cage </Description><Size>Cage Height : 4 mm - 10 mm   Bone Screw Diameter : 3.5 mm &amp; 4.0 mm   Bone Screw Length : 8 mm - 18 mm   </Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>384821</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC001</BillingCode><Name>WeTop Cervical Cage</Name><Description>PEEK Cervical Cage</Description><Size>12x12mm, 12x16mm, 14x18mm, 16x18mm, 16x20mm 18x20mm - all available in height ranges 4.5mm to 14mm</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>221267</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY034</BillingCode><PriorBillingCodes><PriorBillingCode>EV012</PriorBillingCode></PriorBillingCodes><Name>Evolution ACDF Contoured Cage</Name><Description>Interbody Fusion Cages are used to restore disc height and support loading during intervertebral body fusion. Interbody Fusion Cages are used to restore disc height and support loading during intervertebral body fusion.</Description><Size>small, large - contoured</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>248234</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HC006</BillingCode><Name>Squale</Name><Description>Cervical Cage</Description><Size>4-10mm</Size><SupplierCode>40349</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>159781</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ083</BillingCode><PriorBillingCodes><PriorBillingCode>JQ030</PriorBillingCode></PriorBillingCodes><Name>IdentiTi Cervical Porous Ti Interbody System</Name><Description>Spacer,  Anterior  Ti</Description><Size>(14-20)mm x (12-16)mm footprint x (5-12)mm height x (5-15) degree lordosis</Size><SupplierCode>40401</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>397837</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ091</BillingCode><PriorBillingCodes><PriorBillingCode>JQ032</PriorBillingCode></PriorBillingCodes><Name>Transcend Nanotec Cervical </Name><Description>  Spacer, PEEK Ti Alloy HA </Description><Size>(14-18)mm x (12-16)mm footprint x (5-10)mm height x 7-10) degrees lordosis </Size><SupplierCode>40401</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>398574</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE561</BillingCode><Name>icotec ACDF Cage</Name><Description>Cervical Fusion Cage</Description><Size>Width: 13mm, 16mm and 18mm, 
Height: 5mm - 10mm,
Depth: 13mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>283852</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ059</BillingCode><Name>IdentiTi NanoTec Interbody System </Name><Description>Spacer, Cervical. Ti ,Ha</Description><Size>(14-22)mm x (12- 19)mm x (4- 14)mm height x (0-15)degree lordosis</Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>397837</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ313</BillingCode><Name>Anatomic Peek Fusion Cage</Name><Description>Fusion device for stabilization use and to promote bone fusion during the normal healing process following surgical correction of disorders of the spine
</Description><Size>Height: 5 - 14mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>422152</ARTG></ARTGs><ChangeExplanation>New listing</ChangeExplanation><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Insert</ActionFlag><CycleStartDate>2024-08-08</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER327</BillingCode><Name>Ulrich Anterior Cervical Cage</Name><Description>Ulrich cerv-X Anterior Cervical Cage-PEEK, convex and lordotic</Description><Size>height (4-10mm) x width (12-16mm) x length (12-14mm) x angle (0-5°)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>279703</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT002</BillingCode><Name>SPICCA Anterior Cervical Fusion Cage</Name><Description>Anterior cervical fusion cage; PEEK, Titanium coated PEEK, or 3D printed Titanium.</Description><Size>Footprints: 15mm x 12mm, 15mm x 14mm, 17.5mm x 15mm, 19.5mm x 17mm; Height: 4mm - 10mm; Lordosis: 7 or 12 degrees.</Size><SupplierCode>40227</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>322720</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM403</BillingCode><PriorBillingCodes><PriorBillingCode>NK008</PriorBillingCode></PriorBillingCodes><Name>Calix Interbody Spacer</Name><Description>Cervical cage, PEEK</Description><Size>Heights 5-12mm. Lordotic and Convex</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>160750</ARTG><ARTG>159605</ARTG><ARTG>170220</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY033</BillingCode><Name>Osimplant Cage</Name><Description>Cervical Cage</Description><Size>Small through large footprints</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>333220</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY018</BillingCode><Name>Precision ShurFit ACDF</Name><Description>Anterior Cervical Interbody Fusion System</Description><Size>14 to 18mm wide  12 to 15mm deep  5 to 12mm height  5 and 10 Degree Lordotic Options</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>317596</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU051</BillingCode><Name>Tryptik Ti cage</Name><Description>Titanium anterior cervical cage</Description><Size>Height: 4.5mm, 5mm, 6mm, 7mm,  8mm, 9mm, 10mm.  Width: 12mm, 14mm  Depth: 15mm, 12mm  Lordosis: convex and 7°.</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>338461</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI332</BillingCode><Name>Cornerstone Cage Ti-Coated</Name><Description>Cervical interbody cage with titanium coating</Description><Size>14-18mm x Depth: 11-16mm x Height: 4-9mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN252</BillingCode><Name>CONDUIT EIT SMART ACDF</Name><Description>Cellular Titanium Cage with Graft Hole</Description><Size>4-12mm height</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>319880</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI328</BillingCode><PriorBillingCodes><PriorBillingCode>ER461</PriorBillingCode></PriorBillingCodes><Name>Endoskeleton TC</Name><Description>Titanium coated anterior interbody fusion device for the lumbar spine, sterile or non-sterile, nanoLock (TM) surface technology</Description><Size>12-16 x 14-18mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>315580</ARTG><ARTG>285244</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER151</BillingCode><Name>Nubic</Name><Description>Cervical Fusion Implant in interbody fusion of the Cervical Spine</Description><Size>(4-12)x13x(14-17) mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>129772</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW769</BillingCode><PriorBillingCodes><PriorBillingCode>ER455</PriorBillingCode></PriorBillingCodes><Name>Cascadia Cervical Interbody System</Name><Description>Cascadia Interbody spacer, Porous Ti</Description><Size>5-13mm heights</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>293886</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW749</BillingCode><PriorBillingCodes><PriorBillingCode>ER142</PriorBillingCode></PriorBillingCodes><Name>Aleutian Cervical Interbody System</Name><Description>Cage, Convex, or Lordotic. PEEK</Description><Size>Height: 5 -15mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>159146</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER537</BillingCode><Name>Signus JASPIS</Name><Description>Cervical porous titanium fusion cage </Description><Size>width (14-18mm) x length (12-14 mm) x height (4-10 mm); lordosis (0-8°)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>129772</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER599</BillingCode><Name>Construx Mini PEEK VBR System</Name><Description>The Construx Mini is an anterior Cervical Interbody PEEK or Titanium Cage</Description><Size>12mm x 12mm 5 degrees lordotic. 5mm-12mm in 1mm increments. 12mm x 12mm, Parallel. 5mm - 12mm in 1mm increments. 15mm x 12mm, 5/10/15 degrees lordotic. 5mm - 12mm in 1mm increments. 15mm x 12mm, Parallel. 5mm-12mm in 1mm increments        Width 12-17 mm; Length 12-15 mm, Height 5-12 mm, lordosis 0-15 degrees  </Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>206571</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI156</BillingCode><Name>Divergence Anterior Cervical Fusion Mini-plate System</Name><Description>Divergence Anterior cervical fusion Mini-plate cage</Description><Size>Height 5-11mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY792</BillingCode><Name>ACIS</Name><Description>Anterior Cervical Interbody Spacer</Description><Size>Small to large</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>133400</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC413</BillingCode><Name>Cornerstone Cage</Name><Description>Sterile and Non-sterile</Description><Size>4 - 14mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU036</BillingCode><Name>Tryptik Anterior Cervical Cage</Name><Description>Tryptik Anterior Cervical Cages are manufactured from PEEK and are anatomically shaped to fit between vertebral bodies. </Description><Size>Heights 5-12mm. Lordotic and Convex</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>166194</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY035</BillingCode><PriorBillingCodes><PriorBillingCode>EV020</PriorBillingCode></PriorBillingCodes><Name>Fukiya ACDF Cage</Name><Description>Fukiya Fusion Cages are used to restore disc height and support loading during intervertebral body fusion. Interbody Fusion Cages are used to restore disc height and support loading during intervertebral body fusion.</Description><Size>6-9 degrees, 5-10mm. Small, Medium, Large, Extra large</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>236042</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY033</BillingCode><PriorBillingCodes><PriorBillingCode>EV010</PriorBillingCode></PriorBillingCodes><Name>Evolution ACDF Cage</Name><Description>Interbody Fusion Cage</Description><Size>5-10mm   small, medium, large, extra large</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>248234</ARTG></ARTGs><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF104</BillingCode><Name>Alias Cage</Name><Description>Titanium or PEEK Fusion Cage with Plasma coating</Description><Size>5-9mm, 4, 8 and 12 degree, Flat and countoured options</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112643</SubGroupID><ARTGs><ARTG>181030</ARTG></ARTGs><ChangeExplanation>Change to Group benefit</ChangeExplanation><MinimumBenefit>2188</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR066</BillingCode><Name>AVS AL PEEK Spacer System</Name><Description>Anterior Lumbar Interbody Fusion Cage</Description><Size>22mm deep x 28mm wide x 10mm - 50mm height and 28mm deep x 33mm wide x 10mm-50mm height.  Both base sizes come in 4 degree and 8 degree angulations</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>315080</ARTG><ARTG>315081</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI186</BillingCode><Name>PIVOX Oblique Lateral Spinal System</Name><Description>Interbody Cage</Description><Size>20-27mm width</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH614</BillingCode><Name>HumanTech - Adonis Spinal Fusion Cage System - ALIF</Name><Description>Adonis Spinal Fusion Cage System - PLIF</Description><Size>L: 22mm   W: 32 H1: 9-17mm   H2: 6.3 - 12.3 A: 7-12 </Size><SupplierCode>40113</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>316185</ARTG><ARTG>316186</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU105</BillingCode><Name>Mectalif Transforaminal</Name><Description>Transforaminal Interbody Fusion Device _ Banana Shape - made with PEEK</Description><Size>Width: 12 and 14 mm. Length: 30 and 34 mm. Height from 8 to 15 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>180172</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ090</BillingCode><PriorBillingCodes><PriorBillingCode>JQ031</PriorBillingCode></PriorBillingCodes><Name>Transcend Lateral </Name><Description>Spacer, PEEK Ti Alloy</Description><Size>(16-26)mm x(25-60)mm Footprint x (4-10)mm height  x(0-15)degrees lordosis</Size><SupplierCode>40401</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>398574</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB126</BillingCode><Name>Sustain - O TPS</Name><Description>TPS coated PEEK radiolucent lumbar interbody fusion device</Description><Size>Height-8mm-18mm,  Width 8mm - 12mm, Length - 26mm-30mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>191535</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE590</BillingCode><Name>Ventura PLIF</Name><Description>NanoMetalene Posterior Lumbar Interbody</Description><Size>9&amp;11mm width  20&amp;24mm length  8-16mm height</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>298002</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HC005</BillingCode><Name>Swingo</Name><Description>Lumbar Cage</Description><Size>7-14mm</Size><SupplierCode>40349</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>159781</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE716</BillingCode><Name>REEF TO PLIF</Name><Description>REEF TO NanoMetalene PLIF</Description><Size>9 &amp; 11mm Widths  20 &amp; 24mm Lengths  7-18mm Heights  0-22 Degree Lordosis  </Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>298002</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC577</BillingCode><Name>R90 Spacer</Name><Description>Spinal Implant (Peek)</Description><Size>Height 7 - 16mm
Lordosis 6 - 18 degrees</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY058</BillingCode><PriorBillingCodes><PriorBillingCode>DR024</PriorBillingCode></PriorBillingCodes><Name>Hygro-L PLIF</Name><Description>Titanium lumbar interbody fusion cage PLIF (paired)</Description><Size>Length (22-26mm) x width (11.5mm); heights (7-14mm); lordotic angle (0-12) </Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>330365</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN248</BillingCode><Name>CONDUIT EIT PLIF Cage</Name><Description>Lumbar Cage with Titanium</Description><Size>7-16mm Heights</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>319880</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH613</BillingCode><Name>HumanTech - Adonis Spinal Fusion Cage System - PLIF</Name><Description>Adonis Spinal Fusion Cage System - PLIF</Description><Size>L 24-32mm   W: 9mm   H: 7-15mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>316186</ARTG><ARTG>316185</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE783</BillingCode><Name>FlareHawk Expandable PLIF Cage</Name><Description>Expandable PEEK &amp; Titanium alloy lumbar interbody fusion device that enables significant graft delivery. FlareHawk is made up of an expandable shell and titanium shim.</Description><Size>0,6,9,15 degree lordosis. Unexpanded: 7mm height x 9mm width or 7mm Height x 7mm width. Expanded: 8mm - 14mm height x 14mm or 11mm width. 25mm or 26mm Lengths</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>380420</ARTG><ARTG>380419</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HC030</BillingCode><Name>ISIS Cage</Name><Description> ISIS Lumbar Cage</Description><Size>Height:8-15mm  Width: 11mm  Length:24mm  Degrees: 0, 4 and 8</Size><SupplierCode>40349</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>280801</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JA007</BillingCode><PriorBillingCodes><PriorBillingCode>OH537</PriorBillingCode></PriorBillingCodes><Name>Medussa-PL Cage</Name><Description>ThoracoLumbar/Lumbar Interbody Fusion Cage - PLIF, TLIF</Description><Size>0°-8°, H 6-16mm L 25-38mm W 9-11mm</Size><SupplierCode>40213</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>289247</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU104</BillingCode><Name>Mectalif Posterior</Name><Description>Posterior Interbody Fusion Device PEEK and TiPEEK</Description><Size>Width: 9 and 11mm. Length: 19, 22 and 25 mm. Height: from 7 to 15 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>180172</ARTG><ARTG>404156</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW046</BillingCode><PriorBillingCodes><PriorBillingCode>BH170</PriorBillingCode></PriorBillingCodes><Name>Zyston Straight Interbody Spacer</Name><Description>Posterior Lumbar Interbody Spacer, PEEK</Description><Size>(7mm x 20mm) to (18mm x 30mm), Convex, Lordotic</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>287188</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY104</BillingCode><PriorBillingCodes><PriorBillingCode>JG003</PriorBillingCode></PriorBillingCodes><Name>Panarea</Name><Description>ACP: Posterior Lumbar Cage 'PLIF'</Description><Size>0, 5, 8, 14, 20 degree angle  24mm to 29mm width  7mm to 16mm height</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>370517</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI508</BillingCode><Name>Fuse Spinal System - Cage</Name><Description>PLIF or TILF Vertebral Body Spacer</Description><Size>length (24.5mm), height (7-14mm), width (7-9.5mm) and lordosis (0-8ᵒ) </Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN236</BillingCode><Name>OPAL</Name><Description>Interbody Fusion Cage</Description><Size>10-15mm, 9-10 x 24mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>231840</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI329</BillingCode><Name>Elevate Spinal System</Name><Description>Expandable Lumbar Fusion Device - Paired</Description><Size>Height: 7-16mm  Width: 10mm  Length: 23mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ060</BillingCode><Name>Transcend NanoTec Interbody System </Name><Description>Spacer, Posterior Oblique.  PEEK Ti Alloy HA</Description><Size>10mm width x (25-35) length x (7-15)mm height x (0-15)degree lordosis</Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>398574</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY137</BillingCode><Name>Syncage</Name><Description>Interbody fusion cage</Description><Size>9-19mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>231840</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB135</BillingCode><Name>Caliber Expandable Lumbar Fusion Device - Paired</Name><Description>Expandable titanium alloy and PEEK lumbar inter-body fusion device</Description><Size>Unexpanded Height 7-12mm, Expanded Height 11-17mm, Width 10-12mm, Length 22mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>190042</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB203</BillingCode><Name>HEDRON P</Name><Description>3D Printed Posterior Lumbar Interbody Spacer</Description><Size>Width: 8-10mm  Length: 22mm  Height: 7-17mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>353398</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF152</BillingCode><Name>Ayers PLIF cage</Name><Description>PLIF Fusion Cage</Description><Size>Curved and Straight Cages in multiple footprints with 3 angles.</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>181030</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB070</BillingCode><Name>SUSTAIN spacer</Name><Description>PLIF cage</Description><Size>8mm-17mm height, 8mm-12mm width, 22mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>191531</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC456</BillingCode><Name>Interfix </Name><Description>Titanium Cage</Description><Size>12 x 20mm - 24 x 50mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI063</BillingCode><Name>Capstone Control</Name><Description>PLIF Vertebral Body Spacer</Description><Size>Length: 22-26mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY071</BillingCode><PriorBillingCodes><PriorBillingCode>DR045</PriorBillingCode></PriorBillingCodes><Name>Tesera P</Name><Description>Titanium PLIF Cage</Description><Size>Length (22-27mm) x Width (9mm) x Height (7-16mm); Lordotic angle (5-7) Degrees</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>354092</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU030</BillingCode><Name>Juliet Posterior Lumbar Interbody Cage</Name><Description>PEEK cage built in anatomical slope.</Description><Size>All 22mm length. 8, 10, 12 and 14mm heights. 0 or 5 degrees anatomical slope.</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>166194</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BF013</BillingCode><Name>Redmond Lumbar Cage System - Fusion Cage</Name><Description>PEEK titanium ALIF</Description><Size>Height: 12, 14, 16, 18, 20mm
Width: 28, 34, 36, 39, 43mm
Length: 24, 27, 30, 32mm
Angle: 6º, 12º, 18º</Size><SupplierCode>40171</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>211536</ARTG></ARTGs><ChangeExplanation>Change to Group benefit</ChangeExplanation><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI273</BillingCode><Name>AVILA</Name><Description>Oblique or Anterior Cage</Description><Size>Small, Medium, Large</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF099</BillingCode><Name>Advantage Plus Cage</Name><Description>Plasma Coated PEEK Cage</Description><Size>Small, medium, Medium Wide, Large, Extra Large</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>181030</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI368</BillingCode><Name>Adaptix Cage</Name><Description>TLIF Vertebral Body Spacer</Description><Size>Length: 34-38 mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB128</BillingCode><Name>Signature-R, Signature-R TPS &amp; Signature-Ti  TLIF System</Name><Description>PEEK or TPS Coated PEEK or Titanium lumbar interbody fusion device</Description><Size>Small - 10 x 28mm with heights from 7-17mm
Large - 11 x 33mm with heights from 7-17mm
PEEK TPS - 10-11mm x 32-37mm with heights from 7-17mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>191535</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB201</BillingCode><Name>SUSTAIN Large</Name><Description>Anterior Lumbar Interbody Fusion Device in PEEK and Titanium</Description><Size>Footprint: 25 X 31mm  Height 9-21mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>191533</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF160</BillingCode><Name>Aerofoil Cage</Name><Description>Lumbar interbody Cage</Description><Size>Length 40-60mm, Height 8-16mm, Curvature 0 - 12 degrees</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>181030</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI065</BillingCode><Name>Clydesdale Spinal System</Name><Description>Lateral vertebral body spacer (PEEK &amp; PTC)</Description><Size>Length: 40mm - 60mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE589</BillingCode><Name>Hollywood TLIF</Name><Description>NanoMetalene Transforaminal Lumbar Interbody</Description><Size>11 x 27mm and 11 x 30mm width and length  7 - 14mm Height  8 degrees lordodis</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>298002</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU163</BillingCode><Name>MectaLIF Anterior SIMPLE - PEEK Cages</Name><Description>PEEK and Ti-PEEK Anterior Cages - Simple</Description><Size>Cage dimensions: 24mm x 31mm, 27mm x 35mm, 30mm X 35mm, 30mm X 40mm
Height: 10-18mm in 2mm increments
Lordosis: from 5° to 20°.</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>291730</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB150</BillingCode><Name>Caliber -L</Name><Description>Expandable Lateral Lumbar Interbody Fusion Device</Description><Size>Width -16mm, Length 25-40mm in 5mm increments
Width -18mm, Length 40-60mm in 5mm increments
Width -22mm, 40 - 60mm in 5mm increments 
Heights - 7-10mm, 8-11mm, 9-13mm, 10-13mm, 10mm-14mm, 11-15mm, 11-16mm, 12-16mm, 12-17mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>190042</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB132</BillingCode><Name>Sustain-IR and Sustain-IR Narrow</Name><Description>PEEK radiolucent interbody lumbar fusion device</Description><Size>Height 7-17mm, Length 26-30mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>191535</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ092</BillingCode><PriorBillingCodes><PriorBillingCode>JQ033</PriorBillingCode></PriorBillingCodes><Name>Transcend Nanotec Lateral </Name><Description>Spacer, Lateral, PEEK Ti Alloy HA </Description><Size>(18-22)mm x (45-60)mm footprint x (4-14)mm height  x (0-10)degree lordosis</Size><SupplierCode>40401</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>398574</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MU103</BillingCode><Name>Mectalif Oblique</Name><Description>Oblique Transforaminal Interbody Fusion Device PEEK and TiPEEK</Description><Size>Width: 10 and 12mm. Length 24, 28, 30, 32,34, 36 and 40 mm. Height: from 7 to 15 mm</Size><SupplierCode>40166</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>180172</ARTG><ARTG>404156</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JQ061</BillingCode><Name>Transcend NanoTec Interbody System </Name><Description>Spacer,  Posterior Straight, PEEK Ti Alloy HA</Description><Size>9mm width x (22-25)mm length x (7-13)mm height x (0-15) degree lordosis</Size><SupplierCode>40399</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>398574</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM515</BillingCode><Name>PLIF Cage</Name><Description>PLIF Cage - PEEK</Description><Size>8, 10 or 12W x 8-16H x 22, 25, 28, 30 or 32L, 0° or 5° </Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>367230</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF101</BillingCode><Name>Revolve Cage</Name><Description>Spinal Cage</Description><Size>9-17mm high, 21-27mm length, 12-22 degrees, PEEK or Titanium</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>181030</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY439</BillingCode><Name>OPAL</Name><Description>Cage Spacer</Description><Size>7-17mm, 10 x 28-32mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>231840</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI172</BillingCode><Name>Divergence-L Anterior/Oblique Lumbar Fusion System </Name><Description>Interbody cage</Description><Size>10-20mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY105</BillingCode><PriorBillingCodes><PriorBillingCode>JG001</PriorBillingCode></PriorBillingCodes><Name>Elba</Name><Description>ACT - Transforaminal Lumbar Interbody Fusion Cage 'TLIF'</Description><Size>Height 7mm to 15mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>370517</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY107</BillingCode><PriorBillingCodes><PriorBillingCode>JG004</PriorBillingCode></PriorBillingCodes><Name>Stromboli</Name><Description>ACX - Direct Lateral Interbody Fusion Cage 'XLIF'</Description><Size>0, 5, 8, 14 degree angle  42mm to 58mm length  7mm to 13mm height</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>370517</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY111</BillingCode><Name>Additive Surgical Lateral Expandable Cage - Giannutri</Name><Description>Lateral Titanium Expandable Cage</Description><Size>46-52mm x 18-22mm, 0-14 Degrees Lordosis</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>370517</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB136</BillingCode><Name>TransContinental TPS</Name><Description>Lateral Lumbar Interbody Fusion (LLIF) Device</Description><Size>Length - 40-60mm in 5mm increments
Height - 7-17mm
Width - 18mm &amp; 22mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>191535</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI331</BillingCode><Name>Elevate Expandable Interbody Device</Name><Description>Expandable Interbody Device - Single</Description><Size>Height: 7-16mm  Width: 10mm  Length: 28-32mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI324</BillingCode><PriorBillingCodes><PriorBillingCode>ER463</PriorBillingCode></PriorBillingCodes><Name>Endoskeleton TA</Name><Description>Titanium anterior interbody fusion device for the lumbar spine, sterile or non-sterile, also with Nano Lock™ surface technology, sterile</Description><Size>32-40 x 21-27mm    Width 32-40mm, Length 21-27mm, Height 10-17mm, 20,25,30,35,40,45,50,55,60,65mm, 0˚ &amp; 7˚angles</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>285244</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB204</BillingCode><Name>HEDRON P</Name><Description>3D Printed Posterior Lumbar Interbody Spacer</Description><Size>Width: 10-12mm  Length: 26-30mm  Height: 7-17mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>353398</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY113</BillingCode><Name>Additive Surgical Posterior Expandable Cage - Procida</Name><Description>TLIF/PLIF Titanium Expandable Fusion Cage</Description><Size>26-32mm, 0-20 degrees Lordosis</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>370517</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN255</BillingCode><Name>CONDUIT EIT SMART LLIF system</Name><Description>Lateral Lumbar Interbody Cage</Description><Size>8-16mm Height</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>319880</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI064</BillingCode><Name>Crescent Spinal System</Name><Description>Titanium</Description><Size>height: 7-16mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI512</BillingCode><Name>Anteralign™ - TL cage</Name><Description>Interbody cage</Description><Size>Height: 8 mm - 16 mm; Width: 20 mm - 23 mm; Length: 40 mm - 60 mm; Lordosis: 6° - 24°</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>422152</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ089</BillingCode><PriorBillingCodes><PriorBillingCode>JQ029</PriorBillingCode></PriorBillingCodes><Name>IdentiTi PS Porous Ti Interbody System</Name><Description>Spacer, Posterior Straight  Ti</Description><Size>9mm x (22-30)mm footprint x (7-14)mm height x (0-15) degree lordosis</Size><SupplierCode>40401</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>397837</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HC015</BillingCode><Name>SHARK CAGE</Name><Description>Lumbar cage</Description><Size>L:8-16mm</Size><SupplierCode>40349</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>201493</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE591</BillingCode><Name>Ventura TLIF</Name><Description>Ventura Nanometalene TLIF</Description><Size>9 &amp;11mm width  28 &amp; 32mm length  8-18mm height</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>298002</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI323</BillingCode><PriorBillingCodes><PriorBillingCode>ER462</PriorBillingCode></PriorBillingCodes><Name>Endoskeleton TL</Name><Description>Titanium Lateral Interbody fusion cage, sterile or non-sterile also with NanoLock™ surface technology, sterile</Description><Size>Length: 40-60mm, Width 18-26mm, Height 8-16mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>285244</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH041</BillingCode><Name>Halis Cages</Name><Description>Interbody Fusion Cage</Description><Size>6, 12 &amp; 18 Degrees Angle</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>312519</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JA005</BillingCode><PriorBillingCodes><PriorBillingCode>OH536</PriorBillingCode></PriorBillingCodes><Name>Dynamic Cage</Name><Description>PLIF/TLIF Spinal Cage</Description><Size>Angle 0° - 12°
Height 7-16mm
Length 22-32mm
Width 8-11mm</Size><SupplierCode>40213</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>289247</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE558</BillingCode><Name>icotec ETurn Cage</Name><Description>TLIF Cage</Description><Size>32mm Length, 12 and 16mm width and 7-15mm height</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>283852</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH043</BillingCode><Name>Lydia Cage</Name><Description>Interbody Fusion Cage</Description><Size>8 &amp; 15 degrees angle, 8-12mm height and 20-24mm length</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>312519</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JA020</BillingCode><PriorBillingCodes><PriorBillingCode>OH538</PriorBillingCode></PriorBillingCodes><Name>Taurus-P</Name><Description>Taurus-P Fusion Cage</Description><Size>0-8°, H7-16mm, L25-40mm, W9-12mm</Size><SupplierCode>40213</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>289247</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW048</BillingCode><PriorBillingCodes><PriorBillingCode>ZI949</PriorBillingCode></PriorBillingCodes><Name>Timberline Lateral Fusion System</Name><Description>Interbody Fusion Implant</Description><Size>25-60mm length</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>287189</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU062</BillingCode><Name>Scarlet AL-T Hyperlordotic Secured Lumbar Cage</Name><Description>Secured Lumbar Cage</Description><Size>Small, Medium, Large footprint  Height: 13 to 26mm.  Lordosis: 20, 25 and 30°.</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>338461</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF167</BillingCode><Name>Elevator ALIF Cage</Name><Description>Anterior Lumbar Cage with integral fixation (PEEK, HA PEEK)  </Description><Size>Angle 8-25 degrees, Small, Medium, Medium Wide, Large, Extra Large, 11-19mm high</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>181030</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN235</BillingCode><PriorBillingCodes><PriorBillingCode>JJ520</PriorBillingCode><PriorBillingCode>JJ899</PriorBillingCode></PriorBillingCodes><Name>CONCORDE Spine System</Name><Description>Interbody Fusion Device</Description><Size>7-18mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>149723</ARTG><ARTG>98094</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY108</BillingCode><PriorBillingCodes><PriorBillingCode>JG005</PriorBillingCode></PriorBillingCodes><Name>Salina</Name><Description>ACL - Lateral Oblique Cage</Description><Size>5 degree angle  26mm to 33mm length  7mm to 14mm height</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>370517</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN254</BillingCode><Name>CONDUIT EIT SMART TLIF</Name><Description>Cellular Titanium Cage with Graft Hole</Description><Size>7-15mm heights</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>319880</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY037</BillingCode><Name>Shinto PLIF Cage</Name><Description>Interbody Fusion Cages are used to restore disc height and support loading during intervertebral body fusion.</Description><Size>Angle 8 - 22 degrees  Length 21 - 26mm   Height 5 - 13mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>393044</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI062</BillingCode><Name>Capstone Control</Name><Description>TLIF vertebral Body Spacer</Description><Size>Length: 27-32mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB143</BillingCode><Name>Rise IntraLIF</Name><Description>Intradiscal Lumbar Interbody Fusion Device</Description><Size>Width 8mm, Length 26mm, 30mm and 34mm
Height 7-14mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>214537</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY112</BillingCode><Name>Additive Surgical Posterior Expandable Cage - Ustica</Name><Description>TLIF Titanium Expandable Cage</Description><Size>29-40mm x 9mm, 2-14 Degree Lordosis</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>370517</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB134</BillingCode><Name>Calber Expandable Lumbar Fusion Device</Name><Description>Expandable titanium alloy and PEEK lumbar interbody fusion device</Description><Size>Un-expanded Height -7-12mm, Expanded Height 11-17mm, Width 10-12mm, Length 26-30mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>190042</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB200</BillingCode><Name>SUSTAIN-RT</Name><Description>Insert and rotate lumbar fusion device</Description><Size>8-10mm x 26-30mm x 6-17mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>191535</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC974</BillingCode><Name>Capstone Cage</Name><Description>TLIF Vertebral Body Spacer</Description><Size>Length: 32mm - 36mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB006</BillingCode><Name>Signature Spacer</Name><Description>PEEK Interbody spacer</Description><Size>small, medium, large. 7mm - 17mm Height</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>190020</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JA006</BillingCode><PriorBillingCodes><PriorBillingCode>OH542</PriorBillingCode></PriorBillingCodes><Name>LP Cage</Name><Description>LP - PLIF Peek Cage</Description><Size>0°-8°, H 8-15mm L 22-27mm W 9-11mm</Size><SupplierCode>40213</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>289247</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF155</BillingCode><Name>Ayers TLIF Cage</Name><Description>TLIF interbody fusion device</Description><Size>Curved and Straight, various sizes and angles.</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>181030</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT001</BillingCode><Name>CALIBER Lordotic Cage</Name><Description>Lumbar fusion cage; PEEK, Titanium coated PEEK, 3D printed Titanium. </Description><Size>Width: 9mm; Length: 24mm - 36mm; Height 6mm - 12mm; Lordosis: 6, 12, 18 degrees</Size><SupplierCode>40227</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>322720</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM511</BillingCode><Name>LLIF Cage</Name><Description>LLIF Cage - PEEK</Description><Size>18, 22, 26W x 8, 10, 12, 14H x 40, 45, 50, 55L x  0°, 8°, 12°</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>367230</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW406</BillingCode><Name>Aria Spinal System / Peek DLIF Interbody Spacer</Name><Description>PEEK DLIF Interbody Spacer</Description><Size>H: 8-18mm L: 40-60mm W: 18-22mm 0-8 degree lordosis</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>298123</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ018</BillingCode><Name>VerteLoc™ Spine System</Name><Description>Interbody Fusion Device</Description><Size>7mm - 18mm</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>217031</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GK009</BillingCode><Name>3D Fusion LLIF Cage </Name><Description>Titanium Lateral Lumbar Interbody Fusion cage </Description><Size>Width: 18-24mm  Length - 34mm-60mm  Height - 3mm-30mm angle 0-35 degrees as per patient specific requirements for the designed cage.</Size><SupplierCode>40226</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>406173</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV152</BillingCode><Name>Modulus TLIF-A</Name><Description>Titanium lumbar interbody fusion device</Description><Size>Width: 9-14mm  Length: 30-40mm  Height: 7-14mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>132498</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI046</BillingCode><Name>Fortilink®-A</Name><Description>Interbody fusion cage</Description><Size>Width: 32-40mm  Length: 25-29mm   Height: 8-22mm</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>346071</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BP006</BillingCode><Name>TiPEEK Interbody system Lumbar DLIF</Name><Description>Sterile                                                                    DLIF Implants  Commercially Pure Titanium and Polyetheretherketone (PEEK-Optima )</Description><Size>Width 18-22mm:  Length 40-60mm:  Height 8-17mm:  Lordosis Angle 0 - 8 degrees</Size><SupplierCode>40061</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>273367</ARTG><ARTG>273374</ARTG><ARTG>273366</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI040</BillingCode><Name>Fortilink® -TC</Name><Description>Transforaminal interbody fusion device</Description><Size>Width: 10mm  Length: 26-36mm  Height: 7-15mm </Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>346071</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI030</BillingCode><Name>Fortilink® -TS</Name><Description>Posterior lumbar interbody fusion device</Description><Size>Width: 10mm  Length: 26mm-32mm  Height: 8-17mm</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>346071</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV154</BillingCode><Name>Modulus XLIF</Name><Description>Lateral lumbar fusion cage</Description><Size>Width: 18-26mm
Length: 45-60mm
Height: 8-14mm
Lordosis 0-15 degree</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>132498</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV014</BillingCode><Name>CoRoent</Name><Description>ALIF cage</Description><Size>XLR</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>132498</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV094</BillingCode><Name>Brigade Ti System</Name><Description>Interbody fusion implant</Description><Size>10-20mm x 34-42mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>132498</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BP001</BillingCode><Name>Ti PEEK Interbody system – Lumbar PLIF/TLIF (single)</Name><Description>Sterile                                                                
PLIF Implants
TLIF Implants
Commercially Pure Titanium and Polyetheretherketone (PEEK-Optima®)</Description><Size>Width 8-12mm: 
Length 22-34mm: 
Height 7-17mm:  
Lordosis Angle 0-8 degrees</Size><SupplierCode>40061</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>273366</ARTG><ARTG>273374</ARTG><ARTG>273367</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BP005</BillingCode><Name>PEEK Interbody system – Lumbar PLIF/TLIF (single)</Name><Description>Sterile and Non sterile                                               
PLIF Implants
TLIF Implants</Description><Size>Width 8-12mm: 
Length 22-34mm: 
Height 7-17mm:  
Lordosis Angle 0-8 degrees</Size><SupplierCode>40061</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>273374</ARTG><ARTG>273366</ARTG><ARTG>273367</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY027</BillingCode><Name>BMD Titanium ALIF Cage</Name><Description>Lumbar Interbody Cage</Description><Size>Heights: 9mm to 19mm</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>323520</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW742</BillingCode><PriorBillingCodes><PriorBillingCode>ER045</PriorBillingCode></PriorBillingCodes><Name>Aleutian Lateral</Name><Description>Lateral Interbody Spacer</Description><Size>(16-22)mm width x (25-60)mm length x (6-20)mm height, (0-15) degreee  lordotic angle</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>159146</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GK008</BillingCode><Name>3D Fusion Lumbar Plate </Name><Description>Titanium Lumbar Fusion Plate</Description><Size>Length: 18-24mm    Width: 10-24mm     thickness: 2-4mm </Size><SupplierCode>40226</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>406173</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH764</BillingCode><PriorBillingCodes><PriorBillingCode>LM404</PriorBillingCode></PriorBillingCodes><Name>Calix Peek Lumbar System</Name><Description>Peek lumbar interbody spacer for fusion of the lumbar spine using an anterior, posterior or transverse approach.</Description><Size>36mm x 24mm x 8mm x 8 deg  36mm x 24mm x 10mm x 8 deg  36mm x 24mm x 12mm x 8 deg  36mm x 24mm x 14mm x 8 deg  36mm x 24mm x 16mm x 8 deg  36mm x 24mm x 18mm x 8 deg  36mm x 24mm x 20mm x 8 deg  36mm x 24mm x 8mm x 12 deg  36mm x 24mm x 10mm x 12 deg  36mm x 24mm x 12mm x 12 deg  36mm x 24mm x 14mm x 12 deg  36mm x 24mm x 16mm x 12 deg  36mm x 24mm x 18mm x 12 deg  36mm x 24mm x 20mm x 12 deg  28mm x 10mm x 6mm  28mm x 10mm x 7mm  28mm x 10mm x 8mm  28mm x 10mm x 9mm  28mm x 10mm x 10mm  28mm x 10mm x 11mm  28mm x 10mm x 12mm  28mm x 10mm x 13mm  28mm x 10mm x 14mm  28mm x 10mm x 15mm  28mm x 10mm x 16mm  22mm x 10mm x 6mm  22mm x 10mm x 7mm  22mm x 10mm x 8mm  22mm x 10mm x 9mm  22mm x 10mm x 10mm  22mm x 10mm x 11mm  22mm x 10mm x 12mm  22mm x 10mm x 13mm  22mm x 10mm x 14mm  22mm x 10mm x 15mm  22mm x 10mm x 16mm  26mm x 10mm x 6mm  26mm x 10mm x 8mm  26mm x 10mm x 10mm  26mm x 10mm x 12mm  26mm x 10mm x 14mm  26mm x 10mm x 6mm x 5o  26mm x 10mm x 8mm x 5o  26mm x 10mm x 10mm x 5o  26mm x 10mm x 12mm x 5o  26mm x 10mm x 14mm x 5o</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>159605</ARTG><ARTG>170220</ARTG><ARTG>160750</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC976</BillingCode><Name>Capstone Cage</Name><Description>PLIF Vertebral Body Spacer</Description><Size>Length: 22mm - 26mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI396</BillingCode><Name>Adaptix Cage</Name><Description>PLIF Vertebral Body Spacer</Description><Size>Length: 24-28 mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB142</BillingCode><Name>RISE - paired</Name><Description>Expandable Lumbar Fusion Device</Description><Size>Width: 8mm, 10mm and 12mm 
Length: 22mm
Height 7-17mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>214537</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB133</BillingCode><Name>Sustain-IR and Sustain-IR Narrow - Paired</Name><Description>PEEK radiolucent interbody lumbar fusion device</Description><Size>Height 7-17mm, Length 18-22mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>191535</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC457</BillingCode><Name>LordoTec Cage (LT-Cage)</Name><Description>Titanium,  PEEK</Description><Size>18-28mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UL010</BillingCode><Name>Revolution Spacer</Name><Description>Spinal Spacer</Description><Size>9-17mm high, 21-27mm length, 12-22 degrees</Size><SupplierCode>40197</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>285840</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER668</BillingCode><Name>FORZA Spacer System-PLIF</Name><Description>FORZA Ti straight or curved spacers, PLIF, paired in various sizes</Description><Size>Profile: (9-11) mm x (23-27) mm  Height:6-14 mm  Lordosis: 0 and 8 degrees</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>206571</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV011</BillingCode><Name>CoRoent</Name><Description>PLIF cage - PEEK or Titanium</Description><Size>Width 8-12mm x Length 20-40mm x Height 6-14mm x Lordosis 0-15°</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>132498</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BF001</BillingCode><Name>Vigor/X'Plo PEEK Interbody Fusion Cage</Name><Description>Rotatable posterior lumbar interbody fusion cage</Description><Size>Heights: 7mm, 8mm, 9mm, 10mm, 11mm, 12mm, 14mm, 16mm and Lengths: 24mm, 26mm, 32mm</Size><SupplierCode>40171</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>211536</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI029</BillingCode><Name>Fortilink®-TS</Name><Description>Posterior lumbar interbody fusion device</Description><Size>Width: 10mm,  Length: 22mm  Height 8mm-17mm</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>346071</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BP007</BillingCode><Name>PEEK Interbody System – Lumbar PLIF/TLIF (Paired)</Name><Description>Sterile and Non sterile
PLIF Implants
TLIF Implants</Description><Size>Width 8-12mm: 
Length 22-34mm: 
Height 7-17mm:  
Lordosis Angle 0-8 degrees,</Size><SupplierCode>40061</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>273374</ARTG><ARTG>273367</ARTG><ARTG>273366</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB002</BillingCode><Name>Thoracic-lumbar PEEK cage</Name><Description>Interbody fusion cage</Description><Size>Height: 6 - 15mm</Size><SupplierCode>40026</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>215887</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH546</BillingCode><Name>Lateral Spine Truss System</Name><Description>Interbody spacer, Porous Ti</Description><Size>8-16mm high</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>252733</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BP003</BillingCode><Name>Ti PEEK Interbody System – Lumbar PLIF/TLIF (Paired)</Name><Description>Sterile                                                                
PLIF Implants
TLIF Implants
Commercially Pure Titanium and Polyetheretherketone (PEEK-Optima®)</Description><Size>Width 8-12mm: 
Length 22-34mm: 
Height 7-17mm:  
Lordosis Angle 0-8 degrees</Size><SupplierCode>40061</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>273366</ARTG><ARTG>273367</ARTG><ARTG>273374</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV012</BillingCode><Name>CoRoent</Name><Description>TLIF cage - PEEK or Titanium</Description><Size>Width 8-14mm x Length 20-40mm x Height 6-14mm x Lordosis 0-15°</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>132498</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV167</BillingCode><Name>3DP Interfixated ALIF</Name><Description>Interbody fusion device with integral fixation</Description><Size>6-10mm X 34-42mm X 24-32mm   10 - 20 degrees lordosis</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>132498</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB252</BillingCode><Name>Aesculap Interbody Cage</Name><Description>TLIF Interbody Cage</Description><Size>All sizes</Size><SupplierCode>40020</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>273761</ARTG><ARTG>122641</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI033</BillingCode><Name>Fortilink®-SA</Name><Description>Interbody fusion device with integrated locking mechanism</Description><Size>Width 32mm-40mm  Length 25mm-29mm  Height 10mm -22mm</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>346071</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV143</BillingCode><Name>Base Interfixated</Name><Description>Interbody fusion implant</Description><Size>6-14mm tall, 34-42mm wide, 24-30mm deep and 0-30° lordosis</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>132498</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB070</BillingCode><Name>Prospace Block</Name><Description>Titanium</Description><Size>9mm-11mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>101789</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV150</BillingCode><Name>Nuvasive TLX Interbody System</Name><Description>Expandable Lumbar Fusion Device</Description><Size>Width 11mm x Length 26-36mm x Height 7-14mm x Lordosis 12-20 degrees</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>132498</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB014</BillingCode><Name>ATP Cage</Name><Description>Lateral Interbody Spacer</Description><Size>Width 22mm x Length 40-60mm x Height 8 - 20mm
Angles 8, 15 &amp; 23 degree lordotic angle</Size><SupplierCode>40026</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>215887</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BP010</BillingCode><Name>TiPEEK Interbody system   Lumbar ALIF</Name><Description>Sterile                                                                    ALIF Implants  Commercially Pure Titanium and Polyetheretherketone (PEEK-Optima )</Description><Size>Width 24-28mm:   Length 28-38mm:   Height 8-17mm:    Lordosis Angle 6-8 degrees,</Size><SupplierCode>40061</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>273367</ARTG><ARTG>273366</ARTG><ARTG>273374</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PB005</BillingCode><Name>TLIF (D-REX) Cage</Name><Description>Interbody fusion cage.</Description><Size>Height: 7-15 mm.</Size><SupplierCode>40026</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>215887</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV153</BillingCode><Name>Modulus TLIF-O</Name><Description>Titanium lumbar interbody fusion device</Description><Size>Width: 10-14mm  Length: 25-35mm  Height: 7-14mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>132498</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV013</BillingCode><Name>CoRoent</Name><Description>XLIF cage – PEEK or Titanium</Description><Size>Width 16mm-26mm x Length 25-60mm x Height 4-20mm x Lordosis 0-35 degrees</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>132498</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH529</BillingCode><Name>ALIF Spine Truss System</Name><Description>Cage</Description><Size>8-20mm height</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>252733</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BF019</BillingCode><Name>Latero Lumbar Cage</Name><Description>PEEK lumbar cage</Description><Size>Height: 10, 11, 12, 13, 14, 15, 16 or 18mm
Width: 16, 18, 20 or 22mm
Length: 30, 35, 40, 45, 50 or 55mm
Angle: 9*</Size><SupplierCode>40171</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>211536</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV168</BillingCode><Name>Modulus ALIF </Name><Description>Integrated fixation lumbar fusion cage</Description><Size>6-12mm X 34-42mm X 24-32mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>132498</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI003</BillingCode><Name>CrossFuse II Interbody Fusion Device</Name><Description>Interbody fusion implant for Lateral Approach (LLIF); PEEK with tantalum markers</Description><Size>(14- 22)mm width X (35-70)mm long X (7-17)mm height; Lordosis 0-18 degrees; Cornal taper:
0-6 degrees</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>233565</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI001</BillingCode><Name>Bullet-Tip Interbody Fusion Device</Name><Description>TLIF interbody fusion implant; PEEK with tantalum markers</Description><Size>(8- 13)mm width X (22-32)mm long X (8-17)mm height; 0-6 degrees Lordosis</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>233565</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RI047</BillingCode><Name>Fortilink®-L</Name><Description>Lateral interbody fusion device</Description><Size>Width: 14-26mm  Length: 40-60mm  Height: 8-15mm</Size><SupplierCode>40088</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>346071</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB365</BillingCode><Name>Aesculap Interbody Cage</Name><Description>PLIF Interbody Cage</Description><Size>All sizes</Size><SupplierCode>40020</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>122641</ARTG><ARTG>273761</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BP002</BillingCode><Name>PEEK Interbody System – Lumbar ALIF</Name><Description>Sterile and Non sterile
ALIF Implants</Description><Size>Width 24-28mm: 
Length 28-38mm: 
Height 8-17mm: 
Lordosis Angle 6 - 8 degrees</Size><SupplierCode>40061</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>273366</ARTG><ARTG>273374</ARTG><ARTG>273367</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH543</BillingCode><Name>Posterior Spine Truss System Interbody Fusion Device</Name><Description>TLIF Cage</Description><Size>(9-12)mm x (22-40)mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>252733</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BP009</BillingCode><Name>PEEK Interbody System – DLIF Lumbar</Name><Description>Sterile and Non sterile 
DLIF Implants</Description><Size>Width 18-22mm:
Length 40-60mm:
Height 8-17mm:
Lordosis Angle 0 - 8 degrees</Size><SupplierCode>40061</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>273366</ARTG><ARTG>273374</ARTG><ARTG>273367</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF157</BillingCode><Name>Nik-Alias Cage</Name><Description>Anterior Lumbar Cage with integral fixation (PEEK, HA PEEK, Titanium, Porous Titanium)</Description><Size>Angle 0 - 12 degrees, Length 40 - 60mm, Height 8 - 16mm</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>181030</ARTG></ARTGs><ChangeExplanation>Change to Group benefit</ChangeExplanation><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU016</BillingCode><Name>Juliet LL Lateral Lumbar Cage</Name><Description>Lateral lumbar - PEEK or titanium</Description><Size>PEEK-
Width: 21mm
Length: 40mm, 45mm, 50mm, 55mm, 60mm
Height: 8mm, 10mm, 12mm, 14mm, 16mm
Lordotic angle: 6º
Titanium-
Width: 17mm, 21mm, 25mm
Length: 25mm, 30mm, 35mm, 40mm, 45mm, 50mm, 55mm, 60mm
Height: 6mm, 8mm, 10mm, 12mm, 14mm, 16mm
Lordotic angle: 0º, 6º</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>166194</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF174</BillingCode><Name>Spoiler ALF Cage</Name><Description>PEEK/ PEEK HA Cage</Description><Size>Small, Medium, Medium Wide, Large, Extra Large</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>181030</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI284</BillingCode><Name>ARTiC Spinal System</Name><Description>Titanium Fusion Cage</Description><Size>Height: 8-15mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC975</BillingCode><Name>Capstone Cage</Name><Description>DLIF Vertebral Body Spacer</Description><Size>Length: 40mm - 60mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB005</BillingCode><Name>TransContinental M Spacer</Name><Description>PEEK Interbody cages</Description><Size>0 degree, 6 degree, 20 degree and 25 degree, Height: 8mm - 21mm . Length: 35mm-60mm, Width: 20mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>191535</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB208</BillingCode><Name>HEDRON A </Name><Description>3D Printed ALIF Spacer</Description><Size>Footprint: 22X 29mm, 24X 35mm, 28X39mm  Height 9-21mm  </Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>353398</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB118</BillingCode><Name>Continental TPS Spacer</Name><Description>ALIF PEEK spacer with Titanium Plasma Spray</Description><Size>Width 25-39mm, Length 20-28mm, Height 9-21mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>191535</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ099</BillingCode><PriorBillingCodes><PriorBillingCode>SQ155</PriorBillingCode></PriorBillingCodes><Name>Neo Cage System</Name><Description>Cage Kit  PLIF, TLIF  Straight, Lordotic</Description><Size>22-26mm Length  7-14mm Width  7-14mm Height</Size><SupplierCode>40483</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>316221</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ150</BillingCode><Name>Evolution Spine E3D-A Interbody System-Static Fusion Cage</Name><Description>Evolution Spine E3D-A Interbody System-Static Fusion Cage, sterile</Description><Size>Footprint: (32-40 mm) x (24-28 mm) Height:9-21 mm Lordosis: 8-30 degrees</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>445955</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU009</BillingCode><Name>Juliet Ti TL, Juliet Ti OL</Name><Description>Titanium lumbar cage</Description><Size>TL - Length: 30mm or 34mm  Height: 8mm, 9mm, 10mm, 11mm, 12mm, 13mm, 14mm, 15mm or 16mm  Width: 10.5mm  Lordosis: 6º  OL - Length: 28mm, 32mm or 36mm  Height: 7mm, 8mm, 9mm, 10mm, 11mm, 12mm, 13mm, 14mm, 15mm or 16 mm  Width: 8mm, 8.5mm, 9mm, 10mm or 10.5mm  Lordosis: 6º or 12º</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>338461</ARTG><ARTG>166194</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY013</BillingCode><Name>E4 TLIF Cage</Name><Description>Interbody Cage</Description><Size>6mm height to 16mm height</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>181030</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER206</BillingCode><Name>Signus TLIF Implant </Name><Description>Signus TLIF Implant (Peek or Titanium)</Description><Size>Height (6-18 mm) x Width 11 mm x Length (28-40) mm x 0 or 6 degree angle</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>129772</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER150</BillingCode><Name>Signus - Semial</Name><Description>Composition - PEEK</Description><Size>Height (ant) 7.80, 10.40, 13.20; Diameter 38, 43, 48; Height (post) 5.4, 8.0, 8.1, 10.8; Angle 5.00, 10.40</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>122274</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM513</BillingCode><Name>TLIF Cage</Name><Description>TLIF Cage</Description><Size>10, 12mm (W) x 7 - 16mm (H) x 28, 33mm (L) x 5°, 10°, 12.5°</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>367230</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GK005</BillingCode><Name>3D Fusion TLIF Cage  </Name><Description>Titanium TLIF cage </Description><Size>Length: 25-60mm     Width: 8-16mm       Height: 3-30mm    Angle 0-35 degrees as per patient specific requirements for the designed cage.  </Size><SupplierCode>40226</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>406173</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER601</BillingCode><PriorBillingCodes><PriorBillingCode>OF046</PriorBillingCode></PriorBillingCodes><Name>Forza PLIF</Name><Description>PEEK PLIF cages in various sizes</Description><Size>9x23/27mm  11x23/27mm  0 and 8 degree  6-16mm height in 1mm increments</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>206571</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER569</BillingCode><Name>SIGNUS VERTACONNECT expandable lumbar cage TLIF Implant</Name><Description>SIGNUS expandable TLIF cage, Titanium alloy</Description><Size>width (12 mm) x length (31 mm / 34 mm / 37 mm);     height:  posterior (8 mm /10mm / 12 mm),    anterior unexpanded (9 mm - 14 mm);  anterior expanded     (13 mm -19 mm)    angle:  anterior unexpanded (3°-7°),  anterior expanded  (11°-19°)           </Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>129772</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER443</BillingCode><Name>LnK Lumbar Interbody Fusion Cage System-ALIF</Name><Description>LnK Lumbar Interbody Fusion Cage System-ALIF, PEEK, lordotic</Description><Size>length (24-29mm) x width (32-38mm) x height (6-19mm) x angle (0-25°)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>286125</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW680</BillingCode><Name>Monterey AL, Cage </Name><Description>ALIF Cage </Description><Size>Height 8mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>356926</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UL009</BillingCode><Name>Revolution Cage</Name><Description>Spinal Cage</Description><Size>9-17mm high, 21-27mm length, 12-22 degrees</Size><SupplierCode>40197</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>285840</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER229</BillingCode><Name>SIGNUS Noval Interbody Fusion Cage </Name><Description>SIGNUS Noval Interbody Fusion Cage </Description><Size>height (8-18 mm) x width (40-48 mm)x lordosis (5-15 degrees)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>129772</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY017</BillingCode><Name>BMD Titanium TLIF Cage</Name><Description>Lumbar Interbody Cage</Description><Size>Height 7mm to 17mm </Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>323520</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UL011</BillingCode><Name>Revolution TC/TS lumbar interbody fusion implant</Name><Description>Revolution TC/TS lumbar interbody fusion implant</Description><Size>21, 24, 27 lengths; 9-17mm heights; 12, 16, 22 deg lordosis</Size><SupplierCode>40197</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>285840</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ055</BillingCode><Name>Australis Spine System</Name><Description>Thoracolumbar Cage PC</Description><Size>Small to extra large</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>217031</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER646</BillingCode><Name>Forza XP Expandable Spacer System</Name><Description>The Forza XP Expandable Spacer System is comprised of an assortment of non-sterile as well as sterile, single use, titanium alloy and polyetheretherketone (PEEK) polymer spacers with height expansion capability. The expandable interbody spacer is inserted into the lumbar disc space and expanded to fit the patient anatomy. The implants are offered in parallel, lordotic, and hyperlordotic configurations to help restore the natural curvature of the spine. The implants can be used in single placement or pairs with typical approaches being transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF). The implants feature a bulleted nose for ease of insertion and anti-migration ripples on both the inferior and superior surfaces to provide increased stability and help prevent anterior/posterior movement of the device.</Description><Size>Length: 24 mm - 28 mm  Width: 10 mm  Starting height: 6.5 mm - 12.5 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>206571</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER442</BillingCode><Name>LnK Lumbar Interbody Fusion Cage System-TLIF</Name><Description>LnK Lumbar Interbody Fusion Cage System-TLIF, PEEK, lordotic</Description><Size>length (26-32mm) x width 11mm x height (7-16mm) x angle (0-8 degrees)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>286125</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM439</BillingCode><PriorBillingCodes><PriorBillingCode>NK122</PriorBillingCode></PriorBillingCodes><Name>Amendia Zeus Fusion Cages-TLIF</Name><Description>Zeus Fusion Cages-TLIF, PEEK (straight-versatile/curved/bullet nosed)</Description><Size>width (9-13 mm) x length (20-36 mm) x height (7-16 mm)</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>233730</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW649</BillingCode><Name>Tritanium TL</Name><Description>Steerable Posterior Lumbar Cage</Description><Size>Footprints: 27mm x 10mm, 31mm x 10mm, 35mm x 10mm; Height 7mm to 14mm; Angulation 0, 6 and 12 degree</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>265560</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KB010</BillingCode><PriorBillingCodes><PriorBillingCode>SV066</PriorBillingCode></PriorBillingCodes><Name>STERISPINE™ Lumbar Cage -Single</Name><Description>Curved and Straight Fusion Cage- Oblique/TLIF/PLIF PEEK (straight/curved/bullet nosed)</Description><Size>Straight:  Height 7-14mm  Width: 10-12mm  Length: 22-32mm  Curved   Height: 7-14mm  Length: 28-32mm</Size><SupplierCode>40247</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>273286</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER643</BillingCode><PriorBillingCodes><PriorBillingCode>OF068</PriorBillingCode></PriorBillingCodes><Name>SKYHAWK Interbody Fusion Device</Name><Description>PEEK Interbody Fusion Device</Description><Size>Width - 16mm, 18mm and 20mm, 22mm, 26mm  Length - 35mm, 40mm, 45mm, 50mm, 55mm, 60mm  Height - 8mm, 10mm, 11mm, 12mm, 13mm, 14mm, 15mm, 16mm, 17mm, 18mm, 19mm, 20mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>206571</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW764</BillingCode><PriorBillingCodes><PriorBillingCode>ER242</PriorBillingCode></PriorBillingCodes><Name>Cascadia Interbody Spacer</Name><Description>Cascadia interbody spacer, porous Ti</Description><Size>8.5 -14mm wide</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>293886</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE711</BillingCode><Name>REEF TO TLIF</Name><Description>REEF TO NanoMetalene TLIF</Description><Size>9&amp;11mm Widths  28, 32, 36mm Lengths  7-18mm Heights  0-22 Degree Lordosis</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>298002</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER162</BillingCode><Name>Signus Mobis Lumbar TLIF Cage</Name><Description>Peek-Optima Lumbar intervertebral TLIF cage</Description><Size>6, 7, 8, 9, 10, 11, 12, 13, 14, 16, 18mm heights</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>129772</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER444</BillingCode><Name>LnK Lumbar Interbody Fusion Cage System/PathLoc-LC Lateral Cage System-DLIF</Name><Description>LnK Lumbar Interbody Fusion Cage System/PathLoc-LC Lateral Cage System-DLIF, PEEK</Description><Size>length (18-24mm) x width (40-65mm) x height (8-16mm) x angle (0-12°)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>286125</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER357</BillingCode><Name>Ulrich Fusion Cages-TLIF</Name><Description>Ulrich Fusion Cages pezo/tezo-TLIF (various shapes), PEEK or Titanium</Description><Size>height (7-14mm) x width (11-16mm) x length (29-34mm) x angle 5°</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>279703</ARTG><ARTG>279705</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER190</BillingCode><Name>Signus Mobis II TLIF Implant</Name><Description>Signus Mobis II Thoracolumbar Fusion Cage-Peek or Ti</Description><Size>Height (6-14 mm)xWidth 9 mm x Length 29 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>129772</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB144</BillingCode><Name>RISE IntraLIF - paired</Name><Description>Intradiscal Lumbar Interbody Fusion Device</Description><Size>8mm Width, 22mm Length 7-14mm Height</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>214537</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN253</BillingCode><Name>CONDUIT EIT SMART PLIF</Name><Description>Cellular Titanium Cage with Graft Hole</Description><Size>8-16mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>319880</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU010</BillingCode><Name>Juliet Ti PO</Name><Description>Titanium lumbar cage</Description><Size>Length: 24mm
Height: 7mm, 8mm, 9mm, 10mm, 11mm, 12mm, 13mm, 14mm, 15mm or 16mm
Width: 8mm, 8.5mm, 9mm or 10.5mm
Lordosis: 6º or 12º</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>166194</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF102</BillingCode><Name>Revolve Spacer</Name><Description>Spinal Spacer</Description><Size>9-17mm high, 21-27mm length, 12-22 degrees</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>181030</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB198</BillingCode><Name>SUSTAIN-RT</Name><Description>Insert and rotate lumbar fusion device</Description><Size>8-10mm X 22mm X 6-17mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>191535</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB127</BillingCode><Name>Sustain - O TPS</Name><Description>TPS coated PEEK radiolucent lumbar interbody fusion device</Description><Size>Height 8-18mm,  Width 8-12mm, Length 22mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>191535</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI322</BillingCode><PriorBillingCodes><PriorBillingCode>ER497</PriorBillingCode></PriorBillingCodes><Name>Endoskeleton TO Interbody Fusion Device</Name><Description>Titanium lumbar posterior interbody fusion cage, sterile or non-sterile, also with  NanoLock™ surface technology, sterile</Description><Size>(22-31mm) x (8-16mm); 0-4 degrees</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>285244</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW729</BillingCode><PriorBillingCodes><PriorBillingCode>ER020</PriorBillingCode></PriorBillingCodes><Name>Aleutian PLIF</Name><Description>Posterior lumbar spacer, PEEK</Description><Size>(22-28)mm long x (8.5-10)mm wide x (4-17)mm high x (0-18) degree lordosis</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>159146</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST711</BillingCode><Name>OIC Cage</Name><Description>Interbody Cage</Description><Size>W 8-11mm, H 6-16mm, L20-25mm, Angle 0, 4 and 8 degrees</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>205486</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER600</BillingCode><PriorBillingCodes><PriorBillingCode>OF058</PriorBillingCode></PriorBillingCodes><Name>FORZA PTC</Name><Description>PEEK/Titanium spacer with porous titanium endplates</Description><Size>9mm X 23mm, Height 7mm-14mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>206571</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM440</BillingCode><PriorBillingCodes><PriorBillingCode>NK123</PriorBillingCode></PriorBillingCodes><Name>Amendia Zeus Fusion Cages-PLIF </Name><Description>Amendia Zeus Fusion Cages-PLIF (paired), PEEK</Description><Size>width (9-13 mm) x length (22-30 mm) x height (7-18 mm) x lordosis (0-8 degrees)</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>233730</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER149</BillingCode><Name>Tetris / Tasmin Family of Lumbar fusion cages</Name><Description>Titanium or peek, Interbody fusion device</Description><Size>(6-24)mm x (20-28) mm x (9-11) mm; lordosis 0-22 degrees</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>129772</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER358</BillingCode><Name>Ulrich Fusion Cages-PLIF (paired)</Name><Description>Ulrich Fusion Cages pezo/tezo-PLIF, paired, various, PEEK or Titanium</Description><Size>height (7-14mm) x length (24-29mm) x angle (5-12°)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>279705</ARTG><ARTG>279703</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KB009</BillingCode><PriorBillingCodes><PriorBillingCode>SV071</PriorBillingCode></PriorBillingCodes><Name>STERISPINE™ Lumbar Cage- Paired</Name><Description>Curved and Straight Fusion Cage- Oblique/TLIF/PLIF PEEK (straight/curved/bullet nosed)- Paired</Description><Size>7 – 14mm in height, 10 – 12mm in width, 22 and 28mm in length</Size><SupplierCode>40247</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>273286</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER440</BillingCode><Name>LnK Lumbar Interbody Fusion Cage System-PLIF</Name><Description>LnK Lumbar Interbody Fusion Cage System-PLIF cages, paired, PEEK, bullet shape, lordotic</Description><Size>Length (25-28mm) x width 11mm x height (6-16 mm) x (angle (0-8 degrees)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>286125</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GK006</BillingCode><Name>3D Fusion PLIF Cage</Name><Description>Titanium PLIF cage </Description><Size>Length: 18-26mm    Width: 8-12mm           Height: 7–25mm      angle 0-35 degrees  as per patient specific requirements for the designed cage   </Size><SupplierCode>40226</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><Suffix>Paired</Suffix><ARTGs><ARTG>406173</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR082</BillingCode><Name>UniLIF</Name><Description>PEEK Unilateral Lumbar Interbody Fusion Cage</Description><Size>Width 11mm, Height 6mm to 13mm, Length 30mm - 33mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>315086</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EY031</BillingCode><Name>BMD Titanium XLIF Cage</Name><Description>Lumbar Interbody Fusion Cage</Description><Size>9mm to 17mm Heights</Size><SupplierCode>39972</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>323520</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER602</BillingCode><PriorBillingCodes><PriorBillingCode>OF047</PriorBillingCode></PriorBillingCodes><Name>FORZA TLIF</Name><Description>PEEK TLIF cages in various sizes</Description><Size>Width - 9mm to 11mm  Length - 27mm to 33mm  Height - 6mm to 16mm   0 - 8 degree</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>206571</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SR050</BillingCode><Name>AVS TL Peek Spacer System</Name><Description>Transforaminal Lumbar Interbody Fusion cage, PEEK</Description><Size>7-18mm x 25--30mm. 0-4 degree</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>315081</ARTG><ARTG>315106</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER570</BillingCode><Name>Biedermann Motech TELIX K Interbody Fusion Cage Implant System</Name><Description>Biedermann Motech TELIX K Interbody Fusion Cage (TLIF), curved profile, Titanium  </Description><Size>(7-17mm) x (28-36mm); lordosis 0/5°  </Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>354050</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER669</BillingCode><Name>FORZA Spacer System-TLIF</Name><Description>FORZA Spacer System-TLIF, Ti, straight or curved</Description><Size>Profile: (9-11) mm x (&gt;27-31) mm  Height: 6-14 mm  Lordosis: 0 or 8 degrees</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>206571</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM502</BillingCode><Name>TLIF Cage</Name><Description>TLIF Cage - Titanium</Description><Size>10, 12W x 7-16H x 28, 33L x 5°, 10°, 12.5°</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>367230</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER603</BillingCode><PriorBillingCodes><PriorBillingCode>OF057</PriorBillingCode></PriorBillingCodes><Name>FORZA PTC</Name><Description>PEEK/Titanium spacer with porous titanium endplates</Description><Size>9mm X 27mm, Height 7mm-14mm  11mm X 27mm, Height 7mm-14mm  11mm X 31mm, Height 7mm-14mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>206571</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW782</BillingCode><PriorBillingCodes><PriorBillingCode>ER506</PriorBillingCode></PriorBillingCodes><Name>Cascadia AL Interbody System</Name><Description>Porous Titanium ALIF cage</Description><Size>Height: 9-21mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>193652</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW730</BillingCode><PriorBillingCodes><PriorBillingCode>ER021</PriorBillingCode></PriorBillingCodes><Name>Aleutian Anterior</Name><Description>Anterior/lateral lumbar interbody spacer</Description><Size>(30-60)mm wide x (18-28)mm long x (8-21)mm height</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>159146</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW560</BillingCode><Name>Tritanium PL Posterior Lumbar Cage</Name><Description>Porous Titanium Alloy Interbody Cage</Description><Size>6-16mm height, 23-32mm length, 9-11mm width, 0, 6 and 12 degrees</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>265560</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER356</BillingCode><Name>Ulrich Fusion Cages-ALIF</Name><Description>Ulrich Fusion Cages pezo/tezo-ALIF (various shapes), PEEK or Titanium</Description><Size>height (8-26mm) x width (22-28mm) x length (28-34mm) x angle (0-12°)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>279703</ARTG><ARTG>279705</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW766</BillingCode><PriorBillingCodes><PriorBillingCode>ER282</PriorBillingCode></PriorBillingCodes><Name>Cascadia Lateral</Name><Description>Interbody spacer, Porous Ti</Description><Size>8-20mm high</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>293886</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PZ019</BillingCode><Name>Australis Spine System</Name><Description>Thoracolumbar Cage</Description><Size>small to extra large</Size><SupplierCode>40099</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>217031</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM485</BillingCode><Name>GoLIF Cage</Name><Description>Lumbar interbody fusion cage</Description><Size>22mm - 26mm (length)  8-15mm (height)</Size><SupplierCode>40194</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>364210</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW731</BillingCode><PriorBillingCodes><PriorBillingCode>ER022</PriorBillingCode></PriorBillingCodes><Name>Aleutian TLIF</Name><Description>Transforaminal lumbar interbody spacer</Description><Size>(8.5-12)mm wide x (22-36)mm long x (4-17)mm height x (6-18) degree lordotic angle</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>159146</ARTG><ARTG>193652</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER441</BillingCode><Name>LnK Lumbar Interbody Fusion Cage System-TPLIF</Name><Description>LnK Lumbar Interbody Fusion Cage System-TPLIF, PEEK</Description><Size>length 32mm x width 11mm x height (6-16mm) x angle (0-8°)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>286125</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW047</BillingCode><PriorBillingCodes><PriorBillingCode>BH143</PriorBillingCode></PriorBillingCodes><Name>Zyston Curved Interbody Spacer</Name><Description>Transformaminal Lumbar Interbody Spacer, PEEK</Description><Size>(7 to 18)mm height to (27x32)mm length, Parallel, Lordotic</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>287188</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT018</BillingCode><Name>Unity+ Lateral Standalone Cage</Name><Description>Thoracolumbar fusion cage: PEEK, Titanium coated PEEK, or 3D printed Titanium.</Description><Size>Width: 22mm, Height: 8mm, 9mm, 11mm, 13mm, 15mm, Width: 40mm, 45mm, 50mm, 55mm, 60mm, Lordosis: 8 or 15 degrees.</Size><SupplierCode>40227</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>322720</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE717</BillingCode><Name>REEF TA</Name><Description>REEF TA NanoMetalene TLIF</Description><Size>9&amp;11mm Widths    28, 32, 36, 40mm Lengths    7-18mm Heights    0 - 20 Degrees Lordosis</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>298002</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH612</BillingCode><Name>HumanTech - Adonis Spinal Fusion Cage System - TLIF/UNILIF</Name><Description>Spinal Fusion Cage - TLIF/UNILIF</Description><Size>L 30-35mm   W: 11-12mm H: 7-15mm   A: 0-5 </Size><SupplierCode>40113</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>316186</ARTG><ARTG>316185</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF178</BillingCode><Name>Chinook PLIF Cage</Name><Description>PLIF Spine Cage</Description><Size>7-14mm high, 24-29mm length, 5-16 degrees, PEEK, PEEK/HA, Titanium</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>181030</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB007</BillingCode><Name>Continental Spacer</Name><Description>PEEK Interbody spacer</Description><Size>x-small, small, medium, large. 0deg, 8deg, 15deg. 9mm - 21mm Height</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>190020</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW520</BillingCode><Name>AVS Navigator</Name><Description>Steerable TLIF Cage</Description><Size>L 26-31mm, H6-15mm, 0 and 4 degree anglulation</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>278569</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF098</BillingCode><Name>Advantage Cage</Name><Description>PEEK Cage</Description><Size>Small, medium, Medium Wide, Large, Extra Large</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>181030</ARTG></ARTGs><ChangeExplanation>Change to Group benefit</ChangeExplanation><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE686</BillingCode><Name>Regatta</Name><Description>Regatta Lateral Interbody System</Description><Size>Height: 8 -16mm  Width: 18 and 23mm  Length: 40,45,50,55 and 60mm  Lordosis: 0, 10 and 15 degrees</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>298002</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY059</BillingCode><PriorBillingCodes><PriorBillingCode>DR023</PriorBillingCode></PriorBillingCodes><Name>Hygro-L PLIF/TLIF (single)</Name><Description>Titanium lumbar interbody fusion cage PLIF/TLIF (single) </Description><Size>length (30-36mm) x width (11.5-13.5mm) heights (7-14mm); lordosis (0-12) degrees</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>330365</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ086</BillingCode><PriorBillingCodes><PriorBillingCode>JQ056</PriorBillingCode></PriorBillingCodes><Name>IdentiTi NanoTec Interbody System </Name><Description>Spacer, LIF. Ti HA </Description><Size>(16-26)mm x (40-65)mm x (4-16)mm height x (0-20) degrees lordosis</Size><SupplierCode>40401</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>397837</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE784</BillingCode><Name>FlareHawk Expandable TLIF Cage</Name><Description>Expandable PEEK &amp; titanium alloy lumbar interbody fusion device that enables significant graft delivery. FlareHawk is made up of an expandable shell and titanium shim.</Description><Size>0,6,9,15 degree lordosis. Unexpanded: 7mm height x 9mm width  or 7mm height x 7mm width. Expanded: 8mm - 14mm height x 14mm or 11mm widths; 29mm or 30mm lengths </Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>380420</ARTG><ARTG>380419</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ100</BillingCode><PriorBillingCodes><PriorBillingCode>SQ159</PriorBillingCode></PriorBillingCodes><Name>Neo Cage System </Name><Description>Cage anatomical, straight, curved</Description><Size>22-36mm length, 7-14mm width, 0-8 degrees</Size><SupplierCode>40483</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>316221</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ087</BillingCode><PriorBillingCodes><PriorBillingCode>JQ027</PriorBillingCode></PriorBillingCodes><Name>IdentiTi PC Porous Ti Interbody System </Name><Description>Spacer, Posterior Curved, Ti </Description><Size>(9-14)mm x (25-35)mm footprint  x (6-15)mm height  x (5-15)degree lordosis </Size><SupplierCode>40401</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>397837</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ085</BillingCode><PriorBillingCodes><PriorBillingCode>JQ018</PriorBillingCode></PriorBillingCodes><Name>IdentiTi LIF Porous Ti Spacer </Name><Description> IdentiTi Porous Ti Spacer Lateral Ti Interbody,  Ti </Description><Size>(4-14)mm  x (25-60)mm footprint  x (0-30)degree lordosis x (16-26)mm Height</Size><SupplierCode>40401</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>397837</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ088</BillingCode><PriorBillingCodes><PriorBillingCode>JQ028</PriorBillingCode></PriorBillingCodes><Name>IdentiTi PO Porous Ti Interbody System</Name><Description>Spacer, Posterior Oblique,  Ti</Description><Size>10mm x (25-35)mm footprint x (7-15)mm height x (5-15)degree lordosis</Size><SupplierCode>40401</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>397837</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ081</BillingCode><PriorBillingCodes><PriorBillingCode>JQ026</PriorBillingCode></PriorBillingCodes><Name>IdentiTi ALIF Porous Ti Interbody System </Name><Description>Spacer, Anterior Lumbar .Ti </Description><Size>(34-42)mm x (24-30)mm footprint x (4-11)mm height x (10-20) degree lordosis</Size><SupplierCode>40401</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>397837</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KH042</BillingCode><Name>DICA Lumbar Cage</Name><Description>Interbody Fusion Cage</Description><Size>7 degrees</Size><SupplierCode>40204</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>312519</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB169</BillingCode><Name>RISE-L Lateral Lumbar Interbody Fusion Device</Name><Description>Expandable titanium lumbar interbody fusion device</Description><Size>Width 18-22mm, Length 40-60mm, Height 7-10mm (unexpanded) - 14-17mm (expanded)</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>214537</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY106</BillingCode><PriorBillingCodes><PriorBillingCode>JG002</PriorBillingCode></PriorBillingCodes><Name>Alicudi</Name><Description>ACA - Anterior Lumbar Fusion Cage</Description><Size>5, 8, 14, 20 degree angle  9mm to 15mm height  30mm to 38mm width</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>370517</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB172</BillingCode><Name>Altera Articulating Expandable TLIF</Name><Description>Articulating Expandable Titanium TLIF Spacer</Description><Size>Length: 26-36mm
Height (non-expanded):8-12mm
Height (expanded): 12-16mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>214537</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN251</BillingCode><Name>CONDUIT EIT SMART ALIF</Name><Description>Cellular Titanium Cage with Graft Hole</Description><Size>8-20mm height</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>319880</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY453</BillingCode><Name>Oracle</Name><Description>Lumbar Interbody Fusion Cage</Description><Size>40-55mm M/L x 22mm A/P, 9-17mm Height</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>231840</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN249</BillingCode><Name>CONDUIT EIT TLIF Cage</Name><Description>Titanium Lumbar Cage</Description><Size>7-15mm heights</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>319880</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN247</BillingCode><Name>CONDUIT EIT ALIF Cage</Name><Description>Lumbar Cage with Titanium</Description><Size>8-18mm heights</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>319880</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU034</BillingCode><Name>Juliet TLIF Cage</Name><Description>PEEK cage with built in anatomical angulations</Description><Size>4 thicknesses - 8, 10, 12 and 14mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>166194</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB141</BillingCode><Name>RISE</Name><Description>Expandable Lumbar Fusion Device</Description><Size>Width:10mm, Length: 26mm, 30mm
Width:12mm, Length: 26mm and 30mm

Heights 7-17mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>214537</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU031</BillingCode><Name>Juliet Anterior Lumbar Cage</Name><Description>PEEK cage with built in anatomical shape. The cage has built in stabilising Titanium spike to stabilise the implant in the disc space.</Description><Size>All 26 mm length. 10, 12, 14 and 16mm height.  5 or 10 degree slope.</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>166194</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF183</BillingCode><Name>Hornet ALIF Cage</Name><Description>Integral fixated ALIF Cage</Description><Size>Small, Medium, Medium Wide, Large, Extra Large</Size><SupplierCode>40413</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>181030</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU046</BillingCode><Name>Juliet Ti LL cage</Name><Description>Titanium lateral lumbar cage</Description><Size>Height: 6mm, 8mm, 10mm, 12mm, 14mm, 16mm, 18mm, 20mm  Width: 17mm, 21mm  Length: 40mm, 45mm, 50mm, 55mm, 60mm  Lordosis: 0°, 8°, 15°, 25°</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>338461</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY061</BillingCode><PriorBillingCodes><PriorBillingCode>DR047</PriorBillingCode></PriorBillingCodes><Name>Kyocera Lateral Lumbar Interbody System</Name><Description>Lateral Lumbar Interbody Cage</Description><Size>18-22mm W, 30-60mm L, 8-20mm H</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>354092</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB004</BillingCode><Name>TransContinental Spacer</Name><Description>PEEK Interbody cages</Description><Size>X-small, small, medium, large, x-large 0 deg, 6 deg and 10 degree 7 - 17mm Height</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>191535</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB202</BillingCode><Name>HEDRON L</Name><Description>3D Printed Lateral Spacer</Description><Size>Width: 18-22mm  Lengths: 40-60mm  Heights: 7-15mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>353398</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY036</BillingCode><Name>Shuriken Cage</Name><Description>Interbody Fusion Cages are used to restore disc height and support loading during intervertebral body fusion.</Description><Size>7-13mm height; 30-35mm length; 6-18 degrees lordosis</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>393044</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB071</BillingCode><Name>SUSTAIN Spacer</Name><Description>TLIF Cage</Description><Size>8mm-17mm height, 8mm-12mm width, 26-30mm length</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>191534</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC673</BillingCode><Name>Verte-Stack</Name><Description>Perimeter Cage</Description><Size>Extra Small, Small, Medium, Large, Extra Large</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>126313</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB205</BillingCode><Name>HEDRON T</Name><Description>3D Printed TLIF Spacer</Description><Size>Width: 10-11mm  Length: 28-33mm  Height: 7-17mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>353398</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY072</BillingCode><PriorBillingCodes><PriorBillingCode>DR046</PriorBillingCode></PriorBillingCodes><Name>Tesera T/ST</Name><Description>Titanium TLIF Cage</Description><Size>Length (28-34mm) x Width (10-11mm) x Height (7-16mm) Lordotic angle (0-7) Degrees</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>354092</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI325</BillingCode><PriorBillingCodes><PriorBillingCode>ER498</PriorBillingCode></PriorBillingCodes><Name>Endoskeleton TT Interbody Fusion Device</Name><Description>Titanium posterior interbody fusion cage, parallel or lordotic, sterile or non-sterile, also with NanoLock™ surface technology, sterile</Description><Size>Height 7-14mm; 30-35mm x11mm, 0˚ or 4˚ angles</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>285244</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC685</BillingCode><Name>Verte-Stack Crescent</Name><Description>PEEK</Description><Size>Height 6 - 18mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107672</SubCategoryID><GroupID>108580</GroupID><SubGroupID>112644</SubGroupID><ARTGs><ARTG>169501</ARTG></ARTGs><MinimumBenefit>3313</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC025</BillingCode><PriorBillingCodes><PriorBillingCode>JA024</PriorBillingCode></PriorBillingCodes><Name>Pro-Disc C (Vivo)</Name><Description>Prosthesis used to replace a cervical inter-vertebral disc and to restore disc height and segmental motion.</Description><Size>5-7mm Hright  15-19 mm Width  12-18mm Depth</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108582</GroupID><SubGroupID>112645</SubGroupID><ARTGs><ARTG>323813</ARTG></ARTGs><MinimumBenefit>6021</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW041</BillingCode><PriorBillingCodes><PriorBillingCode>ZA057</PriorBillingCode></PriorBillingCodes><Name>Mobi-C Cervical Disc Prosthesis</Name><Description>A cervical intervertebral disc replacement consisting of superior and inferior spinal plates and a mobile bearing insert.</Description><Size>Depth (13-19mm) x width (15-19mm) x height (4.5-7mm)</Size><SupplierCode>39969</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108582</GroupID><SubGroupID>112645</SubGroupID><ARTGs><ARTG>297897</ARTG></ARTGs><MinimumBenefit>6021</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PC026</BillingCode><PriorBillingCodes><PriorBillingCode>JA032</PriorBillingCode></PriorBillingCodes><Name>Prodisc-C</Name><Description>Cervical Intervertebral Disc</Description><Size>5-7mm Height; 15-19mm Width; 12-18mm Depth</Size><SupplierCode>40100</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108582</GroupID><SubGroupID>112645</SubGroupID><ARTGs><ARTG>196068</ARTG></ARTGs><MinimumBenefit>6021</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH521</BillingCode><Name>CP ESP Cervical disc</Name><Description>Cervical disc prosthesis</Description><Size>13-15 x 15-20 H5/6/7</Size><SupplierCode>40113</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108582</GroupID><SubGroupID>112645</SubGroupID><ARTGs><ARTG>205414</ARTG></ARTGs><MinimumBenefit>6021</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU039</BillingCode><Name>BAGUERA C</Name><Description>Cervical Disc Prosthesis</Description><Size>Height: 5-7mm  Footprint: 13-16mm X 16-18mm</Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108582</GroupID><SubGroupID>112645</SubGroupID><ARTGs><ARTG>166149</ARTG></ARTGs><MinimumBenefit>6021</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY053</BillingCode><PriorBillingCodes><PriorBillingCode>DR004</PriorBillingCode></PriorBillingCodes><Name>Freedom Cervical Disc</Name><Description>Cervical disc replacement prosthesis.</Description><Size>Footprints: 13x16mm, 15x18mm, 17x20mm   Heights: 5, 6mm</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108582</GroupID><SubGroupID>112645</SubGroupID><ARTGs><ARTG>280296</ARTG></ARTGs><MinimumBenefit>6021</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI058</BillingCode><Name>Bryan Cervical Disc</Name><Description>Cervical intervertebral disc prosthesis consisting of a polyurethane nucleus designed to fit between two titanium alloy shells</Description><Size>14mm-18mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108582</GroupID><SubGroupID>112645</SubGroupID><ARTGs><ARTG>100706</ARTG></ARTGs><MinimumBenefit>6021</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI059</BillingCode><Name>Prestige Cervical Disc</Name><Description>Cervical intervertebral disc prosthesis with ball-and-trough designed articulation</Description><Size>5mm - 8mm x 12mm - 18mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108582</GroupID><SubGroupID>112645</SubGroupID><ARTGs><ARTG>100706</ARTG></ARTGs><MinimumBenefit>6021</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB347</BillingCode><Name>activ C Cervical Disc Prosthesis</Name><Description>Cervical disc prosthesis consisting of superior and inferior endplates, plasmapore coated with anatomical adapted footprint and shape.</Description><Size>XS=16Wx13Lx5H or 6H; S=16Wx14Lx5H OR 6H; M=17WX15LX5H or 6H; L=18Wx16Lx5H or 6H; XL=19Wx17Lx5H or 6H; XXL=19Wx18Lx5H or 6H</Size><SupplierCode>40020</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108582</GroupID><SubGroupID>112645</SubGroupID><ARTGs><ARTG>181018</ARTG></ARTGs><MinimumBenefit>6021</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH756</BillingCode><PriorBillingCodes><PriorBillingCode>LM425</PriorBillingCode></PriorBillingCodes><Name>Synergy Disc</Name><Description>The Synergy Disc is a three-component system consisting of an Inferior titanium endplate, a UHMWPE core and a Superior titanium endplate.</Description><Size>Small (A-P: 14 mm, Lateral: 15 mm), Medium (A-P: 16 mm, Lateral: 17 mm) and Large (A-P: 16 mm, Lateral: 17 mm).</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108582</GroupID><SubGroupID>112645</SubGroupID><ARTGs><ARTG>238877</ARTG></ARTGs><MinimumBenefit>6021</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB104</BillingCode><Name>SECURE Cervical Artificial Disc</Name><Description>Cervical Disc Replacement System</Description><Size>5mm - 9mm, 11x12 - 15x18mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108582</GroupID><SubGroupID>112645</SubGroupID><ARTGs><ARTG>191978</ARTG></ARTGs><MinimumBenefit>6021</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JP004</BillingCode><PriorBillingCodes><PriorBillingCode>JA024</PriorBillingCode></PriorBillingCodes><Name>Pro-Disc C (Vivo)</Name><Description>Prosthesis used to replace a cervical inter-vertebral disc and to restore disc height and segmental motion.</Description><Size>5-7mm Hright  15-19 mm Width  12-18mm Depth</Size><SupplierCode>39934</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108582</GroupID><SubGroupID>112645</SubGroupID><ARTGs><ARTG>323813</ARTG></ARTGs><MinimumBenefit>6021</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JP011</BillingCode><PriorBillingCodes><PriorBillingCode>JA032</PriorBillingCode></PriorBillingCodes><Name>Prodisc-C</Name><Description>Cervical Intervertebral Disc</Description><Size>5-7mm Height; 15-19mm Width; 12-18mm Depth</Size><SupplierCode>39934</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108582</GroupID><SubGroupID>112645</SubGroupID><ARTGs><ARTG>196068</ARTG></ARTGs><MinimumBenefit>6021</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV171</BillingCode><Name>Nuvasive Simplify Cervical Artificial Disc</Name><Description>Cervical disc prosthesis</Description><Size>Footprints: 12mm x 15mm, 14mm x 16mm, 16mm x 18mm  Heights: 4mm, 5mm, 6mm  Lordosis: 0, 5 degrees</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108582</GroupID><SubGroupID>112645</SubGroupID><ARTGs><ARTG>387763</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>6021</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH490</BillingCode><Name>M6C Artificial Cervical Disc</Name><Description>The M6 artificial cervical disc is an intervertebral disc prosthesis designed to maintain motion of a functional spinal unit when the native disc is diseased.</Description><Size>Footprints:
12.5mm x 15mm
15mm x 15mm
14mm x 17mm
16mm x 17mm
Heights: 
6mm &amp; 7mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108582</GroupID><SubGroupID>112645</SubGroupID><ARTGs><ARTG>177101</ARTG></ARTGs><MinimumBenefit>6021</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER675</BillingCode><Name>SIGNUS ROTAIO</Name><Description>Cervical Disc Prosthesis</Description><Size>Footprint: width × depth (mm): 15×13; 17×13; 17×15, 19×15  Height: 5-6 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108582</GroupID><SubGroupID>112645</SubGroupID><ARTGs><ARTG>216748</ARTG></ARTGs><MinimumBenefit>6021</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IY060</BillingCode><PriorBillingCodes><PriorBillingCode>DR001</PriorBillingCode></PriorBillingCodes><Name>Freedom Lumbar Disc</Name><Description>Lumbar Disc Replacement Prosthesis</Description><Size>26mmx36mm, 28mmx38mm, 30mmx40mm, 12-16mm, 4-12 degrees.</Size><SupplierCode>40470</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108582</GroupID><SubGroupID>112646</SubGroupID><ARTGs><ARTG>279935</ARTG></ARTGs><MinimumBenefit>8847</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DU065</BillingCode><Name>Baguera L  </Name><Description>Lumbar Disc Prosthesis  </Description><Size>Height: 8, 10, 12 mm.  Footprint: 27 x 35mm; 30 x 39mm; 31 x 42mm  </Size><SupplierCode>40420</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108582</GroupID><SubGroupID>112646</SubGroupID><ARTGs><ARTG>338474</ARTG></ARTGs><MinimumBenefit>8847</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH467</BillingCode><Name>LP-ESP® Intervertebral Disc Prosthesis</Name><Description>Lumbar disc prosthesis</Description><Size>10-12mm thickness, 7/9/11 degrees</Size><SupplierCode>40113</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108582</GroupID><SubGroupID>112646</SubGroupID><ARTGs><ARTG>181919</ARTG></ARTGs><MinimumBenefit>8847</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH531</BillingCode><Name>M6L Artificial Lumbar Disc</Name><Description>Intervertebral Artificial Disc – Lumbar</Description><Size>(Medium, Large, Xlarge) footprint, 3 - 16 degrees lordosis</Size><SupplierCode>40192</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108582</GroupID><SubGroupID>112646</SubGroupID><ARTGs><ARTG>177102</ARTG></ARTGs><MinimumBenefit>8847</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB361</BillingCode><Name>activ L Lumbar Disc Prosthesis</Name><Description>activ L is the lumbar disc prosthesis for the motion preserving treatment of degenerative disc disease of the lumbar spine.</Description><Size>H= 8.5mm/10mm/ 12mm/ 14mm. 
Small: D= 26mm x W = 31mm
Medium: D= 28mm x W = 34.5mm
Large: D= 30mm x W = 39mm
Extra Large: D= 33mm x W = 40mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107673</SubCategoryID><GroupID>108582</GroupID><SubGroupID>112646</SubGroupID><ARTGs><ARTG>120419</ARTG></ARTGs><MinimumBenefit>8847</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB137</BillingCode><Name>Fortify® I Integrated Corpectomy Spacer System - Core</Name><Description>PEEK and Titanium Cores with option of fixed lower endplate</Description><Size>12mm, 14mm and 20mm diameter Height 24-90mm to 32-120mm (expanded)</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112647</SubGroupID><ARTGs><ARTG>190055</ARTG></ARTGs><MinimumBenefit>2016</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB288</BillingCode><Name>Aesculap Vertebral Body System</Name><Description>Vertebral Body System, Titanium Alloy</Description><Size>All sizes</Size><SupplierCode>40020</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112648</SubGroupID><Suffix>ThoracoLumbar</Suffix><ARTGs><ARTG>132297</ARTG></ARTGs><MinimumBenefit>3920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV078</BillingCode><Name>X-CORE (Expandable  cage)</Name><Description>Expandable VBR Cage</Description><Size>Diameter: 12-22mm
Height: 15-121mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112648</SubGroupID><Suffix>ThoracoLumbar</Suffix><ARTGs><ARTG>132498</ARTG></ARTGs><MinimumBenefit>3920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW770</BillingCode><PriorBillingCodes><PriorBillingCode>ER471</PriorBillingCode></PriorBillingCodes><Name>CAPRI Small  Expandable Corpectomy Cage System</Name><Description>Vertebral Body Replacement</Description><Size>(13-16) x (16-20) mm – height 18-74mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112648</SubGroupID><Suffix>ThoracoLumbar</Suffix><ARTGs><ARTG>291618</ARTG></ARTGs><MinimumBenefit>3920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE773</BillingCode><Name>KONG-TL</Name><Description>KONG-TL VBR Bodies</Description><Size>19mm Diameter:  19-23mm, 20-24mm, 22-29mm, 23-30mm, 27-37mm &amp; 33-49mm Heights  </Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112648</SubGroupID><Suffix>ThoracoLumbar</Suffix><ARTGs><ARTG>345871</ARTG></ARTGs><MinimumBenefit>3920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE756</BillingCode><Name>KONG-TL</Name><Description>KONG-TL VBR Extension with Screw</Description><Size>19mm Diameter, 20 &amp; 35mm Heights</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112648</SubGroupID><Suffix>ThoracoLumbar</Suffix><ARTGs><ARTG>345871</ARTG></ARTGs><MinimumBenefit>3920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH576</BillingCode><Name>SAMSON - Expandable Vertebral Body Replacement - Center Piece</Name><Description>Center Piece</Description><Size>Height 20mm - 120mm  Diam 20mm</Size><SupplierCode>40113</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112648</SubGroupID><Suffix>ThoracoLumbar</Suffix><ARTGs><ARTG>316057</ARTG></ARTGs><MinimumBenefit>3920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK448</BillingCode><Name>VLIFT</Name><Description>Vertebral Body Replacement System, DIS Implant</Description><Size>Diameters 12 to 22mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112648</SubGroupID><Suffix>ThoracoLumbar</Suffix><ARTGs><ARTG>130216</ARTG></ARTGs><MinimumBenefit>3920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB093</BillingCode><Name>FORTIFY Ti Corpectomy Spacer Core</Name><Description>Expandable corpectomy spacer</Description><Size>12mm, 16mm and 20mm x 15mm-135mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112648</SubGroupID><Suffix>ThoracoLumbar</Suffix><ARTGs><ARTG>190055</ARTG></ARTGs><MinimumBenefit>3920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER309</BillingCode><Name>Ulrich Anterior Distraction Device</Name><Description>Ulrich Anterior Distraction Device (ADD)-telescoping cage,  thoracolumbar</Description><Size>dia (12-16 mm) x height collapsed (10-39 mm) x height extended (13-65 mm) x angle (0-6°)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112648</SubGroupID><Suffix>ThoracoLumbar</Suffix><ARTGs><ARTG>279702</ARTG></ARTGs><MinimumBenefit>3920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY794</BillingCode><Name>XRL</Name><Description>Expandable Vertebral Body</Description><Size>22 - 121mm Height</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112648</SubGroupID><Suffix>ThoracoLumbar</Suffix><ARTGs><ARTG>133398</ARTG></ARTGs><MinimumBenefit>3920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB055</BillingCode><Name>Xpand Corpectomy Spacer System</Name><Description>Expandable corpectomy spacer</Description><Size>small, Medium, Large. 15-120mm in varying lordotic/kyphotic angles</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112648</SubGroupID><Suffix>ThoracoLumbar</Suffix><ARTGs><ARTG>190055</ARTG></ARTGs><MinimumBenefit>3920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB097</BillingCode><Name>FORTIFY R Corpectomy Spacer Core</Name><Description>Expandable corpectomy spacer</Description><Size>14mm -20mm  15mm-120mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112648</SubGroupID><Suffix>ThoracoLumbar</Suffix><ARTGs><ARTG>190055</ARTG></ARTGs><MinimumBenefit>3920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI298</BillingCode><Name>T2 Stratosphere Expandable Corpectomy System</Name><Description>Centrepiece</Description><Size>13-25mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112648</SubGroupID><Suffix>ThoracoLumbar</Suffix><ARTGs><ARTG>169501</ARTG></ARTGs><MinimumBenefit>3920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC820</BillingCode><Name>T2</Name><Description>Expandable vertebral body replacement cage</Description><Size>Diameters: 13 - 31mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112648</SubGroupID><Suffix>ThoracoLumbar</Suffix><ARTGs><ARTG>169501</ARTG></ARTGs><MinimumBenefit>3920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER354</BillingCode><Name>Ulrich thoracolumbar body replacement system (ObeliscPro)-Telescoping cage</Name><Description>Ulrich thoracolumbar body replacement system (ObeliscPro)-Telescoping cage, thoracolumbar</Description><Size>dia 20 mm x collapsed height (17-76 mm) x expanded height (23-132 mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112648</SubGroupID><Suffix>ThoracoLumbar</Suffix><ARTGs><ARTG>279702</ARTG></ARTGs><MinimumBenefit>3920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW757</BillingCode><PriorBillingCodes><PriorBillingCode>ER210</PriorBillingCode></PriorBillingCodes><Name>Capri Vertebral Body Replacement System-Cage</Name><Description>Cage, Internal or External Component</Description><Size>23 - 122mm height, multiple footprints</Size><SupplierCode>40329</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112648</SubGroupID><Suffix>ThoracoLumbar</Suffix><ARTGs><ARTG>204117</ARTG></ARTGs><MinimumBenefit>3920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV102</BillingCode><Name>X-Core Mini</Name><Description>the NuVasive X-CORE Mini expandable VBR System is a vertebral body repalcement device for use in the spine (C3 to L5) to replace a diseased or damaged vertebral body caused by tumor or fracure, to restore height of a collapsed vertebral body, and to achieve decompression of the spinal cord and neural tissues,</Description><Size>15-80mm</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112648</SubGroupID><Suffix>Cervical</Suffix><ARTGs><ARTG>132498</ARTG></ARTGs><MinimumBenefit>2755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB066</BillingCode><Name>XP and R Corpectomy Spacer System</Name><Description>Expandable Corpectomy spacer</Description><Size>Small, Medium,15-88mm in varying lordotic/kyphotic angles</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112648</SubGroupID><Suffix>Cervical</Suffix><ARTGs><ARTG>190055</ARTG></ARTGs><MinimumBenefit>2755</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER184</BillingCode><Name>SIGNUS Poseidon/POSEIDON ST Vertebral Body Replacement System-Vertebral Body</Name><Description>SIGNUS POSIDON/POSEIDON ST Vertebral Body, porous titanium</Description><Size>Dia 16/20mm x (Height 12-89mm)    </Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112648</SubGroupID><Suffix>ThoracoLumbar</Suffix><ARTGs><ARTG>216750</ARTG></ARTGs><MinimumBenefit>3920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER350</BillingCode><Name>Ulrich Anterior Distraction Device System (ADDplus)-Telescopic cage</Name><Description>Ulrich Anterior Distraction System (ADDplus) telescopic cage, integral end plate, cervical.</Description><Size>dia 12 mm x collapsed height (13-40 mm) x expanded height (18-65 mm) x angle (0-18°)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112648</SubGroupID><Suffix>ThoracoLumbar</Suffix><ARTGs><ARTG>279702</ARTG></ARTGs><MinimumBenefit>3920</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB098</BillingCode><Name>FORTIFY R Corpectomy Spacer Endplate</Name><Description>Expandable corpectomy spacer endplate</Description><Size>14-30mm X 14-25mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112649</SubGroupID><ARTGs><ARTG>190055</ARTG></ARTGs><MinimumBenefit>928</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE757</BillingCode><Name>KONG-TL</Name><Description>KONG-TL VBR Endplates with Screw</Description><Size>26-52mm Lengths  20-29mm Widths  0,4, 8 &amp; 12 Degree Angles</Size><SupplierCode>39975</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112649</SubGroupID><ARTGs><ARTG>345871</ARTG></ARTGs><MinimumBenefit>928</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OH575</BillingCode><Name>SAMSON - Expandable Vertebral Body Replacement - End Plates</Name><Description>End Plates</Description><Size>L: 20mm W: 25-55mm A: 0-8 </Size><SupplierCode>40113</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112649</SubGroupID><ARTGs><ARTG>316057</ARTG></ARTGs><MinimumBenefit>928</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI299</BillingCode><Name>T2 Stratosphere Expandable Corpectomy System</Name><Description>End Cap</Description><Size>13-30mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112649</SubGroupID><ARTGs><ARTG>169501</ARTG></ARTGs><MinimumBenefit>928</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB096</BillingCode><Name>FORTIFY Ti Corpectomy Spacer Endplate</Name><Description>Expandable  corpectomy spacer endplate</Description><Size>12 and 20mm x 12-50mm 0-12deg.  13mm Round, 16mm, 16mm Round,16mm Footprint. 16mm,  18mm Round, 18mm Footprint.  20mm Round, 20mm, 20mm Footprint. 12 X 13mm. 12mm X 13mm Footprint.  16 X 30mm Footprint, 16 x35mm Footprint, 16 x 40mm Footprint, 16 x 45mm Footprint, 18 x30mm Footprint, 18X 35mm Footprint, 18X40mm Footprint, 18 X 45mm Footprint</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112649</SubGroupID><ARTGs><ARTG>190055</ARTG></ARTGs><MinimumBenefit>928</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NV079</BillingCode><Name>X-CORE (End Cap)</Name><Description>End plate</Description><Size>Round 12-30mm x -8° to 16°; Rectangular 12-22mm x 15-60mm x -8° to 16°</Size><SupplierCode>40129</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112649</SubGroupID><ARTGs><ARTG>132498</ARTG></ARTGs><MinimumBenefit>928</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER185</BillingCode><Name>SIGNUS POSEIDON/POSEIDON ST Vertebral Body Replacement System-End Plate</Name><Description>SIGNUS POSEIDON/POSEIDON ST End Plate; porous titanium; </Description><Size>Dia (16mm) x (18 mm - 20mm) x (18 mm – 59 mm); lordosis 0°/ 5°/10°/15°/20°</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112649</SubGroupID><ARTGs><ARTG>216750</ARTG></ARTGs><MinimumBenefit>928</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER355</BillingCode><Name>Ulrich thoracolumbar body replacement system (ObeliscPRO)-End plates</Name><Description>Ulrich thoracolumbar body replacement system (ObeliscPRO)-End plates, various shapes</Description><Size>dia (20-32 mm) x angle (0-15°); oval (32x26 mm) x angle (0-15°); lateral length (35-55 mm) x angle (0-15°)</Size><SupplierCode>40067</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112649</SubGroupID><ARTGs><ARTG>279702</ARTG></ARTGs><MinimumBenefit>928</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY795</BillingCode><Name>XRL</Name><Description>Endplate</Description><Size>-10˚/+15˚ Degrees</Size><SupplierCode>39932</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112649</SubGroupID><ARTGs><ARTG>133398</ARTG></ARTGs><MinimumBenefit>928</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LB138</BillingCode><Name>Fortify I Integrated Corpectomy Spacer System - Endplates</Name><Description>PEEK and Titanium endplates</Description><Size>Lateral – 22mm X 40-50mm, 14mm X 14-16mm, 12-14mmX 14-16mm, 21x23mm and 25 X 30mm</Size><SupplierCode>40358</SupplierCode><CategoryID>107561</CategoryID><SubCategoryID>107674</SubCategoryID><GroupID>108586</GroupID><SubGroupID>112649</SubGroupID><ARTGs><ARTG>190055</ARTG></ARTGs><MinimumBenefit>928</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE620</BillingCode><Name>Park Modified Pectus Bar</Name><Description>Park Modified Pectus bar available in titanium alloy and stainless steel</Description><Size>6" - 152mm, 7" - 178mm, 8" - 203mm, 9" - 228mm, 10" - 254mm, 11" - 279mm, 12" - 305mm, 13" - 330mm, 14" - 356mm, 15" = 381mm, 16" - 406mm, 17" - 432mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107647</SubCategoryID><GroupID>108488</GroupID><SubGroupID>112650</SubGroupID><ARTGs><ARTG>317581</ARTG></ARTGs><MinimumBenefit>1193</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE621</BillingCode><Name>Park Pectus Hinge Plate Stabiliser</Name><Description>Stabilisation of Pectus Bar - optional use in asymmetric or adult pectus excavatum to prevent bar displacement stripping of intercostal muscles</Description><Size>65mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107647</SubCategoryID><GroupID>108489</GroupID><SubGroupID>112651</SubGroupID><ARTGs><ARTG>317581</ARTG></ARTGs><MinimumBenefit>480</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ396</BillingCode><Name>HeartMate 3 System Controller</Name><Description>System Controller</Description><Size>One size only</Size><SupplierCode>40062</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107649</SubCategoryID><GroupID>108492</GroupID><SubGroupID>112655</SubGroupID><Suffix>No Suffix</Suffix><ARTGs><ARTG>289763</ARTG></ARTGs><MinimumBenefit>4275</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ384</BillingCode><Name>HeartMate II Left Ventricular Assist System - System Controller</Name><Description>System controller</Description><Size>One size only</Size><SupplierCode>40062</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107649</SubCategoryID><GroupID>108492</GroupID><SubGroupID>112655</SubGroupID><Suffix>No Suffix</Suffix><ARTGs><ARTG>172007</ARTG></ARTGs><MinimumBenefit>4275</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ400</BillingCode><Name>HeartMate Left Ventricular System - Battery Charger</Name><Description>Battery Charger for HeartMate Batteries</Description><Size>one size</Size><SupplierCode>40062</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107649</SubCategoryID><GroupID>108492</GroupID><SubGroupID>112657</SubGroupID><Suffix>No Suffix</Suffix><ARTGs><ARTG>167132</ARTG></ARTGs><MinimumBenefit>2295</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ385</BillingCode><Name>HeartMate Left Ventricular Assist System - Battery Set</Name><Description>Rechargeable HeartMate specific batteries</Description><Size>One size only, set of 4</Size><SupplierCode>40062</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107649</SubCategoryID><GroupID>108492</GroupID><SubGroupID>112657</SubGroupID><Suffix>No Suffix</Suffix><ARTGs><ARTG>167134</ARTG></ARTGs><MinimumBenefit>2295</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ375</BillingCode><Name>HeartMate Left Ventricular Assist System - Battery Clip Set</Name><Description>Battery clip set</Description><Size>one size only</Size><SupplierCode>40062</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107649</SubCategoryID><GroupID>108492</GroupID><SubGroupID>112658</SubGroupID><ARTGs><ARTG>167134</ARTG></ARTGs><MinimumBenefit>1520</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ382</BillingCode><Name>HeartMate II Left Ventricular Assist System - Modular Belt</Name><Description>Modular belt to hold System Controller and Batteries</Description><Size>Small / Medium 
Large</Size><SupplierCode>40062</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107649</SubCategoryID><GroupID>108493</GroupID><SubGroupID>112659</SubGroupID><Suffix>No Suffix</Suffix><ARTGs><ARTG>272795</ARTG></ARTGs><MinimumBenefit>328</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ399</BillingCode><Name>Heart Mate 3 Holster Vest</Name><Description>Holster Vest</Description><Size>Small, medium and large</Size><SupplierCode>40062</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107649</SubCategoryID><GroupID>108493</GroupID><SubGroupID>112659</SubGroupID><Suffix>No Suffix</Suffix><ARTGs><ARTG>272795</ARTG></ARTGs><MinimumBenefit>328</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ397</BillingCode><Name>Heart Mate 3 Shower Bag</Name><Description>Shower Bag</Description><Size>One size only; set of 2</Size><SupplierCode>40062</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107649</SubCategoryID><GroupID>108493</GroupID><SubGroupID>112660</SubGroupID><Suffix>No Suffix</Suffix><ARTGs><ARTG>272795</ARTG></ARTGs><MinimumBenefit>428</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ380</BillingCode><Name>HeartMate II Left Ventricular Assist System - Shower Bag</Name><Description>Shower Bag</Description><Size>One size only; set of 2</Size><SupplierCode>40062</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107649</SubCategoryID><GroupID>108493</GroupID><SubGroupID>112660</SubGroupID><Suffix>No Suffix</Suffix><ARTGs><ARTG>272795</ARTG></ARTGs><MinimumBenefit>428</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ381</BillingCode><Name>HeartMate II Left Ventricular Assist System - Stabilization Belt</Name><Description>Fabric belt for Stabilizing percutaneous lead</Description><Size>Small / medium; set of 2 
large; set of 2</Size><SupplierCode>40062</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107649</SubCategoryID><GroupID>108493</GroupID><SubGroupID>112661</SubGroupID><Suffix>No Suffix</Suffix><ARTGs><ARTG>221217</ARTG></ARTGs><MinimumBenefit>95</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI309</BillingCode><Name>Cardioblate® Surgical Ablation Pen XL</Name><Description>The Cardioblate® Surgical Ablation Pen XL facilitates cardiac ablation in areas that are difficult to ablate with a bipolar device.</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107653</SubCategoryID><GroupID>108500</GroupID><SubGroupID>112672</SubGroupID><Suffix>Medtronic</Suffix><ARTGs><ARTG>140537</ARTG></ARTGs><MinimumBenefit>2876</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI487</BillingCode><Name>Cardioblate MAPS </Name><Description>Surgical RF Mapping, Ablation, Pacing and Sensing catheter.</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107653</SubCategoryID><GroupID>108500</GroupID><SubGroupID>112672</SubGroupID><Suffix>Medtronic - MAPS</Suffix><ARTGs><ARTG>155379</ARTG></ARTGs><MinimumBenefit>2000</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ246</BillingCode><Name>Cardioblate XL Pen VLFT</Name><Description>Monopolar radio-frequency catheter-pen for point-by-point cardiac ablation compatible with the Valleylab FT10 FT series energy platform  </Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107653</SubCategoryID><GroupID>108500</GroupID><SubGroupID>112672</SubGroupID><Suffix>Medtronic</Suffix><ARTGs><ARTG>377935</ARTG></ARTGs><MinimumBenefit>2876</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI308</BillingCode><Name>Cardioblate BP2 RF Surgical Ablation Device</Name><Description>The Cardioblate BP2 RF Surgical Ablation devices feature dual electrodes for the delivery of irrigated RF energy.  iRF technology combines saline to facilitate treatment</Description><Size>Standard, Low Profile</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107653</SubCategoryID><GroupID>108500</GroupID><SubGroupID>112673</SubGroupID><Suffix>Medtronic</Suffix><ARTGs><ARTG>140537</ARTG></ARTGs><MinimumBenefit>3523</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ065</BillingCode><Name>Atricure Isolator Linear Pen</Name><Description>Surgical Radio Frequency (RF) Isolator Linear Pen for Atrial Fibrillation surgery</Description><Size>One size only</Size><SupplierCode>40063</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107653</SubCategoryID><GroupID>108500</GroupID><SubGroupID>112673</SubGroupID><Suffix>AA-Med - Isolator Linear Pen</Suffix><ARTGs><ARTG>326626</ARTG><ARTG>326627</ARTG></ARTGs><MinimumBenefit>2000</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ064</BillingCode><Name>ATRICURE COOLRAIL LINEAR PEN</Name><Description>Surgical Radio Frequency (RF) Irrigated Linear Pen for Atrial Fibrillation surgery</Description><Size>One size only</Size><SupplierCode>40063</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107653</SubCategoryID><GroupID>108500</GroupID><SubGroupID>112673</SubGroupID><Suffix>AA-Med - Coolrail</Suffix><ARTGs><ARTG>326625</ARTG></ARTGs><MinimumBenefit>2600</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ055</BillingCode><Name>ATRICURE ISOLATOR SYNERGY RF CLAMPS</Name><Description>Surgical Radio Frequency (RF) Clamps for Atrial Fibrillation surgery</Description><Size>Short, Long</Size><SupplierCode>40063</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107653</SubCategoryID><GroupID>108500</GroupID><SubGroupID>112673</SubGroupID><Suffix>AA-Med - Isolator Synergy</Suffix><ARTGs><ARTG>163534</ARTG></ARTGs><MinimumBenefit>4200</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ056</BillingCode><Name>Isolator Synergy Access</Name><Description>Articulating Surgical Radio Frequency (RF) Clamp for Atrial Fibrillation Surgery</Description><Size>One size only</Size><SupplierCode>40063</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107653</SubCategoryID><GroupID>108500</GroupID><SubGroupID>112673</SubGroupID><Suffix>AA-Med - Isolator Synergy</Suffix><ARTGs><ARTG>167710</ARTG><ARTG>297560</ARTG></ARTGs><MinimumBenefit>4200</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ243</BillingCode><Name>Cardioblate BP2 surgical ablation device</Name><Description>Valleylab FT10 FT series energy platform compatible bipolar RF ablation catheter with saline irrigation and choice of standard or low-profile jaw designs</Description><Size>Standard, Low Profile</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107653</SubCategoryID><GroupID>108500</GroupID><SubGroupID>112673</SubGroupID><Suffix>Medtronic</Suffix><ARTGs><ARTG>378230</ARTG><ARTG>378231</ARTG></ARTGs><MinimumBenefit>3523</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI310</BillingCode><Name>Cardioblate® Gemini® Surgical Ablation System</Name><Description>The Cardioblate® Gemini® Surgical Ablation System is designed for minimally invasive ablation procedures. Gemini-s combines the efficacy of irrigated RF energy through a bipolar jaw, to facilitate deeper energy penetration, with real time measured customised energy delivery for greater confidence in achieving transmural cardiac lesions.</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107653</SubCategoryID><GroupID>108500</GroupID><SubGroupID>112674</SubGroupID><Suffix>Medtronic - Cardioblate Gemini</Suffix><ARTGs><ARTG>153878</ARTG></ARTGs><MinimumBenefit>6040</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI312</BillingCode><Name>Cardioblate® BP2 RF Surgical Ablation System</Name><Description>The Cardioblate® BP2 RF Surgical Ablation system features dual electrodes for the delivery of irrigated RF energy.  iRF technology combines saline to facilitate treatment</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107653</SubCategoryID><GroupID>108500</GroupID><SubGroupID>112674</SubGroupID><Suffix>Medtronic - Cardioblate BP2</Suffix><ARTGs><ARTG>146949</ARTG></ARTGs><MinimumBenefit>4614</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ080</BillingCode><Name>EPi-Sense Guided Coagulation System with VisiTrax Device CDK-1413 </Name><Description>Surgical Radio Frequency (RF) catheter for Atrial Fibrillation surgery</Description><Size>EPi-Sense Probe: 3cm (end effector) </Size><SupplierCode>40063</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107653</SubCategoryID><GroupID>108500</GroupID><SubGroupID>112674</SubGroupID><Suffix>AA-Med Episense</Suffix><ARTGs><ARTG>347670</ARTG></ARTGs><MinimumBenefit>6040</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ244</BillingCode><Name>Cardioblate BP2/PEN FT System</Name><Description>The Cardioblate BP2/PEN FT System includes both the FT-10 energy platform compatible Cardioblate BP2 surgical ablation device and Cardioblate PEN FT. This system features dual electrodes for the delivery of saline irrigated RF energy</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107653</SubCategoryID><GroupID>108500</GroupID><SubGroupID>112674</SubGroupID><Suffix>Medtronic - Cardioblate BP2</Suffix><ARTGs><ARTG>377936</ARTG></ARTGs><MinimumBenefit>4614</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ245</BillingCode><Name>Cardioblate Gemini-S FT Clamp</Name><Description>Valleylab FT10 FT series energy platform compatible bipolar RF ablation catheter with saline irrigation designed for minimally invasive ablation procedures</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107653</SubCategoryID><GroupID>108500</GroupID><SubGroupID>112674</SubGroupID><Suffix>Medtronic - Cardioblate Gemini</Suffix><ARTGs><ARTG>377933</ARTG></ARTGs><MinimumBenefit>6040</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ057</BillingCode><Name>cryoICE Cryoablation Surgical Probes</Name><Description>Surgical Cryoablation probes for atrial fibrillation surgery</Description><Size>One size only</Size><SupplierCode>40063</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107653</SubCategoryID><GroupID>108501</GroupID><SubGroupID>112676</SubGroupID><Suffix>AA-Med cryoICE</Suffix><ARTGs><ARTG>202110</ARTG><ARTG>311095</ARTG></ARTGs><MinimumBenefit>3800</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI311</BillingCode><Name>CryoFlex™ Surgical Ablation Probe</Name><Description>The CryoFlex™ Surgical Ablation Probe utilises a gas for freezing cells in the surgical treatment of cardiac arrhythmias.</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107653</SubCategoryID><GroupID>108501</GroupID><SubGroupID>112676</SubGroupID><Suffix>Medtronic - CryoFlex</Suffix><ARTGs><ARTG>158928</ARTG></ARTGs><MinimumBenefit>4695</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI307</BillingCode><Name>SurgiFrost 10</Name><Description>SurgiFrost 10 is a malleable, single-use cryosurgical device developed to treat cardiac arrhythmias during heart surgery.  Freezing preserves tissue integrity. SurgiFrost10 features a malleable shaft and flexible tip with adjustable insulation sleeve.</Description><Size>One size ony</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107653</SubCategoryID><GroupID>108501</GroupID><SubGroupID>112676</SubGroupID><Suffix>Medtronic - SurgiFrost 10</Suffix><ARTGs><ARTG>158928</ARTG></ARTGs><MinimumBenefit>4095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI306</BillingCode><Name>CryoFlex™ Surgical Clamp and Probe</Name><Description>The CryoFlex™ Surgical Clamp and Probe combines the utility of the CryoFlex™ Probe with the delivery of a clamp.</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107653</SubCategoryID><GroupID>108501</GroupID><SubGroupID>112677</SubGroupID><Suffix>Medtronic</Suffix><ARTGs><ARTG>158929</ARTG></ARTGs><MinimumBenefit>5095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX292</BillingCode><Name>Supple Peri-Guard (4 x 4cm)</Name><Description>Model No PC0404SN - 4 x 4cm Bovine pericardium patch</Description><Size>4 x 4cm</Size><SupplierCode>39947</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107658</SubCategoryID><GroupID>108535</GroupID><SubGroupID>112699</SubGroupID><ARTGs><ARTG>152945</ARTG></ARTGs><MinimumBenefit>333</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER507</BillingCode><Name>LeMaitre Xenosure Biologic Patch-Small, &lt; 25cm²</Name><Description>The XenoSure Biologic Patch is a high-quality bovine pericardium
patch used for vascular and cardiovascular reconstructions.</Description><Size>0.8 x 8 cm Tapered Patch
  1 x 6 cm   Rounded Patch
  1 x 10 cm Tapered Patch
  1.5 x 10 cm Tapered Patch
  1 x 14 cm Tapered Patch
  2 x 9 cm Rounded Patch
  4 x 4 cm Square Patch
  4 x 6 cm Rectangular Patch</Size><SupplierCode>40067</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107658</SubCategoryID><GroupID>108535</GroupID><SubGroupID>112699</SubGroupID><ARTGs><ARTG>310096</ARTG></ARTGs><MinimumBenefit>333</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX293</BillingCode><Name>Supple Peri-Guard (6 x 8cm)</Name><Description>Model No PC0608SN -6 x 8cm Bovine pericardium patch</Description><Size>6 x 8cm</Size><SupplierCode>39947</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107658</SubCategoryID><GroupID>108535</GroupID><SubGroupID>112700</SubGroupID><ARTGs><ARTG>152945</ARTG></ARTGs><MinimumBenefit>523</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER508</BillingCode><Name>LeMaitre Xenosure Biologic Patch-Medium, 25-75cm²</Name><Description>The XenoSure Biologic Patch is a high-quality bovine pericardium patch used for vascular and cardiovascular reconstructions.</Description><Size>6 x 8 cm Rectangular Patch
  5 x 10 cm Rectangular Patch</Size><SupplierCode>40067</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107658</SubCategoryID><GroupID>108535</GroupID><SubGroupID>112700</SubGroupID><ARTGs><ARTG>310096</ARTG></ARTGs><MinimumBenefit>523</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EL033</BillingCode><Name>Baxter Augmentation / Substitution Material, Human or Animal Origin, Sterile Pericardial Patch.</Name><Description>Edwards Pericardial Patch. Bovine Pericardium.</Description><Size>10cm x 15cm</Size><SupplierCode>40072</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107658</SubCategoryID><GroupID>108535</GroupID><SubGroupID>112701</SubGroupID><ARTGs><ARTG>154067</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER509</BillingCode><Name>LeMaitre Xenosure Biologic Patch-Large, &gt;75cm²</Name><Description>The XenoSure Biologic Patch is a high-quality bovine pericardium patch used for vascular and cardiovascular reconstructions.</Description><Size>8 x 14 cm Rectangular Patch
10 x 16 cm Rectangular Patch
12 x 25 cm Rectangular Patch</Size><SupplierCode>40067</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107658</SubCategoryID><GroupID>108535</GroupID><SubGroupID>112701</SubGroupID><ARTGs><ARTG>310096</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX294</BillingCode><Name>Supple Peri-Guard (10 x 16cm)</Name><Description>Model No PC1016SN - 10 x 16 Bovine pericardium patch</Description><Size>10 x 16cm</Size><SupplierCode>39947</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107658</SubCategoryID><GroupID>108535</GroupID><SubGroupID>112701</SubGroupID><ARTGs><ARTG>152945</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX295</BillingCode><Name>Supple Peri-Guard (8 x 14cm)</Name><Description>Nodel No PC0814SN - 8 x 14 Bovine pericardium patch</Description><Size>8 x 14cm</Size><SupplierCode>39947</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107658</SubCategoryID><GroupID>108535</GroupID><SubGroupID>112701</SubGroupID><ARTGs><ARTG>152945</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT292</BillingCode><PriorBillingCodes><PriorBillingCode>GT271</PriorBillingCode><PriorBillingCode>GT275</PriorBillingCode></PriorBillingCodes><Name>GORE-TEX ® Cardiovascular Patch</Name><Description>E-PTFE</Description><Size>Cardiovascular Patch &lt; 75cm²</Size><SupplierCode>40435</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107658</SubCategoryID><GroupID>108536</GroupID><SubGroupID>112702</SubGroupID><ARTGs><ARTG>153256</ARTG><ARTG>153255</ARTG></ARTGs><MinimumBenefit>228</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT293</BillingCode><PriorBillingCodes><PriorBillingCode>GT120</PriorBillingCode><PriorBillingCode>GT121</PriorBillingCode></PriorBillingCodes><Name>GORE-TEX ® Cardiovascular Patch</Name><Description>E-PTFE</Description><Size>Cardiovascular Patch ≥ 75cm²</Size><SupplierCode>40435</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107658</SubCategoryID><GroupID>108536</GroupID><SubGroupID>112703</SubGroupID><ARTGs><ARTG>153256</ARTG><ARTG>153255</ARTG></ARTGs><MinimumBenefit>495</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU048</BillingCode><Name>Gelweave Graft</Name><Description>Straight Polyester Woven</Description><Size>6-38mm x 15-20cm</Size><SupplierCode>40450</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107662</SubCategoryID><GroupID>108548</GroupID><SubGroupID>112707</SubGroupID><ARTGs><ARTG>125606</ARTG></ARTGs><MinimumBenefit>463</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU047</BillingCode><Name>Gelweave Graft</Name><Description>Straight Polyester Woven</Description><Size>6-38mm x 25-40cm</Size><SupplierCode>40450</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107662</SubCategoryID><GroupID>108548</GroupID><SubGroupID>112708</SubGroupID><ARTGs><ARTG>125606</ARTG></ARTGs><MinimumBenefit>481</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU023</BillingCode><Name>Gelweave Graft</Name><Description>Straight, Polyester, Woven</Description><Size>6-38mm x 50-60cm</Size><SupplierCode>40450</SupplierCode><CategoryID>107560</CategoryID><SubCategoryID>107662</SubCategoryID><GroupID>108548</GroupID><SubGroupID>112709</SubGroupID><ARTGs><ARTG>125606</ARTG></ARTGs><MinimumBenefit>627</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RW004</BillingCode><Name>Barrigel</Name><Description>Biodegradable gel of 9ml hyaluronic acid supplied in a kit of three 3 ml syringes</Description><Size>One size only</Size><SupplierCode>39939</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107588</SubCategoryID><GroupID>107940</GroupID><SubGroupID>112711</SubGroupID><ARTGs><ARTG>339926</ARTG></ARTGs><MinimumBenefit>1730</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS368</BillingCode><Name>SpaceOAR System</Name><Description>The SpaceOAR System consists of components for preparation of a synthetic, absorbable hydrogel spacer and a delivery mechanism packaged in a single kit. The hydrogel spacer creates a temporary space between the prostate and rectum during radiation therapy.</Description><Size>10CC</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107588</SubCategoryID><GroupID>107940</GroupID><SubGroupID>112711</SubGroupID><ARTGs><ARTG>354010</ARTG></ARTGs><MinimumBenefit>1730</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS388</BillingCode><Name>SpaceOAR VUE System</Name><Description>The SpaceOAR VUE System is a radiotherapy protection spacer consisting of components for preparation of synthetic absorbable hydrogel spacer and a delivery mechanism packaged in a single kit. The hydrogel spacer creates a temporary space between the prostate and rectum during radiation therapy. The hydrogel is radiopaque for visibility under computed tomography (CT) and cone beam CT.</Description><Size>10CC</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107588</SubCategoryID><GroupID>107940</GroupID><SubGroupID>112711</SubGroupID><ARTGs><ARTG>373630</ARTG></ARTGs><MinimumBenefit>1730</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS369</BillingCode><PriorBillingCodes><PriorBillingCode>MB024</PriorBillingCode></PriorBillingCodes><Name>TraceIT Gel System</Name><Description>TraceIT System is intended to create a temporary space within soft tissue during radiation therapy.</Description><Size>10mL</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107588</SubCategoryID><GroupID>107940</GroupID><SubGroupID>112711</SubGroupID><ARTGs><ARTG>268092</ARTG></ARTGs><MinimumBenefit>1730</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS370</BillingCode><PriorBillingCodes><PriorBillingCode>MB025</PriorBillingCode></PriorBillingCodes><Name>TraceIT Gel System</Name><Description>TraceIT System is intended to create a temporary space within soft tissue during radiation therapy.</Description><Size>3mL</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107588</SubCategoryID><GroupID>107940</GroupID><SubGroupID>112712</SubGroupID><ARTGs><ARTG>268092</ARTG></ARTGs><MinimumBenefit>843</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RW003</BillingCode><Name>Barrigel</Name><Description>Biodegrable gel of hyaluronic acid supplied in a 3ml syringe</Description><Size>3ml</Size><SupplierCode>39939</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107588</SubCategoryID><GroupID>107940</GroupID><SubGroupID>112712</SubGroupID><ARTGs><ARTG>339926</ARTG></ARTGs><MinimumBenefit>843</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RQ078</BillingCode><Name>TheraStrand Rx with AgX100 Brachytherapy Kit</Name><Description>The TheraStrand RX brachytherapy kit is prescription-loaded and supplied sterile.  The prescription generally comprises 25 needles containing the brachytherapy I-125 sources (80-100 seeds) sequenced per the physician's treatment plan.  All sources are of the same activity/strength.</Description><Size>The seed includes a silver rod with I 125 contained in a sealed titanium capsule of 4.5 mm length and 0.8 mm in diameter.</Size><SupplierCode>40089</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107588</SubCategoryID><GroupID>107942</GroupID><SubGroupID>112713</SubGroupID><ARTGs><ARTG>205063</ARTG></ARTGs><MinimumBenefit>5766</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RQ079</BillingCode><Name>I-Seed AgX100 Cartridge Brachytherapy Kit</Name><Description>The I-Seed AgX100 Cartridge brachytherapy kit comprises 8 or fewer cartridges (max. 20 seed) in a vertical seed magazine, VSM20. The kit is supplied sterile and is compatible with the Mick applicator.</Description><Size>The I-Seed AgX100 Cartridge Brachytherapy Kit generally contains 8 or fewer cartridges, each a max. 20 seeds, a total of 80-100 seeds. Each seed comprises a silver rod with the source within 4.5 x 0.8mm sealed titanium capsule.</Size><SupplierCode>40089</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107588</SubCategoryID><GroupID>107942</GroupID><SubGroupID>112713</SubGroupID><ARTGs><ARTG>205023</ARTG></ARTGs><MinimumBenefit>5766</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CL001</BillingCode><Name>Advantage I-125 Pre-load</Name><Description>Advantage I-125 Pre-load consists of stranded Advantage I-125 seeds pre-loaded on prescription into brachytherapy needles specifically for treatment of an individual patient.  They arrive sterile and pre-packaged ready for use in theatre</Description><Size>Stranded seeds are pre-loaded in brachytherapy needles in a prescribed configuration; up to 120 seeds</Size><SupplierCode>40042</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107588</SubCategoryID><GroupID>107942</GroupID><SubGroupID>112713</SubGroupID><ARTGs><ARTG>175081</ARTG></ARTGs><MinimumBenefit>5766</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA253</BillingCode><Name>ReadyLink® Implant</Name><Description>BrachySource® Seed Implants in the ReadyLink® Delivery System.  Up to 120 seeds per patient.</Description><Size>Seeds are 4.5mm x 0.8mm welded titanium capsule preconnected in user defined trains.</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107588</SubCategoryID><GroupID>107942</GroupID><SubGroupID>112713</SubGroupID><ARTGs><ARTG>225237</ARTG><ARTG>225238</ARTG><ARTG>225230</ARTG><ARTG>225229</ARTG><ARTG>225231</ARTG></ARTGs><MinimumBenefit>5766</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA252</BillingCode><Name>BrachySource® I-125 Implant</Name><Description>BrachySource® Seeds supplied either loose, in Cartridges or needles or as a calibration source.  Up to 120 seeds per patient.</Description><Size>Seeds are a 4.5mm x 0.8mm welded titanium capsule.</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107588</SubCategoryID><GroupID>107942</GroupID><SubGroupID>112713</SubGroupID><ARTGs><ARTG>225230</ARTG><ARTG>225237</ARTG><ARTG>225238</ARTG><ARTG>225231</ARTG><ARTG>225229</ARTG></ARTGs><MinimumBenefit>5766</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CL002</BillingCode><Name>Advantage I-125 Seed</Name><Description>Advantage I-125 seeds are sealed radioactive sources containing Iodine-125 for interstitial brachytherapy</Description><Size>3mm x 0.5mm silver rod within 4.5 x 0.8mm sealed titanium capsule, up to 120 seeds</Size><SupplierCode>40042</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107588</SubCategoryID><GroupID>107942</GroupID><SubGroupID>112713</SubGroupID><ARTGs><ARTG>154457</ARTG></ARTGs><MinimumBenefit>5766</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA251</BillingCode><Name>BrachySource® I-125 seeds</Name><Description>Single BrachySource® Seeds supplied either loose, in Cartridges or needles or as a calibration source.  To be used only if more than 120 seeds are used per patient.</Description><Size>Seeds are a 4.5mm x 0.8mm welded titanium capsule.</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107588</SubCategoryID><GroupID>107942</GroupID><SubGroupID>112714</SubGroupID><ARTGs><ARTG>225230</ARTG><ARTG>225237</ARTG><ARTG>225238</ARTG><ARTG>225231</ARTG><ARTG>225229</ARTG></ARTGs><MinimumBenefit>73</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RQ076</BillingCode><Name>Theragenics C20 IsoLoader Magazines in TPSII Individual - 20 seeds per magazine - sterile</Name><Description>The C20 IsoLoader cartridge is a shielded cartridge holding up to 20 I125 seeds, supplied in accordance with the surgeon's requirements.  Benefit is per seed.</Description><Size>1 representation in a delivery magazine with a loading of up to 20 seeds</Size><SupplierCode>40089</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107588</SubCategoryID><GroupID>107942</GroupID><SubGroupID>112714</SubGroupID><ARTGs><ARTG>271520</ARTG></ARTGs><MinimumBenefit>73</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RQ077</BillingCode><Name>TheraStrand RX with I-Seed AgX100 I125 implants</Name><Description>AgX100 I-125 Seeds pre-loaded. The billing code is to be applied only if more than 100 seeds are used per patient. Benefit is per seed.</Description><Size>One representation with a loading of more than 100 seeds. The seed includes a silver rod with I 125 contained in a sealed titanium capsule of 4.5 mm length and 0.8 mm in diameter</Size><SupplierCode>40089</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107588</SubCategoryID><GroupID>107942</GroupID><SubGroupID>112714</SubGroupID><ARTGs><ARTG>205063</ARTG></ARTGs><MinimumBenefit>73</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CL003</BillingCode><Name>Advantage I-125 Seed</Name><Description>The Advantage I-125 seed is a sealed radioactive source containing Iodine-125 for interstitial brachytherapy</Description><Size>3mm x 0.5mm silver rod within 4.5 x 0.8mm sealed titanium capsule</Size><SupplierCode>40042</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107588</SubCategoryID><GroupID>107942</GroupID><SubGroupID>112714</SubGroupID><ARTGs><ARTG>154457</ARTG></ARTGs><MinimumBenefit>73</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB086</BillingCode><Name>Celsite Epoxy Peritoneal Port</Name><Description>Epoxy/titanium</Description><Size>32x27x13mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107943</GroupID><SubGroupID>112715</SubGroupID><ARTGs><ARTG>133738</ARTG></ARTGs><MinimumBenefit>424</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB385</BillingCode><Name>Celsite Access Port</Name><Description>Single Access Port</Description><Size>Standard 32 x 27 x 12.2mm  Small  26 x 22 x 9.7mm  Baby/Brachial 22 x 18 x 8.7mm  </Size><SupplierCode>40020</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107943</GroupID><SubGroupID>112715</SubGroupID><ARTGs><ARTG>133738</ARTG><ARTG>137735</ARTG></ARTGs><MinimumBenefit>424</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB083</BillingCode><Name>Celsite Epoxy Dual Access Port</Name><Description>Dual lumen power injectable implanted port</Description><Size>Standard/small/baby</Size><SupplierCode>40020</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107943</GroupID><SubGroupID>112716</SubGroupID><ARTGs><ARTG>133738</ARTG></ARTGs><MinimumBenefit>555</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UX001</BillingCode><PriorBillingCodes><PriorBillingCode>AH006</PriorBillingCode></PriorBillingCodes><Name>DOSI-FUSER</Name><Description>Non electronic, elastomeric balloon driven, ambulatory infusion pump, which can be supplied in a variety of volumes and flow rates to meet different clinical applications.  Its primary purpose is for continuous delivery of fluids/medications.</Description><Size>65ml - 140mm x 45mm x 40mm; 100ml - 140mm x 52mm x 50mm; 150 - 140mm x 55mm x 55mm; 250ml - 140mm x 60mm x 60mm; 400ml, 500ml, 600ml</Size><SupplierCode>40225</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112717</SubGroupID><Suffix>Set</Suffix><ARTGs><ARTG>324361</ARTG></ARTGs><MinimumBenefit>92</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX247</BillingCode><Name>Intermate</Name><Description>Sterile infusor devices, elastomeric driven</Description><Size>SV 200 - 200ml/hr, nominal 100ml vol. max 105 mL. SV 100 - 100ml/hr, nominal 100ml vol. max 105 mL. LV 250, 250ml/hr, 275ml vol. SV 50 - 50ml/hr, nominal 100ml vol. max 105mL.  LV 100  - 100ml/hr, 275ml vol. LV 50, 50ml/hr, 275ml vol</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112717</SubGroupID><Suffix>Set</Suffix><ARTGs><ARTG>168893</ARTG></ARTGs><MinimumBenefit>92</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CU003</BillingCode><Name>Neofuser Pump</Name><Description>Continuous flow rate ambulatory and disposable silicone balloon infusion pump</Description><Size>Volume 100ml, 275ml, 450ml</Size><SupplierCode>39995</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112717</SubGroupID><Suffix>Set</Suffix><ARTGs><ARTG>286078</ARTG></ARTGs><MinimumBenefit>92</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX287</BillingCode><Name>Intermate XLV 250</Name><Description>Sterile infusor devices, elastomeric driven.  The Intermate XLV 250 is an ambulatory device utilising elastomeric technology to deliver continuous infusion of parenteral therapy to patients in an ambulatory setting. The device is specifically suitable for patients requiring intravenous immunoglobulin therapy. The nominal flow rate of the Intermate XLV 250 is 250mL/hr, however when used for the administration of IVIG the flow rate is reduced to approximately 120mL/hr.</Description><Size>Volume 500mL. Approximate infusion time for IVIG solutions is 4.2 hrs.</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112717</SubGroupID><Suffix>Set</Suffix><ARTGs><ARTG>168893</ARTG></ARTGs><MinimumBenefit>92</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX327</BillingCode><Name>Infusor</Name><Description>Sterile Infusor Devices, Elastomeric Driven</Description><Size>LV 10, 10ml/hr, 240ml vol  LV 5, 5ml/hr, 240ml vol</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112717</SubGroupID><Suffix>Set</Suffix><ARTGs><ARTG>168893</ARTG></ARTGs><MinimumBenefit>92</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX057</BillingCode><Name>Autofuser Fixed Rate w/Bolus</Name><Description>Fixed rate elastomeric infusion pump. Several basal rate options. Bolus volume options with several refill times available. Rigid, rounded, low profile housing. Front low pressure port for ease of filling. Graduated markings for monitoring infusion.    The Arrow  AutoFuser  Disposable Pain Pump from Teleflex is designed to safely and reliably deliver regional anaesthesia medications to help effectively manage post-operative pain in patients following surgery involving implanted prosthesis such as knee, hip or shoulder reconstructions. Effective management of postoperative pain in the immediate and early postoperative period facilitates early patient mobilisation and reduces the likelihood of implanted prosthesis failure. The device is also used to facilitate the delivery of epidural medical during labour in expectant mothers and can also be used for the delivery of medications necessary in the treatment of oncology patients.    The Arrow  AutoFuser  Disposable Pain Pump offers multiple  reservoir sizes and configurations to meet a variety of clinical demands. The AutoSelector  Variable Rate Selector gives the clinician the ability to adjust the basal infusion rate to meet the individualized needs of each patient to help control their post-operative pain. The patient controlled bolus gives patients the ability to address breakthrough pain without interrupting the basal rate.</Description><Size>275ml, 550ml</Size><SupplierCode>40451</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112717</SubGroupID><Suffix>Bolus</Suffix><ARTGs><ARTG>288197</ARTG></ARTGs><MinimumBenefit>28</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX281</BillingCode><Name>Baxter Folfusor</Name><Description>Sterile infusor devices, elastomeric driven.  Folfusor SV 0.5mL/hr 120mL (Baxter Code 2C4700K), Folfusor SV 2.5mL/hr 120mL (Baxter Code 2C4711K), Folfusor SV 5mL/hr 120mL (Baxter Code 2C4705K). The Baxter Folfusor is a disposable infusion pump used in an ambulatory setting for the continuous infusion of intravenous medications. The codes listed above represent three separate flow rates specific to Chemotherapy protocols.</Description><Size>120mL Maximum Volume</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112717</SubGroupID><Suffix>Set</Suffix><ARTGs><ARTG>168893</ARTG></ARTGs><MinimumBenefit>92</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ146</BillingCode><Name>ON-Q Pain Relief System</Name><Description>Elastomeric Infusion Pump System</Description><Size>100-400ml</Size><SupplierCode>40325</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112717</SubGroupID><Suffix>Set</Suffix><ARTGs><ARTG>142526</ARTG></ARTGs><MinimumBenefit>92</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TY001</BillingCode><Name>mobiFUSER</Name><Description>Disposable sterile non electronic elastomeric infusion device. Variable flow rates available. For continuous fluid/medication delivery</Description><Size>Maximum Capacity 275ml</Size><SupplierCode>40408</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112717</SubGroupID><Suffix>Bolus</Suffix><ARTGs><ARTG>188661</ARTG></ARTGs><MinimumBenefit>28</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SI050</BillingCode><Name>Neofuser Plus</Name><Description>Neofuser® Plus is a single-use, portable
elastomeric infusion pump that provides
medication at accurate continuous pre-fixed flow
with additional bolus doses via patient controlled
analgesia (PCA) module. Neofuser® Plus has
been mainly designed for systemic or regional
preoperative and postoperative pain
management therapy.</Description><Size>60 ml
60 ml
100ml
100ml
275ml
275ml
450 ml
450 ml</Size><SupplierCode>40340</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112717</SubGroupID><Suffix>Bolus</Suffix><ARTGs><ARTG>306862</ARTG></ARTGs><MinimumBenefit>28</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RN006</BillingCode><Name>Surefuser+ Fixed Flow</Name><Description>Elastomeric balloon driven, ambulatory infusion pump with a variety fixed infusion rates.</Description><Size>50ml, 100ml, 250ml</Size><SupplierCode>40133</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112717</SubGroupID><ARTGs><ARTG>92233</ARTG></ARTGs><MinimumBenefit>28</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SI049</BillingCode><Name>Neofuser Pump</Name><Description>Neofuser® is a single-use, portable elastomeric  infusion pump that provides medication at  accurate continuous pre-fixed flow.</Description><Size>60mL, 100mL, 275mL, 450mL</Size><SupplierCode>40340</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112717</SubGroupID><ARTGs><ARTG>306862</ARTG></ARTGs><MinimumBenefit>28</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX058</BillingCode><Name>Autofuser Fixed Rate</Name><Description>Fixed rate elastomeric infusion pump. Several basal rate options. Rigid, rounded, low profile housing. Front low pressure port for ease of filling. Graduated markings for monitoring infusion.      The Arrow  AutoFuser  Disposable Pain Pump from Teleflex is designed to safely and reliably deliver regional anaesthesia medications to help effectively manage post-operative pain in patients following surgery involving implanted prosthesis such as knee, hip or shoulder reconstructions. Effective management of postoperative pain in the immediate and early postoperative period facilitates early patient mobilisation and reduces the likelihood of implanted prosthesis failure. The device is also used to facilitate the delivery of epidural medical during labour in expectant mothers and can also be used for the delivery of medications necessary in the treatment of oncology patients.    The Arrow  AutoFuser  Disposable Pain Pump offers multiple  reservoir sizes and configurations to meet a variety of clinical demands. The AutoSelector  Variable Rate Selector gives the clinician the ability to adjust the basal infusion rate to meet the individualized needs of each patient to help control their post-operative pain. The patient controlled bolus gives patients the ability to address breakthrough pain without interrupting the continuous basal infusion.</Description><Size>100ml, 150ml, 275ml</Size><SupplierCode>40451</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112717</SubGroupID><ARTGs><ARTG>288197</ARTG></ARTGs><MinimumBenefit>28</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB349</BillingCode><Name>Easypump</Name><Description>Disposable Elastomeric infusion pump system</Description><Size>LT: Filling Volume: 60ml - 400ml, Flow Rate: 0.5ml/h - 10ml/h
ST: Filling Volume: 50ml - 500ml, Flow Rate: 50ml/h - 500ml/h</Size><SupplierCode>40020</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112717</SubGroupID><ARTGs><ARTG>221448</ARTG></ARTGs><MinimumBenefit>28</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BU024</BillingCode><Name>Tuoren Infusion Pump</Name><Description>Non electronic, elastomeric balloon driven, ambulatory infusion pump, which can be supplied in a variety of volumes and flow rates to meet different clinical applications.  Its primary purpose is for continuous delivery of fluids/medications.</Description><Size>60ml - 300ml</Size><SupplierCode>39964</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112717</SubGroupID><Suffix>Set</Suffix><ARTGs><ARTG>323586</ARTG></ARTGs><MinimumBenefit>92</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX328</BillingCode><Name>Infusor</Name><Description>Sterile Infusor Devices, Elastomeric Driven</Description><Size>LV 2, 2ml/hr, 275 ml vol;  LV 1.5, 1.5ml/hr, 275 ml vol.</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112717</SubGroupID><Suffix>Set</Suffix><ARTGs><ARTG>168893</ARTG></ARTGs><MinimumBenefit>92</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RN004</BillingCode><Name>Surefuser+</Name><Description>Elastomeric balloon driven, ambulatory infusion pump with variable infusion rate</Description><Size>100ml, 250ml</Size><SupplierCode>40133</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112718</SubGroupID><ARTGs><ARTG>92233</ARTG></ARTGs><MinimumBenefit>142</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SI051</BillingCode><Name>Neofuser Vario</Name><Description>Single-use, portable
elastomeric multirate infusion pump</Description><Size>1 - 7 ml/h
2 - 14 ml/h
1 - 7 ml/h
2 - 14 ml/h
1 - 7 ml/h
2 - 14 ml/h
1 - 7 ml/h
2 - 14 ml/h</Size><SupplierCode>40340</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112718</SubGroupID><ARTGs><ARTG>306862</ARTG></ARTGs><MinimumBenefit>142</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX059</BillingCode><Name>Autofuser Autoselector Variable Rate w/Bolus</Name><Description>Fixed rate elastomeric infusion pump. Several basal rate options. Bolus volume options with several refill times available. Rigid, rounded, low profile housing. Front low pressure port for ease of filling. Graduated markings for monitoring infusion. The Arrow  AutoFuser  Disposable Pain Pump from Teleflex is designed to safely and reliably deliver regional anaesthesia medications to help effectively manage post-operative pain in patients following surgery involving implanted prosthesis such as knee, hip or shoulder reconstructions. Effective management of postoperative pain in the immediate and early postoperative period facilitates early patient mobilisation and reduces the likelihood of implanted prosthesis failure. The device is also used to facilitate the delivery of epidural medical during labour in expectant mothers and can also be used for the delivery of medications necessary in the treatment of oncology patients.    The Arrow  AutoFuser  Disposable Pain Pump offers multiple  reservoir sizes and configurations to meet a variety of clinical demands. The AutoSelector  Variable Rate Selector gives the clinician the ability to adjust the basal infusion rate to meet the individualized needs of each patient to help control their post-operative pain. The patient controlled bolus gives patients the ability to address breakthrough pain without interrupting the basal rate.</Description><Size>275ml, 550ml</Size><SupplierCode>40451</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112718</SubGroupID><Suffix>Bolus</Suffix><ARTGs><ARTG>288197</ARTG></ARTGs><MinimumBenefit>367</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ037</BillingCode><Name>ON-Q Pain Relief System</Name><Description>Elastomeric Infusion Pump System with Bolus</Description><Size>270-400ml</Size><SupplierCode>40325</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112718</SubGroupID><Suffix>Bolus</Suffix><ARTGs><ARTG>142526</ARTG></ARTGs><MinimumBenefit>367</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ035</BillingCode><Name>ON-Q Pain Relief System</Name><Description>Elastomeric Infusion Pump System, Select-A-Flow, Dual</Description><Size>270ml - 600ml</Size><SupplierCode>40325</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112718</SubGroupID><Suffix>Set</Suffix><ARTGs><ARTG>142526</ARTG></ARTGs><MinimumBenefit>319</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CU004</BillingCode><Name>Neofuser Vario Pump</Name><Description>Variable flow rate ambulatory and disposable silicone balloon infusion pump</Description><Size>Volume 60ml, 100ml, 180ml, 275ml, 450ml</Size><SupplierCode>39995</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112718</SubGroupID><Suffix>Set</Suffix><ARTGs><ARTG>286078</ARTG></ARTGs><MinimumBenefit>319</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UX004</BillingCode><PriorBillingCodes><PriorBillingCode>AH012</PriorBillingCode></PriorBillingCodes><Name>DOSI-FUSER Multiflow System</Name><Description>Elastomeric pump providing drug infusion at a constant flow. Facilitates the ability for a clinician to adjust the infusion rate of the contents of the infuser. Offers a wide range of flow rates from 1ml/h to 7ml/h in steps of 1ml/h, and from 2ml/h to 14ml/h in steps of 2ml/h.</Description><Size>65ml, 100ml, 150ml, and 250ml.</Size><SupplierCode>40225</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112718</SubGroupID><Suffix>Set</Suffix><ARTGs><ARTG>324361</ARTG></ARTGs><MinimumBenefit>319</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CU005</BillingCode><Name>Neofuser Bolus Pump</Name><Description>Ambulatory and disposable silicone balloon infusion pump with bolus function</Description><Size>Volume 100ml, 275ml, 450ml</Size><SupplierCode>39995</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112718</SubGroupID><Suffix>Bolus</Suffix><ARTGs><ARTG>286078</ARTG></ARTGs><MinimumBenefit>367</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX249</BillingCode><Name>Multirate with PCM</Name><Description>Sterile infusor devices, elastomeric driven</Description><Size>Multirate 5, 7 or 12 ml/hr with PCM</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112718</SubGroupID><Suffix>Bolus</Suffix><ARTGs><ARTG>168893</ARTG></ARTGs><MinimumBenefit>367</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX330</BillingCode><Name>Basal Bolus Infusor</Name><Description>Sterile Infusor Devices, Balloon based</Description><Size>Basal/Bolus 60, Basal 0.5ml/hr, Bolus 0.5 x 65ml
Basal/Bolus 15, Basal 0.5ml/hr, Bolus 2ml/hr x 65ml
Basal/Bolus infusor, Basal 2ml/hr, Bolus 2ml/hr x 65ml</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112718</SubGroupID><Suffix>Bolus</Suffix><ARTGs><ARTG>168893</ARTG></ARTGs><MinimumBenefit>367</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RN007</BillingCode><Name>Surefuser+ PCA</Name><Description>Elastomeric balloon pump with variable infusion rate and a patient-controlled analgesia (PCA) infuser.</Description><Size>50ml, 100ml, 150ml, 250ml, 300ml</Size><SupplierCode>40133</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112718</SubGroupID><Suffix>Bolus</Suffix><ARTGs><ARTG>92233</ARTG></ARTGs><MinimumBenefit>367</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BU025</BillingCode><Name>Tuoren Infusion Pump</Name><Description>Non electronic, elastomeric balloon driven, ambulatory infusion pump, which can be supplied in a variety of volumes and flow rates to meet different clinical applications.  Its primary purpose is for continuous delivery of fluids/medications.</Description><Size>60ml - 300ml</Size><SupplierCode>39964</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112718</SubGroupID><Suffix>Bolus</Suffix><ARTGs><ARTG>323586</ARTG></ARTGs><MinimumBenefit>367</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX060</BillingCode><Name>Autofuser Autoselector Variable Rate</Name><Description>Fixed rate elastomeric infusion pump. Several basal rate options. Bolus volume options with several refill times available. Rigid, rounded, low profile housing. Front low pressure port for ease of filling. Graduated markings for monitoring infusion.  The Arrow  AutoFuser  Disposable Pain Pump from Teleflex is designed to safely and reliably deliver regional anaesthesia medications to help effectively manage post-operative pain in patients following surgery involving implanted prosthesis such as knee, hip or shoulder reconstructions. Effective management of postoperative pain in the immediate and early postoperative period facilitates early patient mobilisation and reduces the likelihood of implanted prosthesis failure. The device is also used to facilitate the delivery of epidural medical during labour in expectant mothers and can also be used for the delivery of medications necessary in the treatment of oncology patients. The Arrow  AutoFuser  Disposable Pain Pump offers multiple  reservoir sizes and configurations to meet a variety of clinical demands. The AutoSelector  Variable Rate Selector gives the clinician the ability to adjust the basal infusion rate to meet the individualized needs of each patient to help control their post-operative pain. The patient controlled bolus gives patients the ability to address breakthrough pain without interrupting the continuous basal rate</Description><Size>100ml, 275ml, 400ml.</Size><SupplierCode>40451</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107944</GroupID><SubGroupID>112718</SubGroupID><ARTGs><ARTG>288197</ARTG></ARTGs><MinimumBenefit>142</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RB001</BillingCode><Name>Accu-Chek Combo System</Name><Description>Insulin delivery device capable of remotely receiving and acting on information about blood glucose levels, performing bolus calculation and bolus advice on additional parameters than what is normally provided.</Description><Size>The Accu-Chek Combo System is only available in one size.</Size><SupplierCode>39930</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107945</GroupID><SubGroupID>112720</SubGroupID><Suffix>DE, SS</Suffix><ARTGs><ARTG>214240</ARTG></ARTGs><MinimumBenefit>8077</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DF004</BillingCode><Name>DANA-i Insulin Pump</Name><Description>ACE (Alternate Control Enabled) secure Bluetooth low energy insulin pump.  EC certified to be connected to approved CGM systems and approved control algorithms (APS - Artificial Pancreas Systems).  </Description><Size>97mm x 44mm x 20mm 85grams</Size><SupplierCode>40175</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107945</GroupID><SubGroupID>112720</SubGroupID><Suffix>DE, SS</Suffix><ARTGs><ARTG>340938</ARTG></ARTGs><MinimumBenefit>8077</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AN014</BillingCode><Name>t:slim X2 Insulin Pump</Name><Description>Ambulatory insulin infusion pump with real-time continuous glucose monitoring (CGM) capability</Description><Size>One size only.</Size><SupplierCode>40028</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107945</GroupID><SubGroupID>112720</SubGroupID><Suffix>DE, SS</Suffix><ARTGs><ARTG>304861</ARTG></ARTGs><MinimumBenefit>8077</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RB006</BillingCode><Name>Accu-Chek Solo micropump - starter kit</Name><Description>Starter kit supply of insulin pump system to accommodate first year of use of Accu-Chek Solo micropump system. Starter kit includes insulin pump base components, blood glucose monitoring system handset control with integrated insulin bolus advisor (diabetes manager) and accessory pack.</Description><Size>Micropump: 68 x 40 x 15 mm  Handset control (diabetes manager): 124 x 64 x 17 mm</Size><SupplierCode>39930</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107945</GroupID><SubGroupID>112720</SubGroupID><Suffix>DE, SS, MP</Suffix><ARTGs><ARTG>311431</ARTG></ARTGs><MinimumBenefit>2375</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FK017</BillingCode><Name>Agilia SP PCA Infusion System</Name><Description>Agilia SP PCA is a programmable electronic medical system dedicated to administering a pre-determined volume of a syringe at a programmed rate. This syringe pump ensures a fluid delivery, by pushing the syringe plunger and advancing the liquid to the patient through an extension set. The Agilia SP PCA syringe pump can also be used for general infusions on adults, pediatrics, and neonatal patients for the intermittent or continuous delivery of parenteral fluids (such as solutions, colloids, parenteral nutrition), medications (such as diluted drugs, chemotherapy, anesthesia drugs), blood and blood derivatives, and medications through clinically accepted routes of administration.  It is intended for use by trained healthcare professionals in clinical healthcare facilities. In PCA therapy, it is also intended for use by the patient in order to self administer doses of analgesic agent, after receiving appropriate training and instructions from the clinical staff. Agilia SP PCA is a transportable and reusable device that can be used every day. </Description><Size>The size of a syringe can be 5, 10, 20, 30 or 50/60 mL.  </Size><SupplierCode>40376</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107945</GroupID><SubGroupID>112721</SubGroupID><ARTGs><ARTG>267873</ARTG></ARTGs><MinimumBenefit>2805</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SI045</BillingCode><Name>CADD®- Solis Pain Management System</Name><Description>Ambulatory Infusion Pump, Battery Powered</Description><Size>680g excluding accessories</Size><SupplierCode>40340</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107945</GroupID><SubGroupID>112721</SubGroupID><ARTGs><ARTG>109467</ARTG></ARTGs><MinimumBenefit>2805</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SI034</BillingCode><Name>CADD-Solis VIP Ambulatory Infusion Pump</Name><Description>Ambulatory Infusion Pump</Description><Size>One size only</Size><SupplierCode>40340</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107945</GroupID><SubGroupID>112721</SubGroupID><ARTGs><ARTG>109467</ARTG></ARTGs><MinimumBenefit>2805</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RE001</BillingCode><Name>Bodyguard Pump</Name><Description>Ambulatory Infusion Pump, Battery Powered</Description><Size>One size only</Size><SupplierCode>40091</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107945</GroupID><SubGroupID>112721</SubGroupID><ARTGs><ARTG>119623</ARTG></ARTGs><MinimumBenefit>2805</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RE002</BillingCode><Name>REM Systems Ambulatory Infusion Pump</Name><Description>Ambulatory infusion pump, syringe.
Models: NIKI T34 Standard; T34L PCA; T34L</Description><Size>One size only</Size><SupplierCode>40091</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107945</GroupID><SubGroupID>112721</SubGroupID><ARTGs><ARTG>131232</ARTG></ARTGs><MinimumBenefit>2805</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FX002</BillingCode><PriorBillingCodes><PriorBillingCode>AH004</PriorBillingCode></PriorBillingCodes><Name>ambIT Infusion Pump</Name><Description>The ambIT Reusable Infusion Pump is an external programmable electronic ambulatory infusion pump used for the delivery of fluid and medications via intravenous, epidural, subcutaneous or regional routes.  It can be programmed with different delivery profiles which include basal rate/continuous only, basal rate with PCA (Patient Controlled Analgesia), PCA Bolus Only or Intermittent Bolus Dose (PIB). It is operated in conjunction with a ambIT disposable administration cassette</Description><Size>AmbIT Single use Pump - 55mm x 36mm x 175mm  AmbIT Single use administration cassette - 20mm x 10mm x 15mm</Size><SupplierCode>40262</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107945</GroupID><SubGroupID>112721</SubGroupID><ARTGs><ARTG>228804</ARTG></ARTGs><MinimumBenefit>2805</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SI052</BillingCode><PriorBillingCodes><PriorBillingCode>SI037</PriorBillingCode><PriorBillingCode>SI038</PriorBillingCode><PriorBillingCode>SI039</PriorBillingCode></PriorBillingCodes><Name>CADD Legacy</Name><Description>CADD Legacy One, CADD Legacy Plus, CADD Legacy PCA</Description><Size>Variants - Continuous, Continuous + Intermittent, PCA</Size><SupplierCode>40340</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107945</GroupID><SubGroupID>112721</SubGroupID><ARTGs><ARTG>109467</ARTG></ARTGs><MinimumBenefit>2805</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE776</BillingCode><PriorBillingCodes><PriorBillingCode>TT005</PriorBillingCode></PriorBillingCodes><Name>Sapphire Infusion System</Name><Description>The Sapphire Infusion System is a new device for ambulatory infusion and acute pain management. It is an infusion pump designed for the volumetric delivery of medications to patients at a programmable rate. Sapphire is the first pump to offer an intuitive, full colour touch screen interface in an ambulatory package, along with best-in-class +/-2.5% product delivery accuracy</Description><Size>Size (in), Weight (oz) 5.6 x 3.8 x 1.9 in. 14.7 oz (including battery)</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107945</GroupID><SubGroupID>112721</SubGroupID><ARTGs><ARTG>201499</ARTG></ARTGs><MinimumBenefit>2805</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FX003</BillingCode><PriorBillingCodes><PriorBillingCode>AH008</PriorBillingCode></PriorBillingCodes><Name>ambIT Single Use Regional Kit</Name><Description>The ambIT Single Use Regional Kit contains: a single use ambIT pump, single use administration cassette with male luer lock fitting, 420ml Medibag, the choice of 75mm, 127mm or 154mm fenestrated nerve/wound catheter, a peel away introducer sheath, button guard and patient carry bag.</Description><Size>ambIT Single Use Pump - 55mm x 36mm x 175mm  Ambit Single use administration cassette - 20mm x 10mm x 15mm   </Size><SupplierCode>40262</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107945</GroupID><SubGroupID>112722</SubGroupID><ARTGs><ARTG>190922</ARTG><ARTG>228804</ARTG><ARTG>190934</ARTG><ARTG>243381</ARTG><ARTG>190933</ARTG><ARTG>228805</ARTG></ARTGs><MinimumBenefit>407</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FX004</BillingCode><PriorBillingCodes><PriorBillingCode>AH013</PriorBillingCode></PriorBillingCodes><Name>ambIT Single Use</Name><Description>Kit contains: a single use ambIT infusion pump, single use administration cassette with spike fitting, Button Guard, 2 x AA batteries, and patient carry bag</Description><Size>AmbIT Single use Pump  - 55mm X 36mm X 175mm  AmbIT Single use administration cassette - 20mm X 10mm X 15mm</Size><SupplierCode>40262</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107945</GroupID><SubGroupID>112722</SubGroupID><ARTGs><ARTG>228804</ARTG><ARTG>228805</ARTG></ARTGs><MinimumBenefit>407</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DQ002</BillingCode><Name>Weight Dose Dispensor</Name><Description>Programmable Infusion Pump</Description><Size>50ml</Size><SupplierCode>40017</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107945</GroupID><SubGroupID>112722</SubGroupID><ARTGs><ARTG>321942</ARTG></ARTGs><MinimumBenefit>407</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>YA001</BillingCode><Name>mylife™ YpsoPump Insulin Pump System</Name><Description>The mylife™ YpsoPump Insulin Pump System is a BLE (bluetooth low energy) insulin pump which can be connected to a BLE Smart Phone and has Continuous Glucose Monitoring (CGM) capability. Smart Phone connection is via a secure pairing code, creating a large easy to read display for set-up and monitoring of the system. The system can be set to automatically adjust delivery of basal insulin based on CGM values with treat to target adaptive control.</Description><Size>One size only</Size><SupplierCode>40431</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107945</GroupID><SubGroupID>112723</SubGroupID><Suffix>DE, SS, ABD</Suffix><ARTGs><ARTG>298274</ARTG></ARTGs><MinimumBenefit>8574</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI452</BillingCode><Name>MiniMed 780G Insulin Pump</Name><Description>MiniMed 780G Insulin Pump with SmartGuard advanced Hybrid Closed Loop (HCL) technology capable of operating in Manual Mode or Auto Mode, with Bluetooth® connectivity and continuous glucose monitoring (CGM) capability.  Provides 3 user selectable targets and can be set to automatically adjust delivery of basal insulin based on CGM. This includes automatically suspending insulin delivery or providing additional insulin delivery as required. </Description><Size>One size only.</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107945</GroupID><SubGroupID>112723</SubGroupID><Suffix>DE, SS, ABD</Suffix><ARTGs><ARTG>376091</ARTG></ARTGs><MinimumBenefit>8574</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI330</BillingCode><Name>Medtronic MiniMed 770G Insulin Pump</Name><Description>MiniMed 770G Insulin Pump with SmartGuard Hybrid Closed Loop (HCL) technology, with Bluetooth® connectivity and continuous glucose monitoring (CGM) capability which can be programmed to automatically adjust delivery of basal insulin based on CGM, and can suspend delivery of insulin when the sensor glucose value falls below or is predicted to fall below predefined threshold values.</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107945</GroupID><SubGroupID>112723</SubGroupID><Suffix>DE, SS, ABD</Suffix><ARTGs><ARTG>332201</ARTG></ARTGs><MinimumBenefit>8574</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AN017</BillingCode><Name>t:slim X2 Insulin Pump with Basal-IQ Technology</Name><Description>Ambulatory insulin infusion pump with real-time continuous glucose monitoring (CGM) capability and incorporating Basal-IQ Predictive Low Glucose Suspend (PLGS) Technology.</Description><Size>One size only.</Size><SupplierCode>40028</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107945</GroupID><SubGroupID>112723</SubGroupID><Suffix>DE, SS</Suffix><ARTGs><ARTG>304681</ARTG></ARTGs><MinimumBenefit>8574</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AN018</BillingCode><Name>t:slim X2 Insulin Pump with Control-IQ Technology</Name><Description>Ambulatory insulin infusion pump with real-time continuous glucose monitoring (CGM) capability and incorporating Control-IQ Technology.</Description><Size>One size only</Size><SupplierCode>40028</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107945</GroupID><SubGroupID>112723</SubGroupID><Suffix>DE, SS</Suffix><ARTGs><ARTG>304681</ARTG></ARTGs><MinimumBenefit>8574</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RB005</BillingCode><Name>Accu-Chek Solo micropump   subsequent supply</Name><Description>Subsequent supply of replaceable components of Accu-Chek Solo insulin pump system to accommodate a subsequent year usage after the initial year of use of Accu-Chek Solo (via Accu-Chek Solo micropump   starter kit).</Description><Size>Micropump: 68 x 40 x 15 mm</Size><SupplierCode>39930</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107945</GroupID><SubGroupID>112724</SubGroupID><ARTGs><ARTG>308702</ARTG></ARTGs><MinimumBenefit>1900</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX326</BillingCode><Name>Infusor</Name><Description>Sterile Infusor Devices, Spring Powered</Description><Size>SV Half, 5ml/hr, nominal 60ml vol, max 65ml.
SV Single day, 2ml/hr, nominal 48ml vol, max 65ml</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107946</GroupID><SubGroupID>112725</SubGroupID><ARTGs><ARTG>168893</ARTG></ARTGs><MinimumBenefit>76</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LE002</BillingCode><Name>Springfusor Infusion System  - Component # 1 Springfusor Pump/s</Name><Description>#1 Spring Powered Fixed Rate Ambulatory Infusion Pump </Description><Size> Pumps are available as 10ml, 30ml, 50ml</Size><SupplierCode>40263</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107946</GroupID><SubGroupID>112725</SubGroupID><Suffix>Set</Suffix><ARTGs><ARTG>159494</ARTG></ARTGs><MinimumBenefit>233</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DQ001</BillingCode><Name>BioQ Pharma ReadyfusOR</Name><Description>Non-electric pre-filled infusion pain kit</Description><Size>250 ml</Size><SupplierCode>40017</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107946</GroupID><SubGroupID>112725</SubGroupID><Suffix>Set</Suffix><ARTGs><ARTG>292140</ARTG></ARTGs><MinimumBenefit>233</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CU001</BillingCode><Name>BeeLINE MotIV Infusion Pump (275ml)</Name><Description>External infusion pump, spring powered, fixed flow rate, 275ml set: set includes reservoir, introducer needle, tubing set, priming/flushing syringes, saturation catheter, dressing, syringes.  30min - 7 day infusion</Description><Size>275ml infuser reservoir = 19cm (7.5") x 7cm (2.8")</Size><SupplierCode>39995</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107946</GroupID><SubGroupID>112725</SubGroupID><Suffix>Set</Suffix><ARTGs><ARTG>167182</ARTG></ARTGs><MinimumBenefit>233</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CU002</BillingCode><Name>BeeLINE MotIV Infusion Pump (100ml)</Name><Description>External infusion pump, spring powered, fixed flow rate, 100ml set: set includes reservoir, introducer needle, tubing set, priming/flushing syringes, saturation catheter, dressing, syringes.  30min - 7 day infusion</Description><Size>100ml infusor reservoir = 13cm (5.1") x 7cm (2.8")</Size><SupplierCode>39995</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107946</GroupID><SubGroupID>112725</SubGroupID><Suffix>Set</Suffix><ARTGs><ARTG>167182</ARTG></ARTGs><MinimumBenefit>233</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ142</BillingCode><Name>ON-Q Pain Relief System</Name><Description>QuikBloc Over-The-Needle Catheter Set</Description><Size>Needles: 20GA 100mm-150mm
Catheters: 16GA 76mm-127mm
Stimulating, Non-stimulating</Size><SupplierCode>40325</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107947</GroupID><SubGroupID>112727</SubGroupID><ARTGs><ARTG>162583</ARTG></ARTGs><MinimumBenefit>72</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ070</BillingCode><Name>ON-Q Pain Relief System</Name><Description>Expansion kit with Soaker catheter, or SilverSoaker antimicrobial catheter</Description><Size>2.5-25cm</Size><SupplierCode>40325</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107947</GroupID><SubGroupID>112727</SubGroupID><ARTGs><ARTG>162583</ARTG></ARTGs><MinimumBenefit>72</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX286</BillingCode><Name>Painfusor Catheter</Name><Description>The Painfusor Catheter is an extended fenestration catheter for the administration of analgesic drugs into surgical wounds to manage acute post-operative pain. Pack contains fenestrated catheter, peel away introducer needle accommodating 19Ga (100 mm length), 3M Tegaderm IV Transparent Film Dressing with border 1633, and GripLok catheter securement device</Description><Size>Catheters are 35cm + Fenestrated section:     (35cm + 2.5cm) - total length 37.5cm, (35cm + 7.5cm) - total length 42.5cm, (35cm + 15cm) - total length 50cm, (35cm + 22.5cm) - total length 57.5cm, (35cm + 30 cm) - total length 65cm</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107947</GroupID><SubGroupID>112727</SubGroupID><ARTGs><ARTG>177499</ARTG></ARTGs><MinimumBenefit>72</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RE003</BillingCode><Name>Bodyguard Pump infusion sets</Name><Description>Single use sterile disposble infusion set for use with Bodyguard Infusion Pump</Description><Size>230 cm length</Size><SupplierCode>40091</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107947</GroupID><SubGroupID>112728</SubGroupID><ARTGs><ARTG>119624</ARTG></ARTGs><MinimumBenefit>26</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SI024</BillingCode><Name>CADD Medication Cassettes</Name><Description>Medication Cassettes for use with CADD pumps</Description><Size>50 mL, 100mL, 250mL</Size><SupplierCode>40340</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107947</GroupID><SubGroupID>112728</SubGroupID><ARTGs><ARTG>316997</ARTG><ARTG>145297</ARTG></ARTGs><MinimumBenefit>26</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FX001</BillingCode><PriorBillingCodes><PriorBillingCode>AH005</PriorBillingCode></PriorBillingCodes><Name>ambIT Infusion Pump Cassette</Name><Description>Single use sterile disposable administration set for use with the ambIT Infusion Pump.  The cassette contains a rotary mechanism that pumps the infusion solution at an accurate and controlled rate.  The cassette includes an administration line with either a spike fitting or a luer lock fitting depending on the solution bag used. The line has an inline air filter.</Description><Size>20mm x 10mm x 15mm</Size><SupplierCode>40262</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107947</GroupID><SubGroupID>112728</SubGroupID><ARTGs><ARTG>228805</ARTG></ARTGs><MinimumBenefit>26</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE777</BillingCode><PriorBillingCodes><PriorBillingCode>TT006</PriorBillingCode></PriorBillingCodes><Name>Sapphire Infusion Cassette and Set</Name><Description>The Sapphire Infusion Cassette and set is a one piece microfibre infusion set with non vented spike, pinch clamp, administration cassette, female luer lock, entrance with a back check valve, pinch clamp and spin male leur lock for use with the sapphire infusion system. The materail components are made from PVC-Non DEHP (tubing, connectors), silicon (Y site and tubing and polypropylene (valves)</Description><Size>210cm</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107947</GroupID><SubGroupID>112728</SubGroupID><ARTGs><ARTG>200689</ARTG></ARTGs><MinimumBenefit>26</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AN016</BillingCode><Name>t:slim Cartridge</Name><Description>Cartridge for use with the t:slim X2 System</Description><Size>Pack of 10</Size><SupplierCode>40028</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107947</GroupID><SubGroupID>112729</SubGroupID><ARTGs><ARTG>304681</ARTG></ARTGs><MinimumBenefit>8</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SI026</BillingCode><Name>CADD Administration Set 175cm TOTM tubing</Name><Description>For use with SI036</Description><Size>250 mL</Size><SupplierCode>40340</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107947</GroupID><SubGroupID>112730</SubGroupID><ARTGs><ARTG>145297</ARTG></ARTGs><MinimumBenefit>7</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SI040</BillingCode><Name>Administration Set</Name><Description>Administration Set for use with CADD pump</Description><Size>Various configurations</Size><SupplierCode>40340</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107947</GroupID><SubGroupID>112730</SubGroupID><ARTGs><ARTG>316996</ARTG><ARTG>145297</ARTG></ARTGs><MinimumBenefit>7</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SI028</BillingCode><Name>CADD Extention Set</Name><Description>CADD Extension set for use with CADD Pumps</Description><Size>Various</Size><SupplierCode>40340</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107947</GroupID><SubGroupID>112730</SubGroupID><ARTGs><ARTG>317222</ARTG><ARTG>145297</ARTG></ARTGs><MinimumBenefit>7</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SI046</BillingCode><Name>Pump Pouch, single use</Name><Description>Pump pouch, single use 50/100mL</Description><Size>50/100mL</Size><SupplierCode>40340</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107947</GroupID><SubGroupID>112731</SubGroupID><ARTGs><ARTG>109467</ARTG></ARTGs><MinimumBenefit>45</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SQ069</BillingCode><Name>ON-Q Pain Relief System</Name><Description>Tunneller, Sheath, Needle</Description><Size>15.2-30.5cm  11-17GA</Size><SupplierCode>40325</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107947</GroupID><SubGroupID>112731</SubGroupID><ARTGs><ARTG>201353</ARTG><ARTG>201495</ARTG></ARTGs><MinimumBenefit>45</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS373</BillingCode><PriorBillingCodes><PriorBillingCode>DE647</PriorBillingCode></PriorBillingCodes><Name>DC Bead LUMI</Name><Description>Drug delivery embolisation system</Description><Size>70-150 microns (black)</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107948</GroupID><SubGroupID>112732</SubGroupID><ARTGs><ARTG>421310</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>1760</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OW001</BillingCode><Name>Hepasphere</Name><Description>Expanding microspheres designed for chemic0-embolisation with chemotherapeutic agents such as Ethiodil, Cisplatin, Epirubicin, Mitomycin, etc.</Description><Size>30 – 200 micron, 25mg or 50mg of microspheres</Size><SupplierCode>40178</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107948</GroupID><SubGroupID>112732</SubGroupID><ARTGs><ARTG>276029</ARTG></ARTGs><MinimumBenefit>1760</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS372</BillingCode><PriorBillingCodes><PriorBillingCode>DE580</PriorBillingCode></PriorBillingCodes><Name>DC Bead M1</Name><Description>Drug delivery embolization system</Description><Size>70-150um</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107948</GroupID><SubGroupID>112732</SubGroupID><ARTGs><ARTG>392647</ARTG></ARTGs><MinimumBenefit>1760</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VN002</BillingCode><PriorBillingCodes><PriorBillingCode>BS316</PriorBillingCode></PriorBillingCodes><Name>Embozene Tandem Microspheres</Name><Description>Embozene TANDEM Microspheres are spherical tightly calibrated, biocompatible, non-resorbable, hydrogel microspheres with an inorganic polyzene-F coating,  colour coded to indicate microsphere size. Each 20 mL syringe is prefilled with 3 mL of product suspended in a non-pyrogenic physiological saline transport solution. Embozene TANDEM microspheres may be loaded with Doxorubican-HCI  and Irinotecan-HCI up to 50 mg/ml which can elute local, controlled, sustained doses of the drugs to targeted tumour sites after embolisation.</Description><Size>Tandem 3ml 40 ± 10 μm  Tandem 3ml 75 ± 15 μm   Tandem 3ml 100 ± 25 μm</Size><SupplierCode>40439</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107948</GroupID><SubGroupID>112732</SubGroupID><ARTGs><ARTG>315383</ARTG></ARTGs><MinimumBenefit>2234</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VN001</BillingCode><PriorBillingCodes><PriorBillingCode>BS315</PriorBillingCode></PriorBillingCodes><Name>Embozene Tandem Microspheres</Name><Description>Embozene TANDEM Microspheres are spherical tightly calibrated, biocompatible, non-resorbable, hydrogel microspheres with an inorganic polyzene-F coating, colour coded to indicate microsphere size. Each 20mL syringe is filled with 2 ml of product suspended in a non-pyrogenic physiological slaine transport solution. Embozene TANDEM Microspheres may be loaded with Doxirubican-HCl and Irinotecan-HCl up to 50mg/ml which can elute local, controlled, sustained doses of drugs to targeted tumour sites after embolisation.</Description><Size>Tandem 2ml 40 ± 10 µm  Tandem 2ml 75 ± 15 µm  Tandem 2ml 100  ± 25 µm</Size><SupplierCode>40439</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107948</GroupID><SubGroupID>112732</SubGroupID><ARTGs><ARTG>315383</ARTG></ARTGs><MinimumBenefit>1760</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS371</BillingCode><PriorBillingCodes><PriorBillingCode>DE275</PriorBillingCode></PriorBillingCodes><Name>DC Bead</Name><Description>Drug delivery embolisation system</Description><Size>100-500 (microns)</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107589</SubCategoryID><GroupID>107948</GroupID><SubGroupID>112732</SubGroupID><ARTGs><ARTG>392646</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>1760</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KI004</BillingCode><Name>MIC-KEY Low Profile Balloon Gastrostomy Feeding Tubes/Kits, ENFit</Name><Description>Sterile Low Profile Enteral Feeding Tube with Accessories</Description><Size>14FR to 24 Fr ; 0.8cm to 5.0cm</Size><SupplierCode>40351</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112734</SubGroupID><ARTGs><ARTG>260222</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DO023</BillingCode><PriorBillingCodes><PriorBillingCode>AS210</PriorBillingCode></PriorBillingCodes><Name>Kangaroo Single Pass PEG</Name><Description>Single Pass PEG</Description><Size>16fg, 20fg</Size><SupplierCode>39963</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112734</SubGroupID><ARTGs><ARTG>141188</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KI001</BillingCode><Name>HALYARD* MIC*Percutaneous Endoscopic Gastrostomy (P.E.G) Feeding Tubes / Kits, Enfit and Non-Enfit</Name><Description>Sterile enteral feeding tube with accessories</Description><Size>14Fr, 20Fr, 24Fr</Size><SupplierCode>40351</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112734</SubGroupID><ARTGs><ARTG>248293</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DO020</BillingCode><PriorBillingCodes><PriorBillingCode>AS205</PriorBillingCode></PriorBillingCodes><Name>Kangaroo Skin Level Cage Gastrostomy Kit</Name><Description>Skin level non-balloon internal retention bolster gastrostomy kit, including gastrostomy tube, accessory bolus and continuous feeding tubes syringes for inflation and flushing. Patient handbook</Description><Size>12fg x 1.2cm, 12fg x 1.5cm, 12fg x 2.0cm, 12fg x 2.5cm, 12fg x 3.0cm, 12fg x 3.5cm, 12fg x 4.0cm, 12fg x 4.5cm, 12fg x 5.0cm, 16fg x 1.5cm, 16fg x 1.7cm, 16fg x 2.0cm, 16fg x 2.4cm, 16fg x 2.7cm, 16fg x 3.0cm, 16fg x 3.5cm, 20fg x 1.5cm, 20fg x 2.0cm, 20fg x 2.5cm, 20fg x 3.0cm, 20fg x 3.5cm, 20fg x 4.0cm, 20fg x 4.5cm</Size><SupplierCode>39963</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112734</SubGroupID><ARTGs><ARTG>185673</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FK013</BillingCode><Name>Freka Belly Button Comfort Kit, ENFit</Name><Description>Gastric replacement system consisting of Freka Belly Button, insertion introducer, 2 compresses, syringe for filling balloon, lubricant gel, Seldinger wire, Freka Button Extension Sets 1 and 2, and Freka Connect. An Initial Placement System (PEG) would have been placed at least 4 weeks prior.</Description><Size>12 Fr x 1.0cm ,12 Fr x 1.5cm, 12 Fr x 2.0cm, 12 Fr x 2.5cm, 12 Fr x 3.0cm, 12 Fr x 3.5cm, 12 Fr x 4.0cm, 12 Fr x 4.5cm,12 Fr x 5.0cm 

14 Fr x 1.0cm, 14 Fr x 1.5cm, 14 Fr x 2.0cm, 14 Fr x 2.5cm, 14 Fr x 3.0cm, 14 Fr x 3.5cm,14 Fr x 4.0cm,14 Fr x 4.5cm, 14 Fr x 5.0cm

16 Fr x 1.0cm, 16 Fr x 1.5cm, 16 Fr x 2.0cm, 16 Fr x 2.5cm, 16 Fr x 3.0cm, 16 Fr x 3.5cm,16 Fr x 4.0cm,16 Fr x 4.5cm, 16 Fr x 5.0cm

18 Fr x 1.0cm, 18 Fr x 1.5cm, 18 Fr x 2.0cm, 18 Fr x 2.5cm, 18 Fr x 3.0cm, 18 Fr x 3.5cm,18 Fr x 4.0cm,18 Fr x 4.5cm, 18 Fr x 5.0cm

20 Fr x 1.0cm, 20 Fr x 1.5cm, 20 Fr x 2.0cm, 20 Fr x 2.5cm, 20 Fr x 3.0cm, 20 Fr x 3.5cm,20 Fr x 4.0cm, 20 Fr x 4.5cm, 20 Fr x 5.0cm

24 Fr x 1.0cm, 24 Fr x 1.5cm, 24 Fr x 2.0cm, 24 Fr x 2.5cm, 24 Fr x 3.0cm, 24 Fr x 3.5cm, 24 Fr x 4.0cm, 24 Fr x 4.5cm, 24 Fr x 5.0cm</Size><SupplierCode>40376</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112734</SubGroupID><ARTGs><ARTG>126462</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FK018</BillingCode><Name>Freka Belly Button  Basic Kit, ENFit</Name><Description>Gastric replacement system consisting of 1 Freka Belly Button, 1 insertion introducer, 2 compresses, 1 Luer syringe for filling balloon, 1 lubricant gel, 1 X10 ml ampoule of sterile water. An Initial Placement System (PEG) would have been placed at least 4 weeks prior.</Description><Size>12 Fr x 1.0cm ,12 Fr x 1.5cm, 12 Fr x 2.0cm, 12 Fr x 2.5cm, 12 Fr x 3.0cm, 12 Fr x 3.5cm, 12 Fr x 4.0cm, 12 Fr x 4.5cm,12 Fr x 5.0cm              14 Fr x 1.0cm, 14 Fr x 1.5cm, 14 Fr x 2.0cm, 14 Fr x 2.5cm, 14 Fr x 3.0cm, 14 Fr x 3.5cm,14 Fr x 4.0cm,14 Fr x 4.5cm, 14 Fr x 5.0cm              16 Fr x 1.0cm, 16 Fr x 1.5cm, 16 Fr x 2.0cm, 16 Fr x 2.5cm, 16 Fr x 3.0cm, 16 Fr x 3.5cm,16 Fr x 4.0cm,16 Fr x 4.5cm, 16 Fr x 5.0cm              18 Fr x 1.0cm, 18 Fr x 1.5cm, 18 Fr x 2.0cm, 18 Fr x 2.5cm, 18 Fr x 3.0cm, 18 Fr x 3.5cm,18 Fr x 4.0cm,18 Fr x 4.5cm, 18 Fr x 5.0cm              20 Fr x 1.0cm, 20 Fr x 1.5cm, 20 Fr x 2.0cm, 20 Fr x 2.5cm, 20 Fr x 3.0cm, 20 Fr x 3.5cm,20 Fr x 4.0cm, 20 Fr x 4.5cm, 20 Fr x 5.0cm              24 Fr x 1.0cm, 24 Fr x 1.5cm, 24 Fr x 2.0cm, 24 Fr x 2.5cm, 24 Fr x 3.0cm, 24 Fr x 3.5cm, 24 Fr x 4.0cm, 24 Fr x 4.5cm, 24 Fr x 5.0cm  </Size><SupplierCode>40376</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112734</SubGroupID><ARTGs><ARTG>126462</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FK011</BillingCode><Name>Freka Pexact, FR 15 set II, ENFit</Name><Description>Kit consisting of a gastropexy device (Loop Fixture II), trocar with peel-away sheath, and silicone balloon tube for direct puncture gastrostomy</Description><Size>Trocar with peel-away sheath:16 Fr, length 17.5 cm
Silicone balloon tube:15 Fr, shaft length 23 ± 1 cm</Size><SupplierCode>40376</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112734</SubGroupID><ARTGs><ARTG>285517</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC185</BillingCode><Name>Percutaneous Endoscopic Gastrostomy (PEG) System</Name><Description>PEG Enteral Feeding Kit - Push or Pull System</Description><Size>18, 20, 24 FR</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112734</SubGroupID><ARTGs><ARTG>135063</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FK008</BillingCode><Name>Freka PEG, ENFit</Name><Description>PEG polyurethane tube with a proximal cone and integrated fixation loop, radio-opaque strip, measuring marks over a length of l-16 cm at 2 cm intervals, radio-opaque silicone retention plate, and a rounded distal opening</Description><Size>9 Fr x 30 cm 
15 Fr x 35 cm
20 Fr x 35 cm</Size><SupplierCode>40376</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112734</SubGroupID><ARTGs><ARTG>126460</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS141</BillingCode><Name>EndoVive Initial Feeding Tube</Name><Description>Silicone enteral feeding tube</Description><Size>Up to 24 Fr</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112734</SubGroupID><ARTGs><ARTG>159455</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE546</BillingCode><Name>Capsule Dome G-Tube</Name><Description>Conventional Length Dome Gastrostomy Tube</Description><Size>20Fr, 10cm length, available with or without guidewire.</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112734</SubGroupID><ARTGs><ARTG>181742</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE536</BillingCode><Name>Capsule Monarch G Tube</Name><Description>Conventional Length Non Balloon Gastronomy Tube.</Description><Size>12F, 14F, 18F, 20F, 10cm length, available with or without guidewire.</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112734</SubGroupID><ARTGs><ARTG>181742</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA047</BillingCode><Name>Gastrostomy Tube</Name><Description>Silicone Tubes and Replacement Tubes</Description><Size>12Fr - 28Fr</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112734</SubGroupID><ARTGs><ARTG>141582</ARTG><ARTG>141583</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE564</BillingCode><Name>Mini ONE Balloon Button</Name><Description>Low Profile Balloon Gastrostomy Tube</Description><Size>12F to 24F and length 0.8 - 6.5cms; Balloon Fill Volumes: 2-15ml</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112734</SubGroupID><ARTGs><ARTG>181741</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE541</BillingCode><Name>Balloon G-Tube</Name><Description>Conventional Length Balloon Gastrostomy tube</Description><Size>12F-24F; 
Length: 10cm;
Balloon fill volumes from 2 -15ml depending on French size.</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112734</SubGroupID><ARTGs><ARTG>181742</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DO022</BillingCode><PriorBillingCodes><PriorBillingCode>AS207</PriorBillingCode></PriorBillingCodes><Name>Kangaroo Skin Level Balloon Gastrostomy Kit</Name><Description>Skin level silicone balloon gastrostomy kit, including gastronomy tube accessory bolus and continuous feeding tubes, syringes for inflation and flushing, Patient Handbook</Description><Size>12-24 Fr., 0.8-5 cm, 3-8ml.</Size><SupplierCode>39963</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112734</SubGroupID><ARTGs><ARTG>185673</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KI002</BillingCode><Name>Halyard* MIC* Percutaneous Endoscopic Gastrostomy (P.E.G) Feeding BASIC Tubes/Kits Enfit and Non-Enf</Name><Description>Sterile enteral feeding tube with accessories</Description><Size>14 Fr, 20 Fr, 24 Fr</Size><SupplierCode>40351</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112734</SubGroupID><ARTGs><ARTG>248293</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DO021</BillingCode><PriorBillingCodes><PriorBillingCode>AS206</PriorBillingCode></PriorBillingCodes><Name>Kangaroo Gastrostomy Feeding Tubes</Name><Description>100% silicone gastrostomy with internal retention balloon</Description><Size>12fg, 14fg, 16fg, 18fg, 20fg, 22fg, 24fg</Size><SupplierCode>39963</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112735</SubGroupID><ARTGs><ARTG>185454</ARTG></ARTGs><MinimumBenefit>82</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NF001</BillingCode><Name>Flocare Gastrostomy tube (G-tube)</Name><Description>The Flocare Gastrostomy tube can be used as a replacement of an existing gastrostomy tube (PEG or G-tube) or as an initial gastrostomy tube during a surgical intervention. This balloon tube is made of medical grade silicone.</Description><Size>Ch14, 18, 20</Size><SupplierCode>40130</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112735</SubGroupID><ARTGs><ARTG>120000</ARTG></ARTGs><MinimumBenefit>82</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KI005</BillingCode><Name>MIC-KEY Low Profile Balloon Feeding Accessories</Name><Description>MIC-KEY Extension Sets, ENFit, available in a variety of sizes and options including, bolus and y-port with straight or right-angle connectors.     MIC-KEY Medication Set is also available, ENFit. </Description><Size>30.5cm, 60.9cm, 5.1cm</Size><SupplierCode>40351</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112735</SubGroupID><ARTGs><ARTG>261430</ARTG></ARTGs><MinimumBenefit>82</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DO024</BillingCode><PriorBillingCodes><PriorBillingCode>MI288</PriorBillingCode></PriorBillingCodes><Name>Kangaroo™ Percutaneous Endoscopic Gastrostomy Feeding Tube Accessories</Name><Description>Feeding Adaptors</Description><Size>16Fr/Ch, 20Fr/Ch - PEG Adaptors</Size><SupplierCode>39963</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112735</SubGroupID><ARTGs><ARTG>184804</ARTG></ARTGs><MinimumBenefit>82</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS142</BillingCode><Name>EndoVive Replacement Feeding Tube</Name><Description>Silicone enteral feeding tube</Description><Size>Up to 28 Fr</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112735</SubGroupID><ARTGs><ARTG>159455</ARTG><ARTG>160876</ARTG></ARTGs><MinimumBenefit>82</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KI007</BillingCode><Name>MIC* Gastrostomy Feeding Tube; MIC* Bolus Gastrostomy Feeding Tube, ENFit</Name><Description>Medical Grade Silicone Construction. Inflatable Silicone Internal Retention Balloon, SECUR-LOK* External Retention Ring, ENFit Feeding Port Connector, Tapered Distal Tip, Radiopaque Stripe along length of Tube</Description><Size>12Fr - 2-3ml balloon, 14Fr - 3-5ml balloon, 16Fr - 3-5ml balloon, 18Fr - 7-10ml balloon, 20Fr - 7-10ml balloon, 22Fr - 7-10ml balloon, 24Fr - 7-10ml balloon, 26Fr - 7-10ml balloon, 28Fr - 7-10ml balloon, 30Fr - 7-10ml balloon</Size><SupplierCode>40351</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112735</SubGroupID><ARTGs><ARTG>248293</ARTG></ARTGs><MinimumBenefit>82</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC334</BillingCode><Name>Entuit Thrive Balloon Retention Gastrostomy Feeding Tube</Name><Description>The gastrostomy feeding tube is a sterile device consisting of a silicone balloon, bi-lumen shaft, three-port funnel and bolster.</Description><Size>12-24 Fr</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112735</SubGroupID><ARTGs><ARTG>226890</ARTG></ARTGs><MinimumBenefit>82</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FK012</BillingCode><Name>Freka Gastrotube, FR 15, ENFit</Name><Description>Gastric replacement system intended for use for long-term intragastric feeding within a fully formed and healed stoma. An Initial Placement System (PEG) would have been placed at least 4 weeks prior. Made of silicone rubber.</Description><Size>Fits 15 Fr</Size><SupplierCode>40376</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112735</SubGroupID><ARTGs><ARTG>126462</ARTG></ARTGs><MinimumBenefit>82</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC335</BillingCode><Name>Entuit Start Initial Placement Gastrostomy Set</Name><Description>Used to assist with the initial placement of feeding tubes while performing a gastrostomy. The set contains multiple dilators, Peel-Away sheath introducer(s) with dilator(s), a wire guide and needle.</Description><Size>Small (dilator 12, 14 Fr), Medium (dilator 16,18 Fr) and Large (dilator 20,22,24 Fr). </Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107590</SubCategoryID><GroupID>107951</GroupID><SubGroupID>112736</SubGroupID><ARTGs><ARTG>219806</ARTG></ARTGs><MinimumBenefit>99</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WA004</BillingCode><Name>Hemospray Endoscopic Hemostat</Name><Description>Inorganic haemostatic agent</Description><Size>20 grams of powder  Catheter: 7-10Fr, length 220cm.</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107979</GroupID><SubGroupID>112753</SubGroupID><Suffix>&gt; 10 grams</Suffix><ARTGs><ARTG>276342</ARTG></ARTGs><MinimumBenefit>497</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VM001</BillingCode><Name>EndoClot Kit</Name><Description>Polysaccharide haemostatic system</Description><Size>2g particles, 2300mm catheter length</Size><SupplierCode>39936</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107979</GroupID><SubGroupID>112753</SubGroupID><ARTGs><ARTG>204921</ARTG></ARTGs><MinimumBenefit>154</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA284</BillingCode><PriorBillingCodes><PriorBillingCode>BA263</PriorBillingCode></PriorBillingCodes><Name>Arista AH FlexiTip XL-R Applicator</Name><Description>Rigid Dual lumen applicator for Arista AH, 38cm long specifically designe for Robotic surgery</Description><Size>38 cm</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107979</GroupID><SubGroupID>112754</SubGroupID><ARTGs><ARTG>258012</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA285</BillingCode><PriorBillingCodes><PriorBillingCode>BA263</PriorBillingCode></PriorBillingCodes><Name>Arista AH Flextip and Flextip XL</Name><Description>Extender tip for delivery of Arista AH powder</Description><Size>14cm  38cm</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107979</GroupID><SubGroupID>112754</SubGroupID><ARTGs><ARTG>258012</ARTG></ARTGs><MinimumBenefit>46</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH414</BillingCode><Name>Gelita-Spon Absorbable Gelatin Sponge-Gelita- Spon Standard</Name><Description>Gelita-Spon Standard is a sterile, single- use, fully bioabsorbable gelatin sponge indicated to achieve rapid haemostasis(e.g. surgically or trauma induced)by tamponade, and arterial embolisation . also indicated for use as a vehicle for a wide range of therapeutic agents, including antibiotics, thrombin and chemotherapeutics without reduction in the sponge's haemostatic effect.</Description><Size>GS-010-Gelita-Spon Standard; 10s-80x50x10m       GS-060-Gelita-Spon Standard Size 12-7; 10s-60x20x7mm                                                                       GS-060-Gelita-Spon Standard Size 12-7; 10s-60x20x7mm                                                                       GS-650- Gelita Spon Standard Size 200; 10s-125x80x10mm                                                                  GS-110-Gelita-Spon Standard Size Special 20; 20s-80x50x1mm                                                              GS-950-Gelita-Spon Standard Film; 20s-200x70x0.5mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107980</GroupID><SubGroupID>112755</SubGroupID><ARTGs><ARTG>155096</ARTG></ARTGs><MinimumBenefit>8</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ006</BillingCode><Name>Spongostan Absorbable Haemostat</Name><Description>Anal 20s (Box of 20)</Description><Size>80 x 30mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107980</GroupID><SubGroupID>112755</SubGroupID><Suffix>Anatomically Conforming</Suffix><ARTGs><ARTG>144852</ARTG></ARTGs><MinimumBenefit>15</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH405</BillingCode><Name>Gelita-Spon Absorbable Gelatin Sponge-Gelita- Spon IR Sponge</Name><Description>Gelita- Spon IR is a sterile, single-use, fully bioabsorbable gelatin sponge indicated to achieve rapid haemostasis(e.g. surgically or trauma induced) by tamponade, and arterial embolisation. also indicated for use as a vehicle for a wide range of therapeutic agents including antibiotics, thrombin and chemotherapeutics without reduction in the sponge's haemostatic effect.</Description><Size>GS-322-Gelita-Spon IR Sponge; 200s-3x2x2mm                                                        GS- 344- Gelita- Spon IR Sponge; 100s-4x4x4mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107980</GroupID><SubGroupID>112755</SubGroupID><ARTGs><ARTG>155094</ARTG></ARTGs><MinimumBenefit>8</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PU059</BillingCode><Name>Gelfoam Sterile Sponge</Name><Description>Sterile, pliable, nonantigenic surgical sponge prepared from specially treated purified gelatine solution</Description><Size>12 - 20mm x 60mm x 7mm, individually packaged for use</Size><SupplierCode>40105</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107980</GroupID><SubGroupID>112755</SubGroupID><Suffix>Low Antigenicity</Suffix><ARTGs><ARTG>17051</ARTG></ARTGs><MinimumBenefit>15</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ007</BillingCode><Name>Spongostan Absorbable Haemostat</Name><Description>Anal 5s (Box of 5)</Description><Size>80 x 30mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107980</GroupID><SubGroupID>112755</SubGroupID><Suffix>Anatomically Conforming</Suffix><ARTGs><ARTG>144852</ARTG></ARTGs><MinimumBenefit>15</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ015</BillingCode><Name>Spongostan Absorbable Haemostat</Name><Description>Dental (Box of 24)</Description><Size>10 x 10 x 10mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107980</GroupID><SubGroupID>112755</SubGroupID><ARTGs><ARTG>144852</ARTG></ARTGs><MinimumBenefit>8</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ005</BillingCode><Name>Spongostan Absorbable Haemostat</Name><Description>Special (Box of 20)</Description><Size>70 x 50 x 1mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107980</GroupID><SubGroupID>112755</SubGroupID><ARTGs><ARTG>144852</ARTG></ARTGs><MinimumBenefit>8</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ003</BillingCode><Name>Spongostan Absorbable Haemostat</Name><Description>Standard (Box of 20)</Description><Size>70 x 50 x 10mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107980</GroupID><SubGroupID>112755</SubGroupID><ARTGs><ARTG>144852</ARTG></ARTGs><MinimumBenefit>8</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH412</BillingCode><Name>Gelita-Spon Absorbable Gelatin Sponge-Gelita- Spon Dental Cube</Name><Description>Gelita-Spon Dental Cube is a  sterile, single-use, indicated to achieve rapid haemostasis dental surgery (oral bone and soft tissue), a void filler to mitigate against the risk of sclerosis created by tooth extraction, root amputations, and the removal of cysts, tumours and impacted teeth.  its absorptive capacity being a function of the amount of gelatin incorporated and, hence, the physical size of the sponge. also indicated for use as a vehicle for a wide range of therapeutic agents.</Description><Size>GS-310 - Gelita-Spon Dental Cubes; 50s - 10 x 10 x 10mm</Size><SupplierCode>40192</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107980</GroupID><SubGroupID>112755</SubGroupID><ARTGs><ARTG>155093</ARTG></ARTGs><MinimumBenefit>8</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH411</BillingCode><Name>Gelita-Spon Absorbable Gelatin Sponge - Gelita-Spon ENT Sponge</Name><Description>GelitaSpon  ENT Sponge is a sterile, single use, water insoluble, fully bioabsorbable, firm, high-density gelatin sponge  indicated to achieve rapid haemostasis during ENT surgery .</Description><Size>8x5x1 cm &amp; 1x1x1cm</Size><SupplierCode>40192</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107980</GroupID><SubGroupID>112755</SubGroupID><ARTGs><ARTG>155092</ARTG></ARTGs><MinimumBenefit>8</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH410</BillingCode><Name>Gelita-Spon Absorbable Gelatin Sponge Anal-Vaginal Tampon</Name><Description>'Gelita-Spon Anal-Vaginal Tampon is a sterile, single use, fully bioabsorbable gelatin sponge  indicated to achieve rapid haemostasis by tamponade, also indicated for use as a vehicle for a wide range of therapeutic agents, including antibiotics, thrombin and chemotherapeutics without reduction in the sponge's haemostatic effect.</Description><Size>3x8cm</Size><SupplierCode>40192</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107980</GroupID><SubGroupID>112755</SubGroupID><ARTGs><ARTG>155095</ARTG></ARTGs><MinimumBenefit>8</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PU060</BillingCode><Name>Gelfoam Sterile Sponge</Name><Description>Sterile, pliable, nonantigenic surgical sponge prepared from specially treated purified gelatine solution</Description><Size>100 - 80mm x 125mm x 10mm in individual packet</Size><SupplierCode>40105</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107980</GroupID><SubGroupID>112756</SubGroupID><Suffix>Low Antigenicity</Suffix><ARTGs><ARTG>17051</ARTG></ARTGs><MinimumBenefit>64</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ004</BillingCode><Name>Spongostan Absorbable Haemostat</Name><Description>Film (Box of 20)</Description><Size>200 x 70 x 0.5mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107980</GroupID><SubGroupID>112756</SubGroupID><ARTGs><ARTG>144852</ARTG></ARTGs><MinimumBenefit>27</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BG002</BillingCode><Name>BloodStop iX</Name><Description>BloodStop iX is a new generation haemostat made from water soluble, oxidised-etherified regenerated cellulose</Description><Size>1.3x5cm, 5x5cm, 5x10cm</Size><SupplierCode>39950</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107981</GroupID><SubGroupID>112759</SubGroupID><Suffix>Antimicrobial, Low Antigenicity</Suffix><ARTGs><ARTG>240712</ARTG></ARTGs><MinimumBenefit>19</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ009</BillingCode><Name>Surgicel Fibrillar Absorbable Haemostat</Name><Description>Fibrous fleece, oxidised regenerated cellulose, the material is biocompatible and also bactericidal</Description><Size>2.5 x 5.1cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107981</GroupID><SubGroupID>112759</SubGroupID><Suffix>Antimicrobial, Low Antigenicity, Micro-fibrous</Suffix><ARTGs><ARTG>166221</ARTG></ARTGs><MinimumBenefit>34</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN112</BillingCode><Name>Surgicel Non-Woven (SNoW) Absorbable Haemostat</Name><Description>Absorbable haemostat, Structured Non-Woven</Description><Size>2.5 x 5cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107981</GroupID><SubGroupID>112759</SubGroupID><Suffix>Antimicrobial, Low Antigenicity, Micro-fibrous</Suffix><ARTGs><ARTG>191054</ARTG></ARTGs><MinimumBenefit>34</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ023</BillingCode><Name>Surgicel Nu-Knit Absorbable Haemostat</Name><Description>High density, oxidised regenerated cellulose, the material is biocompatible and also bactericidal</Description><Size>2.5 x 2.5cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107981</GroupID><SubGroupID>112759</SubGroupID><Suffix>Antimicrobial, Low Antigenicity, Woven</Suffix><ARTGs><ARTG>177701</ARTG></ARTGs><MinimumBenefit>33</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ432</BillingCode><Name>SURGICEL Nu knit Absorbable Haemostat</Name><Description>High density , oxidised regenerated cellulose, the material is biocompatible and also bactericidal.</Description><Size>2.5 x 8.75cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107981</GroupID><SubGroupID>112759</SubGroupID><Suffix>Antimicrobial, Low Antigenicity, Woven</Suffix><ARTGs><ARTG>177701</ARTG></ARTGs><MinimumBenefit>33</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH424</BillingCode><Name>Gelitacel Oxidised Resorbable Cellulose Gauze (15)</Name><Description>Gelitacel is a white, single-use, non-toxic, sterile, bioarbsorbable, weakly acidic, viscose-free, knitted haemostatic fabric (USP)</Description><Size>5 x 7 cm</Size><SupplierCode>40192</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107981</GroupID><SubGroupID>112759</SubGroupID><ARTGs><ARTG>157255</ARTG></ARTGs><MinimumBenefit>8</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ054</BillingCode><PriorBillingCodes><PriorBillingCode>LM487</PriorBillingCode></PriorBillingCodes><Name>Haemostatic Gauze  </Name><Description>Haemostatic Gauze</Description><Size>≤50cm²</Size><SupplierCode>40363</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107981</GroupID><SubGroupID>112759</SubGroupID><ARTGs><ARTG>332360</ARTG></ARTGs><MinimumBenefit>8</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ013</BillingCode><Name>Surgicel ORIGINAL Absorbable Haemostat</Name><Description>Oxidised regenerated cellulose gauze, the material is biocompatible and also bactericidal</Description><Size>5 x 7.5cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107981</GroupID><SubGroupID>112759</SubGroupID><Suffix>Antimicrobial, Low Antigenicity</Suffix><ARTGs><ARTG>171589</ARTG><ARTG>177702</ARTG></ARTGs><MinimumBenefit>19</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ014</BillingCode><Name>Surgicel ORIGINAL Absorbable Haemostat</Name><Description>Oxidised regenerated cellulose gauze, the material is biocompatible and also bactericidal</Description><Size>1.25  x 5cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107981</GroupID><SubGroupID>112759</SubGroupID><Suffix>Antimicrobial, Low Antigenicity</Suffix><ARTGs><ARTG>171589</ARTG><ARTG>177702</ARTG></ARTGs><MinimumBenefit>19</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ008</BillingCode><Name>Surgicel Nu-Knit Absorbable Haemostat</Name><Description>High density, oxidised regenerated cellulose, the material is biocompatible and also bactericidal</Description><Size>7.5 x 10cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107981</GroupID><SubGroupID>112760</SubGroupID><Suffix>Antimicrobial, Low Antigenicity, Woven</Suffix><ARTGs><ARTG>177701</ARTG></ARTGs><MinimumBenefit>39</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN116</BillingCode><Name>Surgicel Non-Woven (SNoW) Absorbable Haemostat</Name><Description>Absorbable haemostat, Structured Non-Woven</Description><Size>5 x 10.2cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107981</GroupID><SubGroupID>112760</SubGroupID><Suffix>Antimicrobial, Low Antigenicity, Micro-fibrous</Suffix><ARTGs><ARTG>191054</ARTG></ARTGs><MinimumBenefit>69</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ030</BillingCode><Name>Surgicel Fibrillar Absorbable Haemostat</Name><Description>Fibrous fleece, oxidised regenerated cellulose, the material is biocompatible and also bactericidal</Description><Size>5.1 x 10.2cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107981</GroupID><SubGroupID>112760</SubGroupID><Suffix>Antimicrobial, Low Antigenicity, Micro-fibrous</Suffix><ARTGs><ARTG>166221</ARTG></ARTGs><MinimumBenefit>69</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ029</BillingCode><Name>Surgicel Fibrillar Absorbable Haemostat</Name><Description>Fibrous fleece, oxidised regenerated cellulose, the material is biocompatible and also bactericidal</Description><Size>10.2 x 10.2cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107981</GroupID><SubGroupID>112761</SubGroupID><Suffix>Antimicrobial, Low Antigenicity, Micro-fibrous</Suffix><ARTGs><ARTG>166221</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH423</BillingCode><Name>Gelitacel Oxidised Resorbable Cellulose Gauze (10)</Name><Description>Gelitacel is a white, single use, non-toxic, sterile, hydrophilic bioabsorbable, weakly acidic, viscose-free, knitted haemostatic fabric (USP)</Description><Size>5 x 35 cm, 10 x 20 cm</Size><SupplierCode>40192</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107981</GroupID><SubGroupID>112761</SubGroupID><ARTGs><ARTG>157255</ARTG></ARTGs><MinimumBenefit>26</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN117</BillingCode><Name>Surgicel Non-Woven (SNoW) Absorbable Haemostat</Name><Description>Absorbable haemostat, Structured Non-Woven</Description><Size>10.2 x 10.2cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107981</GroupID><SubGroupID>112761</SubGroupID><Suffix>Antimicrobial, Low Antigenicity, Micro-fibrous</Suffix><ARTGs><ARTG>191054</ARTG></ARTGs><MinimumBenefit>98</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ433</BillingCode><Name>SURGICEL Nu knit Absorbable Haemostat</Name><Description>High density , oxidised regenerated cellulose, the material is biocompatible and also bactericidal.</Description><Size>15.2 x 22.9cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107981</GroupID><SubGroupID>112761</SubGroupID><Suffix>Antimicrobial, Low Antigenicity, Woven</Suffix><ARTGs><ARTG>177701</ARTG></ARTGs><MinimumBenefit>91</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ012</BillingCode><Name>Surgicel ORIGINAL Absorbable Haemostat</Name><Description>Oxidised regenerated cellulose gauze, the material is biocompatible and also bactericidal</Description><Size>5-10.2 x 20-35cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107981</GroupID><SubGroupID>112761</SubGroupID><Suffix>Antimicrobial, Low Antigenicity</Suffix><ARTGs><ARTG>177702</ARTG><ARTG>171589</ARTG></ARTGs><MinimumBenefit>34</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ053</BillingCode><PriorBillingCodes><PriorBillingCode>LM486</PriorBillingCode></PriorBillingCodes><Name>Haemostatic Gauze </Name><Description>Haemostatic Gauze </Description><Size>&gt;75cm²</Size><SupplierCode>40363</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107981</GroupID><SubGroupID>112761</SubGroupID><ARTGs><ARTG>332360</ARTG></ARTGs><MinimumBenefit>26</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BG001</BillingCode><Name>BloodStop iX</Name><Description>BloodStop iX is a new generation haemostat made from water soluble, oxidised-etherified regenerated cellulose</Description><Size>10x20cm, 5x35cm</Size><SupplierCode>39950</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107981</GroupID><SubGroupID>112761</SubGroupID><ARTGs><ARTG>240712</ARTG></ARTGs><MinimumBenefit>33</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX258</BillingCode><Name>FloSeal Hemostatic Matrix</Name><Description>FloSeal is a proprietary combination of collagen-derived particles and topical thrombin. Comes with a syringe with needle or needle free  vial adapter.  It is not sponge, but is a high viscosity gel for haemostasis.  Clinical proven to control bleeding from capillary oozing to arterial spurting.</Description><Size>5ml</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107982</GroupID><SubGroupID>112762</SubGroupID><Suffix>Complete Biomaterial</Suffix><ARTGs><ARTG>330266</ARTG></ARTGs><MinimumBenefit>394</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FY001</BillingCode><PriorBillingCodes><PriorBillingCode>MQ038</PriorBillingCode></PriorBillingCodes><Name>Purastat</Name><Description>Haemostatic material in the form of a pre-filled syringe</Description><Size>1ml, 2ml, 5ml</Size><SupplierCode>40259</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107982</GroupID><SubGroupID>112762</SubGroupID><Suffix>Complete Biomaterial</Suffix><ARTGs><ARTG>267486</ARTG><ARTG>283717</ARTG></ARTGs><MinimumBenefit>394</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ640</BillingCode><Name>Surgiflo Haemostatic Matrix</Name><Description>Absorbable Porcine Gelatin Matrix Pre-packaged in a Syringe</Description><Size>6ml</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107982</GroupID><SubGroupID>112762</SubGroupID><ARTGs><ARTG>204900</ARTG></ARTGs><MinimumBenefit>343</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX259</BillingCode><Name>FloSeal Hemostatic Matrix</Name><Description>FloSeal is a proprietary combination of collagen-derived particles and topical thrombin. Comes with a syringe with needle or needle free  vial adapter. It is not sponge, but is a high viscosity gel for haemostasis.  Clinically proven to control bleeding from capillary oozing to arterial spurting.</Description><Size>10ml</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107982</GroupID><SubGroupID>112763</SubGroupID><Suffix>Complete Biomaterial</Suffix><ARTGs><ARTG>330266</ARTG></ARTGs><MinimumBenefit>640</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN172</BillingCode><Name>Surgiflo Haemostatic Matrix with Thrombin</Name><Description>Absorbable Porcine Gelatin Matrix pre-packaged in a syringe and with plasma derived Human Thrombin</Description><Size>8mls</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107982</GroupID><SubGroupID>112763</SubGroupID><Suffix>Complete Biomaterial</Suffix><ARTGs><ARTG>226071</ARTG><ARTG>280654</ARTG></ARTGs><MinimumBenefit>640</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AN009</BillingCode><Name>Collatamp G</Name><Description>Biodegradeable collagen implant with gentamicin</Description><Size>5cm x 5cm x 0.5cm</Size><SupplierCode>40028</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107982</GroupID><SubGroupID>112764</SubGroupID><Suffix>Antibiotic</Suffix><ARTGs><ARTG>156287</ARTG></ARTGs><MinimumBenefit>122</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AN008</BillingCode><Name>Collatamp G</Name><Description>Biodegradable collagen implant with gentamicin</Description><Size>10cm x 10cm x 0.5cm, 20cm x 5cm x 0.5cm</Size><SupplierCode>40028</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107982</GroupID><SubGroupID>112765</SubGroupID><Suffix>Antibiotic</Suffix><ARTGs><ARTG>156287</ARTG></ARTGs><MinimumBenefit>277</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VB001</BillingCode><Name>HEMOBLAST 35cm Laparoscopic Applicator</Name><Description>Single-use laparoscopic applicator device, designed to deliver HEMOBLAST Bellows hemostatic powder.</Description><Size>35cm in length</Size><SupplierCode>40229</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107982</GroupID><SubGroupID>112766</SubGroupID><ARTGs><ARTG>304086</ARTG></ARTGs><MinimumBenefit>28</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FY003</BillingCode><PriorBillingCodes><PriorBillingCode>MQ040</PriorBillingCode></PriorBillingCodes><Name>PuraStat Applicator Type E</Name><Description>PuraStat is used as an adjunct to haemostasis when control of bleeding by ligature or conventional surgical procedures is ineffective or impractical.</Description><Size>1600mm, 2200mm</Size><SupplierCode>40259</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107982</GroupID><SubGroupID>112766</SubGroupID><ARTGs><ARTG>283717</ARTG></ARTGs><MinimumBenefit>28</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VB002</BillingCode><Name>HEMOBLAST Bellows</Name><Description>Haemostatic powder comprised of collagen, chondroitin sulfate, and thrombin.</Description><Size>1.65 gm powder/1500 IU thrombin</Size><SupplierCode>40229</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107592</SubCategoryID><GroupID>107982</GroupID><SubGroupID>112767</SubGroupID><Suffix>Complete Biomaterial</Suffix><ARTGs><ARTG>337110</ARTG></ARTGs><MinimumBenefit>903</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL008</BillingCode><Name>Olympus Biliary Stent Set</Name><Description>Radio-opaque Polyethglare Stent Set</Description><Size>7Fr 3cm - 15cm, 8Fr 3cm - 15cm, 10Fr 3cm - 15cm</Size><SupplierCode>40122</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112768</SubGroupID><ARTGs><ARTG>145856</ARTG></ARTGs><MinimumBenefit>74</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL003</BillingCode><Name>Bile Duct Stent</Name><Description>Polyethylene Stents</Description><Size>7FR - 12FR 3cm - 15cm</Size><SupplierCode>40122</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112768</SubGroupID><ARTGs><ARTG>145851</ARTG></ARTGs><MinimumBenefit>74</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS184</BillingCode><Name>Advanix Plastic Stent</Name><Description>Plastic stent manufactured individually</Description><Size>5-18cm length, 7-10 FR diameter</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112768</SubGroupID><ARTGs><ARTG>127387</ARTG></ARTGs><MinimumBenefit>74</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS055</BillingCode><Name>RX Biliary Stent</Name><Description>Polyurethane Biliary Stent</Description><Size>Diameters up to 12Fr &amp; lengths up to 15cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112768</SubGroupID><Suffix>Delivery System</Suffix><ARTGs><ARTG>127387</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS173</BillingCode><Name>Advanix Plastic Stent with Naviflex Delivery System</Name><Description>Plastic stent manufactured pre loaded on a delivery catheter</Description><Size>5-18cm length, 7-10 FR diameter</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112768</SubGroupID><Suffix>Delivery System</Suffix><ARTGs><ARTG>127387</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS054</BillingCode><Name>Flexima Biliary Stent</Name><Description>Polyurethane Biliary Stent</Description><Size>Diameters up to 12Fr &amp; lengths up to 15cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112768</SubGroupID><Suffix>Delivery System</Suffix><ARTGs><ARTG>127387</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC013</BillingCode><Name>Zimmon Biliary Stent Set</Name><Description>Double pigtail plastic biliary stent with delivery system</Description><Size>5 - 11.5Fr, Length 2 - 18cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112768</SubGroupID><Suffix>Delivery System</Suffix><ARTGs><ARTG>139771</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC108</BillingCode><Name>Geenan Pancreatic Stent Set</Name><Description>Radiopaque Polyethylene Stent with or without ductal flaps - includes pushing catheter</Description><Size>Diameter 3 - 11.5 FR, Length 2 - 15cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112768</SubGroupID><Suffix>Delivery System</Suffix><ARTGs><ARTG>142999</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC106</BillingCode><Name>Cotton-Leung Biliary Stent Set</Name><Description>Polyethylene Stent preloaded on an Oasis Introduction System</Description><Size>Diameter 7 - 11.5 FR,  length 5 - 15cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112768</SubGroupID><Suffix>Delivery System</Suffix><ARTGs><ARTG>139771</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC017</BillingCode><Name>Cotton-Leung Biliary Stent Set</Name><Description>Set includes stent, positioning sleeve to collapse the duodenal flap, 170cm pushing catheter and 320cm guiding catheter. 7Fr stents do not include guiding catheter.</Description><Size>7 - 11.5Fr, Length 5 - 18cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112768</SubGroupID><Suffix>Delivery System</Suffix><ARTGs><ARTG>139771</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC228</BillingCode><Name>Tannenbaum Biliary Stent Set preloaded on the OASIS Introduction System</Name><Description>Plastic Biliary Stent</Description><Size>8.5 - 11.5 Fr,   5 - 15 cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112768</SubGroupID><Suffix>Delivery System</Suffix><ARTGs><ARTG>139771</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS066</BillingCode><Name>Biliary Drainage Stent, Amsterdam Biliary Stent</Name><Description>C-Flex or Polyurethane Biliary Stent</Description><Size>Diameters up to 12Fr &amp; lengths up to 15cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112768</SubGroupID><ARTGs><ARTG>127387</ARTG></ARTGs><MinimumBenefit>74</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC006</BillingCode><Name>Cotton-Leung Biliary Stent Only</Name><Description>.</Description><Size>6 - 11.5Fr, Length 3 - 20cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112768</SubGroupID><ARTGs><ARTG>139770</ARTG></ARTGs><MinimumBenefit>74</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WA003</BillingCode><Name>Compass BDS Biliary Stent</Name><Description>Plastic biliary stent</Description><Size>7 Fr, Length: 5-15cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112768</SubGroupID><ARTGs><ARTG>133255</ARTG></ARTGs><MinimumBenefit>74</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC267</BillingCode><Name>Cotton-Leung Sof-Flex Biliary Stent</Name><Description>Cotton-Leung Sof-Flex Biliary Stent</Description><Size>6 - 11.5 Fr; Length 3 - 20cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112768</SubGroupID><ARTGs><ARTG>139770</ARTG></ARTGs><MinimumBenefit>74</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC012</BillingCode><Name>Zimmon Biliary Stent Only</Name><Description>.</Description><Size>5 - 11.5Fr, Length 3 - 18cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112768</SubGroupID><ARTGs><ARTG>139770</ARTG></ARTGs><MinimumBenefit>74</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC064</BillingCode><Name>Tannenbaum Biliary Stent only</Name><Description>Plastic biliary stent with proximal and distal flaps</Description><Size>Diameter: 8.5,10,11.5 FR. Length Between Flaps: 5 --&gt;15 cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112768</SubGroupID><ARTGs><ARTG>139770</ARTG></ARTGs><MinimumBenefit>74</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC008</BillingCode><Name>Cotton-Huibregste Biliary Stent Only</Name><Description>.</Description><Size>7 - 11.5Fr, Length 5 - 21cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112768</SubGroupID><ARTGs><ARTG>139770</ARTG></ARTGs><MinimumBenefit>74</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS215</BillingCode><Name>WallFlex Biliary Stent</Name><Description>Bare Metal Stent</Description><Size>6 - 10 x 40 - 120mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112769</SubGroupID><ARTGs><ARTG>226864</ARTG><ARTG>136261</ARTG></ARTGs><MinimumBenefit>2008</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS354</BillingCode><Name>Epic Biliary Endoscopic Stent System</Name><Description>Uncovered self-expanding nitinol biliary stent</Description><Size>Diameter 6-10mm, Length 40-100mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112769</SubGroupID><ARTGs><ARTG>299016</ARTG></ARTGs><MinimumBenefit>2008</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS199</BillingCode><Name>Protege™GPS™ Self-expanding Billary Stent System</Name><Description>Nitinol self expanding stent pre-mounted on 6F OTW delivery system</Description><Size>Diameter (mm) 6 -14, Length (mm) 20 - 150</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112769</SubGroupID><ARTGs><ARTG>189741</ARTG></ARTGs><MinimumBenefit>2008</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AK013</BillingCode><Name>Biliary Nitinol Stents</Name><Description>Biliary Nitinol Stents, self expandable</Description><Size>6mm - 10mm wide  40mm - 120mm long</Size><SupplierCode>39961</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112769</SubGroupID><ARTGs><ARTG>365092</ARTG></ARTGs><MinimumBenefit>2008</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET039</BillingCode><Name>SX-Ella Tips Stent</Name><Description>Uncovered, self-expanding nitinol stent</Description><Size>Dia 10-14mm, length 52-77mm</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112769</SubGroupID><ARTGs><ARTG>144490</ARTG></ARTGs><MinimumBenefit>2008</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC308</BillingCode><Name>Evolution Biliary Stent System (uncovered)</Name><Description>Self expanding bare metal biliary stent system.</Description><Size>Diameters :8 -10mm
Lengths: 40 -100mm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112769</SubGroupID><ARTGs><ARTG>177491</ARTG></ARTGs><MinimumBenefit>2008</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC270</BillingCode><Name>Zilver Biliary Stent System</Name><Description>Self expanding metal biliary stent system</Description><Size>Diameters 6, 8, 10mm; Lengths 4, 6, 8, 10, 12cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112769</SubGroupID><ARTGs><ARTG>177491</ARTG></ARTGs><MinimumBenefit>2008</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC331</BillingCode><Name>Zilver 635 Biliary Stent</Name><Description>The Zilver 635 Biliary Stent is a self-expandable stent made of nitinol.</Description><Size>Length: 4-8cm, Diameter: 6-14mm, Delivery system: 40cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112769</SubGroupID><ARTGs><ARTG>236948</ARTG></ARTGs><MinimumBenefit>2008</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS051</BillingCode><Name>Wallstent Biliary Stent</Name><Description>Monofilament wire, self-expanding stent</Description><Size>Diameters up to 10mm &amp; lengths up to 100mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112769</SubGroupID><ARTGs><ARTG>136261</ARTG></ARTGs><MinimumBenefit>2008</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET038</BillingCode><Name>SX-Ella Biliary Stent</Name><Description>Self-expanding nitinol stent</Description><Size>Diameter 8 - 10mm, Length 40 - 100mm.</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112769</SubGroupID><ARTGs><ARTG>144490</ARTG></ARTGs><MinimumBenefit>2008</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS200</BillingCode><Name>VisiPro™ Balloon-Expandable Biliary Stent System</Name><Description>Stainless Steel balloon expandable stent mounted onto a non-compliant balloon catheter</Description><Size>Diameter (mm) 5 - 10, Length (mm) 12 -57</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112769</SubGroupID><ARTGs><ARTG>189741</ARTG></ARTGs><MinimumBenefit>2008</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PY038</BillingCode><Name>Niti-S Biliary Uncovered Stents</Name><Description>Niti-S Biliary Uncovered Stents.</Description><Size>Diameter:  6mm to 10mm   Length:  40mm to 120mm</Size><SupplierCode>40093</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112769</SubGroupID><ARTGs><ARTG>130531</ARTG></ARTGs><MinimumBenefit>2008</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UK013</BillingCode><Name>HANAROSTENT</Name><Description>HANAROSTENT® Biliary Hilar (NNN)  HANAROSTENT® FAST™ Biliary (NNN)  HANAROSTENT® Biliary (NNN)  HANAROSTENT® Benefit™ Biliary (NNN)</Description><Size>Diameter 6-10mm, Length 40-120mm</Size><SupplierCode>40267</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112769</SubGroupID><ARTGs><ARTG>272684</ARTG></ARTGs><MinimumBenefit>2008</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT116</BillingCode><Name>Gore Biliary Endoprostheses</Name><Description>ePTFE</Description><Size>Short or Long Catheter 8-10mmx4-8cm</Size><SupplierCode>40435</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112770</SubGroupID><ARTGs><ARTG>130493</ARTG></ARTGs><MinimumBenefit>2730</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UK012</BillingCode><Name>HANAROSTENT</Name><Description>HANAROSTENT Biliary, Plumber Biliary, Biliary Flap, Biliary Flap Lasso, Biliary Lasso, Multi-Hole Biliary, TwynLay Biliary, FAST Biliary Flap.  Self-expanding nitinol biliary stent</Description><Size>Diameter 6-16mm, Length 20-150mm</Size><SupplierCode>40267</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112770</SubGroupID><ARTGs><ARTG>272683</ARTG><ARTG>336629</ARTG></ARTGs><MinimumBenefit>2730</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PY049</BillingCode><Name>Niti-S Biliary Covered and Partially Covered Stents</Name><Description>Niti-S Biliary Covered and Partially Covered Stents</Description><Size>Diameter:  4mm to 16mm  Length:  10mm to 120mm</Size><SupplierCode>40093</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112770</SubGroupID><ARTGs><ARTG>130531</ARTG></ARTGs><MinimumBenefit>2730</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MB023</BillingCode><Name>Allium Biliary Stent</Name><Description>Endoscopic or Transhepatic biliary stent made of nitinol with copolymer covering and unraveling technology for atraumatic removal</Description><Size>Stent length - 60, 80, 100, 120mm. Diameter  - 8, 10mm. Anchor optional</Size><SupplierCode>40183</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112770</SubGroupID><ARTGs><ARTG>205006</ARTG></ARTGs><MinimumBenefit>2730</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS052</BillingCode><Name>Wallstent Biliary Stent</Name><Description>Monofilament wire, self-expanding stent</Description><Size>Diameters up to 10mm &amp; lengths up to 100mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112770</SubGroupID><ARTGs><ARTG>136261</ARTG></ARTGs><MinimumBenefit>2730</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS214</BillingCode><Name>WallFlex Biliary Stent</Name><Description>Stent with permalume covering</Description><Size>6 - 10 x 40 - 120mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112770</SubGroupID><ARTGs><ARTG>136261</ARTG><ARTG>177661</ARTG><ARTG>226864</ARTG></ARTGs><MinimumBenefit>2730</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS070</BillingCode><Name>Wallstent RX Biliary Stent</Name><Description>Monofilament wire, self-expanding stent</Description><Size>Diameters up to 10mm &amp; lengths up to 100mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112770</SubGroupID><ARTGs><ARTG>136261</ARTG></ARTGs><MinimumBenefit>2730</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC309</BillingCode><Name>Evolution Biliary Stent System (covered)</Name><Description>Self expanding partially or fully covered biliary stent system.</Description><Size>Diameters: 8 - 10mm
Lengths: 40 - 80mm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107985</GroupID><SubGroupID>112770</SubGroupID><ARTGs><ARTG>177491</ARTG></ARTGs><MinimumBenefit>2730</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS046</BillingCode><Name>Ultraflex Oesophageal Stent; Ultraflex Oesophageal NG Stent</Name><Description>Nitinol, self expanding stent</Description><Size>Diameters up to 30mm &amp; lengths up to 150mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107987</GroupID><SubGroupID>112772</SubGroupID><ARTGs><ARTG>120176</ARTG></ARTGs><MinimumBenefit>2256</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE691</BillingCode><PriorBillingCodes><PriorBillingCode>PY022</PriorBillingCode></PriorBillingCodes><Name>Niti-S Oesophageal Double Stent &amp; Beta Double &amp; D-Double Stent</Name><Description>Niti-S Oesophageal covered Double Stent &amp; Beta Double and D-Double self-expanding metal stent made from Nitinol, with an anti-migration outer uncovered wire construction to allow the mesh to embed in the oesophageal wall. Also with anti reflux valve inner polyurethane layer, PTFE &amp; silicone covering to prevent tumor ingrowth.  String for retrieval or re-positioning.</Description><Size>Diameter: 10mm to 28mm  Length: 40mm to 200mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107987</GroupID><SubGroupID>112773</SubGroupID><ARTGs><ARTG>130535</ARTG></ARTGs><MinimumBenefit>3159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET001</BillingCode><Name>Ferx Ella Esophageal Stent</Name><Description>Kit includes esophageal stent, introducer, balloon catheter</Description><Size>Diam 20mm, Length 80 - 160mm</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107987</GroupID><SubGroupID>112773</SubGroupID><ARTGs><ARTG>95573</ARTG></ARTGs><MinimumBenefit>3159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET045</BillingCode><Name>Boubella Esophageal Stent</Name><Description>Self expandable stainless steel wire stent with anti-reflux valve</Description><Size>Length 90 - 210mm</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107987</GroupID><SubGroupID>112773</SubGroupID><ARTGs><ARTG>95573</ARTG></ARTGs><MinimumBenefit>3159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC246</BillingCode><Name>Evolution Oesophageal Metal Stent</Name><Description>Oesophogeal Self Expanding Metal Stent with controlled release delivery system</Description><Size>8, 10, 12.5 and 15cm Lengths, 25mm flared ends with 20mm body or 23mm flared ends with 18mm body</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107987</GroupID><SubGroupID>112773</SubGroupID><ARTGs><ARTG>153840</ARTG></ARTGs><MinimumBenefit>3159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS381</BillingCode><Name>Agile Esophageal Stent</Name><Description>Nitinol, Self-expanding</Description><Size>Diameters up to 23mm &amp; lengths up to 15cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107987</GroupID><SubGroupID>112773</SubGroupID><ARTGs><ARTG>339843</ARTG></ARTGs><MinimumBenefit>3159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE690</BillingCode><PriorBillingCodes><PriorBillingCode>PY021</PriorBillingCode></PriorBillingCodes><Name>Niti-S Oesophageal Fully Covered Stent</Name><Description>Niti-S Oesophageal fully covered self expanding nitinol stent with covering of PTFE, silicone, a polyurethane layer. Nylon drawstring for removal or repositiong</Description><Size>Diameter: 10mm to 36mm  Length: 60mm to 230mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107987</GroupID><SubGroupID>112773</SubGroupID><ARTGs><ARTG>130535</ARTG></ARTGs><MinimumBenefit>3159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET069</BillingCode><Name>SX - ELLA Stent Esophageal HV (HV Stent Plus)</Name><Description>The SX-ELLA Atent Esophageal HV (HV Stent Plus) is a self-expandable, fully covered nitinol stent, pre-loaded on a delivery system. The stent is designed to provide relief from malignant or benign strictures in the oesophagus, or treating anastomic leaks. HV Stent Plus includes an anti-migration collar &amp; is also available with an anti-reflux valve</Description><Size>Stent Body Diameter = 18 - 20mm  Stent Flare Diameter = 24 - 25mm  Stent nominal length = 85/110/135/150mm  </Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107987</GroupID><SubGroupID>112773</SubGroupID><ARTGs><ARTG>95573</ARTG></ARTGs><MinimumBenefit>3159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET070</BillingCode><Name>SX- ELLA Stent Danis</Name><Description>The Danis Procedure Pack Basic contains the SX-ELLA Stent Danis, a nitinol wire that is compressed &amp; preloaded within a delivery system, along with various instruments necessary for the stent implantation. The Stent Denis is a removable stent system for the treatment of bleeding esophageal varices. It is intended to be implanted and then removed within seven days of the date of implantation in order to avoid the risk of in-growth into the stent mesh</Description><Size>One size: Stent flares diameter 30mm; Stent body diameter 25mm; Nominal length 135mm</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107987</GroupID><SubGroupID>112773</SubGroupID><ARTGs><ARTG>95573</ARTG></ARTGs><MinimumBenefit>3159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UK018</BillingCode><Name>HANAROSTENT</Name><Description>HANAROSTENT Esophagus, Esophagus Valve, Esophagus Benign BS, Bariatric Surgery, Esophagus TTS, Esophagus Skidproof, Esophagus Asymmetric,  Esophagus Bone Shape Partial Covered, Esophagus Valve Partial covered. Covered esophagus stent, self-expanding nitinol</Description><Size>Diameter 18-30mm, Length 50-240mm</Size><SupplierCode>40267</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107987</GroupID><SubGroupID>112773</SubGroupID><ARTGs><ARTG>336712</ARTG><ARTG>272685</ARTG></ARTGs><MinimumBenefit>3159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC310</BillingCode><Name>Evolution Oesophageal Stent System (Fully covered)</Name><Description>Oesophageal self expanding metal stent with controlled release delivery system</Description><Size>Diameters:18 - 20mm
Lengths: 80 - 120mm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107987</GroupID><SubGroupID>112773</SubGroupID><ARTGs><ARTG>200836</ARTG></ARTGs><MinimumBenefit>3159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UK017</BillingCode><Name>CHOOSTENT</Name><Description>CHOOSTENT Esophagus, Esophagus Valve, Esophagus Asymmetric, Esophagus Upper. Covered esophageal stent, self-expanding nitinol</Description><Size>Diameter 18-24mm, Length 50-220mm</Size><SupplierCode>40267</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107987</GroupID><SubGroupID>112773</SubGroupID><ARTGs><ARTG>272685</ARTG></ARTGs><MinimumBenefit>3159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS298</BillingCode><Name>Ultraflex Oesophageal NG Covered Stent</Name><Description>Translucent polyurethane covered nitinol, self expanding stent</Description><Size>Diameters up to 30mm &amp; lengths up to 150mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107987</GroupID><SubGroupID>112773</SubGroupID><ARTGs><ARTG>120176</ARTG></ARTGs><MinimumBenefit>3159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS089</BillingCode><Name>WallFlex Oesophageal Stent, WallFlex RMV Oesophageal Stent</Name><Description>Nitinol, self expanding stent</Description><Size>Diameters up to 30mm &amp; lengths up to 155mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107987</GroupID><SubGroupID>112773</SubGroupID><ARTGs><ARTG>120176</ARTG></ARTGs><MinimumBenefit>3159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET077</BillingCode><Name>ELLA BD Stent</Name><Description>The ELLA BD Stent is a self-expanding biodegradable stent made of polydiaxanone designed to slowly degrade when in contact with living tissue. Full degradation of stent occurs within 11-12 weeks of implantation. It is designed for dilation and treatment of benign oesophageal lesions.</Description><Size>Stent body diameters = 18mm - 25mm;   Stent flares diameters = 23mm - 31mm;   Stent nominal length = 60/80/100/135mm.</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107987</GroupID><SubGroupID>112774</SubGroupID><ARTGs><ARTG>232514</ARTG></ARTGs><MinimumBenefit>4513</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE709</BillingCode><Name>Hot Spaxus</Name><Description>Hot Spaxus is a self-expanding nitinol stent that maintains an anastomotic conduit between two adjacent organs. It has an Electrocautery Enhanced Delivery System.</Description><Size>Length 20mm, Lumen Diameter 8 - 16mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107988</GroupID><SubGroupID>112775</SubGroupID><Suffix>Electrocautery</Suffix><ARTGs><ARTG>226438</ARTG></ARTGs><MinimumBenefit>4345</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS317</BillingCode><Name>HOT AXIOS</Name><Description>Stent with Electrocautery Enhanced Delivery System for use in pseudocyst drainage. Self-expanding nitinol stent</Description><Size>Length 8-15mm, Lumen Diameter 6-20mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107988</GroupID><SubGroupID>112775</SubGroupID><Suffix>Electrocautery</Suffix><ARTGs><ARTG>282177</ARTG></ARTGs><MinimumBenefit>4345</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UK032</BillingCode><Name>HANAROSTENT® HOT Plumber™ with Z-EUS IT™</Name><Description>A lumen apposing metallic stent is a prescription device that consists of a metallic stent, intended for placement to facilitate transmural endoscopic drainage of pancreatic pseudocysts, walled-off pancreatic necrosis and gallbladder. This stent is intended to be removed upon confirmation of cyst resolution.   This device also includes an electrocautery delivery system that is able to be connected to electrosurgical generator so electrode punch tip allows easy access to the targeted tissue when the pure cut mode is activated through compatible electrosurgical unit.  The stent is a flexible, fully silicone covered, self-expanding nitinol stent, which is preloaded within the electrocautery-enhanced delivery system. The electrocautery delivery system is designed to be used in the gastrointestinal tract in conjunction with commercially available echoendoscopes with a 3.7 mm diameter or larger working channel and is compatible with commercially-available 0.035-inch endoscopic guidewires.    The monopolar electrosurgical energy is used to delivery system and the generator is not included in this device.</Description><Size>Diameter 10–16mm, Length 20-40mm</Size><SupplierCode>40267</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107988</GroupID><SubGroupID>112775</SubGroupID><Suffix>Electrocautery</Suffix><ARTGs><ARTG>407746</ARTG></ARTGs><MinimumBenefit>4345</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UK025</BillingCode><Name>HANAROSTENT Pancreatic Stent</Name><Description>Pancreatic Covered Stent</Description><Size>Diameter 10-12mm, Length 20-40mm</Size><SupplierCode>40267</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107988</GroupID><SubGroupID>112775</SubGroupID><ARTGs><ARTG>336713</ARTG></ARTGs><MinimumBenefit>3124</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE694</BillingCode><PriorBillingCodes><PriorBillingCode>PY040</PriorBillingCode></PriorBillingCodes><Name>Niti-S Nagi and Spaxus Pancreatic, Pseudocyst and Gall Bladder Drainage Stent</Name><Description>Fully Covered, self-expanding metal pancreatic pseudocyst intra-luminal drainage stent</Description><Size>Diameter: 8, 10,12,14,16mm  Length: 1,2,3cm</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107593</SubCategoryID><GroupID>107988</GroupID><SubGroupID>112775</SubGroupID><ARTGs><ARTG>226438</ARTG></ARTGs><MinimumBenefit>3124</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET088</BillingCode><Name>Comfort Drain</Name><Description>The Comfort Drain is a silicone anorectal fistula drainage catheter, that is designed to provide a knotless closure of the drain.</Description><Size>Inner Diameter: 0.3mm, Outer Diameter: 1.5mm, Length: 180mm.</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107992</GroupID><SubGroupID>112776</SubGroupID><ARTGs><ARTG>220607</ARTG></ARTGs><MinimumBenefit>114</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FN002</BillingCode><Name>Pleurx</Name><Description>Pleurx Pleural Catheter Mini Kit</Description><Size>Catheter 24cm x 15.5Fr</Size><SupplierCode>40272</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107992</GroupID><SubGroupID>112777</SubGroupID><ARTGs><ARTG>321900</ARTG></ARTGs><MinimumBenefit>384</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WA002</BillingCode><Name>Fuhrman Pleural/Pneumopericardial Drainage Set</Name><Description>Percutaneous drainage kit.  Components: Introducer needle, wire guide, dilator, radiopaque pigtail catheter, three-way stopcock, and multipurpose tubing adapter.</Description><Size>Catheter length 15cm, 6-10.2 Fr</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107992</GroupID><SubGroupID>112777</SubGroupID><ARTGs><ARTG>405270</ARTG></ARTGs><MinimumBenefit>121</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RK001</BillingCode><Name>Rocket IPC Pleural/Peritoneal Tunnelled Catheter Insertion kit</Name><Description>Rocket IPC Pleural/Peritoneal Tunnelled Catheter Insertion kit with catheter</Description><Size>16fg x 69cm silicone catheter with cuff</Size><SupplierCode>40425</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107992</GroupID><SubGroupID>112777</SubGroupID><ARTGs><ARTG>166369</ARTG></ARTGs><MinimumBenefit>384</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MS065</BillingCode><Name>ASEPT Pleural Drainage System</Name><Description>Indwelling tunnelled pleural catheter insertion kit</Description><Size>15F x 66cm silicone catheter with fenestrations and cuff</Size><SupplierCode>39931</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107992</GroupID><SubGroupID>112777</SubGroupID><ARTGs><ARTG>285155</ARTG></ARTGs><MinimumBenefit>384</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WA001</BillingCode><Name>Thal-Quick Chest Tube Set</Name><Description>The set consists of introducer needle, wire guide, dilators, coaxial chest tube inserter and clear catheter with radiopaque strip.</Description><Size>8-36 Fr, Length: 18-41cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107992</GroupID><SubGroupID>112777</SubGroupID><ARTGs><ARTG>142280</ARTG></ARTGs><MinimumBenefit>121</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WA005</BillingCode><Name>Wayne Pneumothorax Set</Name><Description>Wayne Pneumothorax Set for Seldinger Placement.  Set includes: introducer needle, wire guide, dilator, pigtail catheter, and Cook Chest Drain Valve</Description><Size>Length: 29cm, 14Fr</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107992</GroupID><SubGroupID>112777</SubGroupID><ARTGs><ARTG>142280</ARTG></ARTGs><MinimumBenefit>95</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ME207</BillingCode><Name>TRU-CLOSE THORACIC VENT</Name><Description>Device for the treatment of spontanious, traumatic or iatrogenic simple pneumothorax.Allowing for amubulation during resolution and the aspiration of small amount of fluids</Description><Size>Catheter outer diameter = 11 French, catheter length = 10cm
Catheter outer diameter = 11 French, catheter length = 13cm
Catheter outer diameter = 13 French, catheter length = 10cm
Catheter outer diameter = 13 French, catheter length = 13cm</Size><SupplierCode>40363</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107992</GroupID><SubGroupID>112777</SubGroupID><ARTGs><ARTG>181784</ARTG></ARTGs><MinimumBenefit>384</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE603</BillingCode><Name>PleuraFlow® Active Clearance Technology® (ACT)</Name><Description>Pleural drainage catheter</Description><Size>20; 24; 28;32FR</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107992</GroupID><SubGroupID>112777</SubGroupID><ARTGs><ARTG>218317</ARTG><ARTG>324895</ARTG></ARTGs><MinimumBenefit>384</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ME208</BillingCode><Name>Redax Unico Percutaneous Drainage Kit</Name><Description>Percutaneous Drainage Kit</Description><Size>9-12 CH</Size><SupplierCode>40363</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107992</GroupID><SubGroupID>112777</SubGroupID><ARTGs><ARTG>204898</ARTG></ARTGs><MinimumBenefit>121</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MS068</BillingCode><Name>ASEPT Peritoneal Drainage System</Name><Description>Indwelling tunnelled peritoneal catheter insertion kit</Description><Size>Catheter: 71 cm x 15.5F</Size><SupplierCode>39931</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107992</GroupID><SubGroupID>112778</SubGroupID><ARTGs><ARTG>285155</ARTG></ARTGs><MinimumBenefit>384</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FN001</BillingCode><Name>Pleurx</Name><Description>Pleurx Peritoneal Catheter Mini Kit</Description><Size>Catheter 71.0cm x 15.5 Fr</Size><SupplierCode>40272</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107992</GroupID><SubGroupID>112778</SubGroupID><ARTGs><ARTG>321900</ARTG></ARTGs><MinimumBenefit>384</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC315</BillingCode><Name>Multipurpose Drainage Catheter</Name><Description>Catheter used in a variety of drainage applications</Description><Size>8.5-14 Fr, Length: 15-60cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107992</GroupID><SubGroupID>112778</SubGroupID><ARTGs><ARTG>139357</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS227</BillingCode><Name>Flexima All-Purpose Drainage Catheter</Name><Description>All-purpose drainage catheters for abscesses and fluid collections.</Description><Size>Length up to 25cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107992</GroupID><SubGroupID>112778</SubGroupID><ARTGs><ARTG>132027</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Benefit</ChangeExplanation><MinimumBenefit>90</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ME223</BillingCode><PriorBillingCodes><PriorBillingCode>NG075</PriorBillingCode></PriorBillingCodes><Name>General Purpose Drainage Catheter</Name><Description>Abscess Drainage Catheters</Description><Size>6FR x 12CM through to 28FR x 50CM</Size><SupplierCode>40363</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107992</GroupID><SubGroupID>112778</SubGroupID><ARTGs><ARTG>98030</ARTG></ARTGs><MinimumBenefit>384</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS229</BillingCode><Name>Flexima vanSonnenburg Sump Catheter</Name><Description>Dual lumen catheters that drain cavity contents by application of suction</Description><Size>Length up to 35cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107992</GroupID><SubGroupID>112778</SubGroupID><ARTGs><ARTG>132027</ARTG></ARTGs><MinimumBenefit>384</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CB016</BillingCode><Name>Skater All-Purpose Drainage Catheter</Name><Description>Locking and non-locking catheter sets with removable pigtail straightener, metal stiffening cannula, flexible stiffening Cannula (not available on 6F and 7F) and locking system with snap-off tab (not available on non-locking pigtail catheters)</Description><Size>Catheter french size  6-16F by 15-60cm length</Size><SupplierCode>39993</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107992</GroupID><SubGroupID>112778</SubGroupID><ARTGs><ARTG>223261</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Description, Size</ChangeExplanation><MinimumBenefit>384</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS250</BillingCode><Name>Flexima Biliary Drainage Catheter</Name><Description>Biliary drainage catheters for drainage of the biliary tree</Description><Size>Length up to 35cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107992</GroupID><SubGroupID>112779</SubGroupID><ARTGs><ARTG>132027</ARTG></ARTGs><MinimumBenefit>97</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC317</BillingCode><Name>Ultrathane Biliary Drainage Catheter</Name><Description>Used for biliary drainage applications.</Description><Size>8.5-14 Fr, 40-60cm length</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107992</GroupID><SubGroupID>112779</SubGroupID><ARTGs><ARTG>138381</ARTG></ARTGs><MinimumBenefit>97</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CB017</BillingCode><Name>Skater Biliary Drainage Catheter</Name><Description>Used for biliary drainage applications</Description><Size>Biliary Drainage Catheter w/Locking Pigtail
8Fx40cm, 10Fx40cm, 12Fx40cm
Biliary Drainage Catheter w/Non-Locking Pigtail
8Fx40cm, 10Fx40cm, 12Fx40cm</Size><SupplierCode>39993</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107992</GroupID><SubGroupID>112779</SubGroupID><ARTGs><ARTG>223261</ARTG></ARTGs><MinimumBenefit>97</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OW008</BillingCode><Name>One-Step Centesis Catheter</Name><Description>Drainage catheter available in straight, pigtail, valved and non-valved with introducer needle</Description><Size>4 French to 8 French
7-17cm</Size><SupplierCode>40178</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107992</GroupID><SubGroupID>112780</SubGroupID><ARTGs><ARTG>108467</ARTG></ARTGs><MinimumBenefit>125</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FN006</BillingCode><Name>Paracentesis/Thoracentesis Catheter Drainage</Name><Description>Thora/Paracentesis kit</Description><Size>8FR, 12cm polyurethane catheter</Size><SupplierCode>40272</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107992</GroupID><SubGroupID>112780</SubGroupID><ARTGs><ARTG>120894</ARTG></ARTGs><MinimumBenefit>57</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FN005</BillingCode><PriorBillingCodes><PriorBillingCode>ZQ010</PriorBillingCode></PriorBillingCodes><Name>Safe-T-Centesis Drainage system</Name><Description>Safe-T-Centesis drainage for para/thoracentesis</Description><Size>6FR and 8FR pigtail catheter with Veress technology</Size><SupplierCode>40272</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107992</GroupID><SubGroupID>112780</SubGroupID><ARTGs><ARTG>120894</ARTG></ARTGs><MinimumBenefit>125</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OW010</BillingCode><Name>ReSolve Locking and Non-Locking Drainage Catheters</Name><Description>Hydrophilic locking and non-locking drainage catheters</Description><Size>6.5 - 14 French</Size><SupplierCode>40178</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107594</SubCategoryID><GroupID>107992</GroupID><SubGroupID>112781</SubGroupID><ARTGs><ARTG>108467</ARTG><ARTG>328288</ARTG></ARTGs><MinimumBenefit>108</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT257</BillingCode><Name>BIO-A Tissue Reinforcement</Name><Description>BIO-A Tissue Reinforcement</Description><Size>9cm x 15cm</Size><SupplierCode>40435</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112782</SubGroupID><Suffix>Contoured</Suffix><ARTGs><ARTG>175834</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT256</BillingCode><Name>BIO-A Tissue Reinforcement</Name><Description>BIO-A Tissue Reinforcement</Description><Size>8cm x 8cm</Size><SupplierCode>40435</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112782</SubGroupID><Suffix>Contoured</Suffix><ARTGs><ARTG>175834</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ050</BillingCode><PriorBillingCodes><PriorBillingCode>ER410</PriorBillingCode><PriorBillingCode>ER410</PriorBillingCode></PriorBillingCodes><Name>TIGR Matrix Surgical Mesh-Small</Name><Description>TIGR Matrix Surgical Mesh-Small, biosynthetic</Description><Size>10x15 cm</Size><SupplierCode>40061</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112782</SubGroupID><Suffix>Contoured</Suffix><ARTGs><ARTG>202446</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT258</BillingCode><Name>BIO-A Tissue Reinforcement</Name><Description>BIO-A Tissue Reinforcement - Configured for Hiatal Hernia</Description><Size>7cm x 10cm</Size><SupplierCode>40435</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112782</SubGroupID><Suffix>Contoured</Suffix><ARTGs><ARTG>175834</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA275</BillingCode><Name>Phasix</Name><Description>Fully resorbable synthetic mesh</Description><Size>Phasix™ Mesh – 3 in. Diameter Circle (7.6 cm.)  Phasix™ Mesh – 4.5 in. Diameter Circle (11 cm.)  Phasix™ Mesh – 2.4 x 6.3 in. Rectangle (6 x 16 cm)  Phasix™ Mesh – 3 x 3 in. Square (8 x 8 cm.)  Phasix™ Mesh – 3 x 6.3 in. Rectangle (8 x 16 cm.)  Phasix™ Mesh – 4 x 4 in. Square (10 x 10 cm.)  Phasix™ Mesh – 4 x 6 in. Rectangle (10.2 x 15.2 cm.)  Phasix™ Mesh – 3 x 8 in. Rectangle (8 x 20 cm.)  Phasix™ Mesh – 4 x 8 in. Rectangle (10 x 20 cm.)</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112782</SubGroupID><Suffix>Contoured</Suffix><ARTGs><ARTG>318473</ARTG></ARTGs><MinimumBenefit>722</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA281</BillingCode><Name>Phasix ST</Name><Description>Fully resorbable mesh with a resorbable hydrogel coating (adhesion barrier)</Description><Size>PHASIX ST 7.6CM ROUND   PHASIX ST 7CMX10CM   PHASIX ST 11CM ROUND   PHASIX ST 10CMX10CM   PHASIX ST 10X15CM   PHASIX ST 15CM ROUND   PHASIX ST 10CMX20CM</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112782</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>318512</ARTG></ARTGs><MinimumBenefit>710</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET091</BillingCode><PriorBillingCodes><PriorBillingCode>WC242</PriorBillingCode></PriorBillingCodes><Name>Biodesign Surgisis Hernia Graft</Name><Description>Biodesign Hernia Graft is 8-layer perforated and quilted porcine sis collagen matrix, non cross-linked, remodelable and resorbable tissue graft</Description><Size>13cm x 15cm, 10cm x 10cm</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112782</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>153052</ARTG></ARTGs><MinimumBenefit>710</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET098</BillingCode><PriorBillingCodes><PriorBillingCode>WC255</PriorBillingCode></PriorBillingCodes><Name>Surgisis Biodesign 4-layer Tissue Graft</Name><Description>Surgisis Soft Tissue Graft</Description><Size>Length 20cm, Width 7cm</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112782</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>153047</ARTG></ARTGs><MinimumBenefit>710</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET100</BillingCode><PriorBillingCodes><PriorBillingCode>WA010</PriorBillingCode></PriorBillingCodes><Name>Biodesign Rectopexy Graft</Name><Description>The Biodesign Rectopexy Graft is a dried multi-layered small intestinal submucosa (SIS) sheet. The graft is used to reinforce soft tissue for the repair of rectal prolapse and rectal intussusception.</Description><Size>7cm x 20cm</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112782</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>317940</ARTG></ARTGs><MinimumBenefit>710</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS182</BillingCode><Name>Permacol  Biological Implant</Name><Description>Flat sheet of acellular porcine three-dimensional, crosslinked, dermal collagen.</Description><Size>3 x 3cm, 5 x 5cm, 2 x 20cm, 5 x 10cm, 4 x 18cm, 10 x 10cm, 10 x 15cm, 6 x 3cm, 10 x 15cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112782</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>269662</ARTG></ARTGs><MinimumBenefit>710</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET090</BillingCode><PriorBillingCodes><PriorBillingCode>WC177</PriorBillingCode></PriorBillingCodes><Name>Biodesign Tissue Graft</Name><Description>Surgical Mesh composed of Sub-Intestinal Submucosa (SIS)</Description><Size>Length - 10cm, Width - 7cm; Length - 7cm, Width - 4cm; Length - 3cm, Width - 2cm.</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112782</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>153047</ARTG></ARTGs><MinimumBenefit>710</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET099</BillingCode><PriorBillingCodes><PriorBillingCode>WC284</PriorBillingCode></PriorBillingCodes><Name>Surgisis Biodesign Hiatal Hernia Graft</Name><Description>Surgisis Biodesign Hiatal Hernia Graft is an extracellular collagen matrix, non cross-linked sterile graft material, that provides support for damaged tissues and assists in host tissue regeneration and remodelling of the diaphragmatic wall following surgical repair for paraoesophageal and hiatal hernia.</Description><Size>7 x 10cm rectangular and U-shaped</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112782</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>153051</ARTG></ARTGs><MinimumBenefit>710</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET094</BillingCode><PriorBillingCodes><PriorBillingCode>WC247</PriorBillingCode></PriorBillingCodes><Name>Biodesign Surgisis 8-Layer Tissue Graft</Name><Description>Biodesign Surgisis 8-layer Tissue Graft is 8 layers of compressed and perforated porcine sis collagen matrix, non cross-linked, remodelable and resorbable tissue graft</Description><Size>13cm x 22cm</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112783</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>153048</ARTG></ARTGs><MinimumBenefit>1341</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET095</BillingCode><PriorBillingCodes><PriorBillingCode>WC249</PriorBillingCode></PriorBillingCodes><Name>Biodesign Surgisis Hernia Graft</Name><Description>Biodesign Hernia Graft is 8-layer perforated and quilted porcine sis collagen matrix, non cross-linked, remodelable and resorbable tissue graft</Description><Size>13cm x 22cm</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112783</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>153052</ARTG></ARTGs><MinimumBenefit>1341</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET096</BillingCode><PriorBillingCodes><PriorBillingCode>WC250</PriorBillingCode></PriorBillingCodes><Name>Biodesign Surgisis Hernia Graft</Name><Description>Biodesign Hernia Graft is 8-layer perforated and quilted porcine sis collagen matrix, non cross-linked, remodelable and resorbable tissue graft</Description><Size>20cm x 20cm</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112783</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>153052</ARTG></ARTGs><MinimumBenefit>1341</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS183</BillingCode><Name>Permacol  Biological Implant</Name><Description>Flat sheet of acellular porcine three-dimensional, crosslinked, dermal collagen.</Description><Size>15 x 20cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112783</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>269662</ARTG></ARTGs><MinimumBenefit>1341</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA286</BillingCode><Name>Phasix ST</Name><Description>Fully resorbable, synthetically derived biologic hernia mesh with added barrier to assist adhesion prevention</Description><Size>13 cm x 25 cm  15 cm x 20 cm</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112783</SubGroupID><Suffix>Contoured</Suffix><ARTGs><ARTG>318512</ARTG></ARTGs><MinimumBenefit>1399</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA288</BillingCode><Name>Phasix Mesh</Name><Description>Synthetic Bioresorbable Mesh</Description><Size>15.2 cm x 20.3 cm rectangle  10 cm x 25 cm rectangle  15 cm x 25 cm rectangle</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112783</SubGroupID><Suffix>Contoured</Suffix><ARTGs><ARTG>318473</ARTG></ARTGs><MinimumBenefit>1399</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT267</BillingCode><Name>Bio A Tissue Reinforcement</Name><Description>Bio A Tissue Reinforcement</Description><Size>10cm x 30cm</Size><SupplierCode>40435</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112783</SubGroupID><Suffix>Contoured</Suffix><ARTGs><ARTG>175834</ARTG></ARTGs><MinimumBenefit>1399</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ049</BillingCode><PriorBillingCodes><PriorBillingCode>ER411</PriorBillingCode><PriorBillingCode>ER411</PriorBillingCode></PriorBillingCodes><Name>TIGR Matrix Surgical Mesh-Medium</Name><Description>TIGR Matrix Surgical Mesh-Medium, biosynthetic</Description><Size>15x20 cm</Size><SupplierCode>40061</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112783</SubGroupID><Suffix>Contoured</Suffix><ARTGs><ARTG>202446</ARTG></ARTGs><MinimumBenefit>1399</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS184</BillingCode><Name>Permacol  Biological Implant</Name><Description>Flat sheet of acellular porcine three-dimensional, crosslinked, dermal collagen.</Description><Size>18 x 28cm and 20 x 30cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112784</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>269662</ARTG></ARTGs><MinimumBenefit>3114</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ048</BillingCode><PriorBillingCodes><PriorBillingCode>ER412</PriorBillingCode><PriorBillingCode>ER412</PriorBillingCode></PriorBillingCodes><Name>TIGR Matrix Surgical Mesh-Large</Name><Description>TIGR Matrix Surgical Mesh-Large, biosynthetic</Description><Size>20x30 cm</Size><SupplierCode>40061</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112784</SubGroupID><Suffix>Contoured</Suffix><ARTGs><ARTG>202446</ARTG></ARTGs><MinimumBenefit>3204</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT268</BillingCode><Name>Bio A Tissue Reinforcement</Name><Description>Bio A Tissue Reinforcement</Description><Size>20cm x 30cm</Size><SupplierCode>40435</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112784</SubGroupID><Suffix>Contoured</Suffix><ARTGs><ARTG>175834</ARTG></ARTGs><MinimumBenefit>3204</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA276</BillingCode><Name>Phasix</Name><Description>Fully resorbable synthetic mesh</Description><Size>Phasix™ Mesh – 6 x 12 in. Rectangle (15 x 30 cm.)  Phasix™ Mesh – 8 x 10 in. Rectangle (20.3 x 25.4 cm.)  Phasix™ Mesh – 8 x 12 in. Rectangle (20 x 30 cm.)</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112784</SubGroupID><Suffix>Contoured</Suffix><ARTGs><ARTG>318473</ARTG></ARTGs><MinimumBenefit>3204</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA278</BillingCode><Name>Phasix ST</Name><Description>Fully resorbable mesh with a resorbable hydrogel coating (adhesion barrier)</Description><Size>PHASIX ST 20X25CM</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112784</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>318512</ARTG></ARTGs><MinimumBenefit>3114</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET097</BillingCode><PriorBillingCodes><PriorBillingCode>WC251</PriorBillingCode></PriorBillingCodes><Name>Biodesign Surgisis  Hernia Graft</Name><Description>Biodesign Hernia Graft is 8-layer perforated and quilted porcine sis collagen matrix, non cross-linked, remodelable and resorbable tissue graft</Description><Size>20cm x 30cm</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112784</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>153052</ARTG></ARTGs><MinimumBenefit>3114</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS187</BillingCode><Name>Permacol  Biological Implant</Name><Description>Flat sheet of acellular porcine three-dimensional, crosslinked, dermal collagen.</Description><Size>20 x 40cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112785</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>269662</ARTG></ARTGs><MinimumBenefit>4061</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA287</BillingCode><Name>Phasix Mesh</Name><Description>Synthesised biologic, resorbable Hernia mesh</Description><Size>25.4 cm x 30.5 cm rectangle</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112785</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>318473</ARTG></ARTGs><MinimumBenefit>4061</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA279</BillingCode><Name>Phasix ST</Name><Description>Fully resorbable mesh with a resorbable hydrogel coating (adhesion barrier)</Description><Size>PHASIX ST 25X30CM</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112785</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>318512</ARTG></ARTGs><MinimumBenefit>4061</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA280</BillingCode><Name>Phasix ST</Name><Description>Fully resorbable mesh with a resorbable hydrogel coating (adhesion barrier)</Description><Size>PHASIX ST 30X35CM</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112786</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>318512</ARTG></ARTGs><MinimumBenefit>4964</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS188</BillingCode><Name>Permacol  Biological Implant</Name><Description>Flat sheet of acellular porcine three-dimensional, crosslinked, dermal collagen.</Description><Size>20 x 50cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112786</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>269662</ARTG></ARTGs><MinimumBenefit>4964</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA277</BillingCode><Name>Phasix</Name><Description>Fully resorbable synthetic mesh</Description><Size>Phasix™ Mesh – 12 x 12 in. Square (30 x 30 cm.)  Phasix™ Mesh – 10 x 16 in. Rectangle (10 x 16 cm.)  Phasix™ Mesh – 14 x 14 in. Square (35 x 35 cm.)  Phasix™ Mesh – 12 x 18 in. Rectangle (30 x 45 cm.)  Phasix™ Mesh – 16 x 16 in. Square (40 x 40 cm.)  Phasix™ Mesh – 18 x 18 in. Square (45 x 45 cm.)  Phasix™ Mesh – 19.5 x 19.5 in. Square (50 x 50 cm.)</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107995</GroupID><SubGroupID>112786</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>318473</ARTG></ARTGs><MinimumBenefit>4964</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MZ010</BillingCode><Name>ABRA Abdominal Wall Closure Set</Name><Description>Abdominal Wall Closure System, for primary closure of large full thickness retrated adbominal wounds.</Description><Size>For wounds up to 30cm long up 30cm across.</Size><SupplierCode>40155</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107996</GroupID><SubGroupID>112787</SubGroupID><ARTGs><ARTG>181416</ARTG></ARTGs><MinimumBenefit>6253</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM492</BillingCode><Name>DermaClose</Name><Description>DERMACLOSE continuous external tissue expander</Description><Size>Multiple lengths to suit size of wound</Size><SupplierCode>40194</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107996</GroupID><SubGroupID>112787</SubGroupID><ARTGs><ARTG>341527</ARTG></ARTGs><MinimumBenefit>6253</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MZ011</BillingCode><Name>ABRA Abdominal Wall Closure Set (Extension Kit Only)</Name><Description>Extention Kit for use with ABRA Abdominal Wall Closure Set CWK08. Used when width or length of open abdomen exceeds 30cm. ABRA is for the primary closure of large full thickness retracted abdominal wounds</Description><Size>Extention Kit, used when wounds to be closed are larger than 30cm long and/or 30cm across.</Size><SupplierCode>40155</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107996</GroupID><SubGroupID>112788</SubGroupID><ARTGs><ARTG>181416</ARTG></ARTGs><MinimumBenefit>1787</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN186</BillingCode><Name>PROLENE Soft Polypropylene Mesh</Name><Description>Nonabsorbable Synthetic Surgical Mesh</Description><Size>≥2500cm²</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112789</SubGroupID><ARTGs><ARTG>389989</ARTG></ARTGs><MinimumBenefit>582</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS174</BillingCode><Name>Parietene™ Flat Sheet Mesh; Parietene™ Lightweight Mesh  </Name><Description>Parietene™ flat sheet mesh is made of non-absorbable monofilament polypropylene 2-dimensional textile. Parietene™ lightweight mesh is made of non-absorbable monofilament polypropylene 2-dimensional textile.</Description><Size>6 cm x 11 cm, 15 cm x 10 cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112790</SubGroupID><ARTGs><ARTG>421377</ARTG><ARTG>421381</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>72</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA070</BillingCode><Name>Bard Mesh and Bard Soft Mesh</Name><Description>Bard Mesh - monofilament polypropylene for the reconstruction of tissue defects 
Bard Soft Mesh - large pore monofilament polypropylene for the reconstruction of tissue defects</Description><Size>2.5x10cm, 4.5x10cm, 5x10cm, 6x13.7cm, 7.5x15cm, 10x15cm, 5x30.5cm</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112790</SubGroupID><ARTGs><ARTG>404318</ARTG><ARTG>410979</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Description</ChangeExplanation><MinimumBenefit>72</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AA016</BillingCode><Name>4D - DOME SEMI ABSORBABLE HERNIA MESH</Name><Description>4D DOME semi absorbable bio mesh for abdominal reinforcement inguinal, femoral and incisional hernias</Description><Size>2.4, 9 x 5 cm 
3.0, 9 x 5 cm 
3.8, 9 x 5 cm</Size><SupplierCode>40043</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112790</SubGroupID><Suffix>Coated, Contoured</Suffix><ARTGs><ARTG>222740</ARTG></ARTGs><MinimumBenefit>316</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ177</BillingCode><Name>Prolene Mesh</Name><Description>Small keyhole polypropylene monofilament non absorbable mesh</Description><Size>Size (cm) 4.6x10; quantity/pack 1 or 3</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112790</SubGroupID><ARTGs><ARTG>389990</ARTG></ARTGs><MinimumBenefit>72</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS164</BillingCode><Name>Parietex™ Hydrophilic 2D Mesh; Parietex™ Hydrophilic 3D Mesh</Name><Description>Parietex™ hydrophilic 2-dimensional mesh is made of non-absorbable multifilament polyester (polyethylene terephthalate) 2-dimensional textile. The mesh is available in two versions: a standard version and a rigid version. Parietex™ hydrophilic 3-dimensional mesh is made of non-absorbable multifilament polyester (polyethylene terephthalate) 3-dimensional textile.</Description><Size>13 cm x 9 cm, 15 cm x 10 cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112790</SubGroupID><ARTGs><ARTG>399214</ARTG><ARTG>399630</ARTG></ARTGs><MinimumBenefit>72</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ175</BillingCode><Name>Prolene Mesh</Name><Description>Medium polypropylene monofilament non absorbable mesh</Description><Size>Size (cm) 6x11, 7.5x15, quantity/pack 1 or 3</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112790</SubGroupID><ARTGs><ARTG>389990</ARTG></ARTGs><MinimumBenefit>72</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ566</BillingCode><Name>PROLENE Mesh</Name><Description>Polypropylene Mesh</Description><Size>10 x 15cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112790</SubGroupID><ARTGs><ARTG>389990</ARTG></ARTGs><MinimumBenefit>72</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ178</BillingCode><Name>Prolene Mesh</Name><Description>Large keyhole polypropylene monofilament non absorbable mesh</Description><Size>Size (cm) 6x13.7; quantity/pack 1 or 3</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112790</SubGroupID><ARTGs><ARTG>389990</ARTG></ARTGs><MinimumBenefit>72</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN181</BillingCode><Name>PROLENE™ Soft Polypropylene Mesh</Name><Description>Nonabsorbable Synthetic Surigcal Mesh</Description><Size>Size (cm) 2.5x10, 7.6x15, 6.4x11.4; quantity/pack 6  </Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112790</SubGroupID><ARTGs><ARTG>389989</ARTG></ARTGs><MinimumBenefit>72</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA222</BillingCode><Name>Bard 3D Max Mesh</Name><Description>3D Mesh</Description><Size>Medium left, Medium Right, large Left, Large Right</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112790</SubGroupID><Suffix>Contoured, Without Fixation</Suffix><ARTGs><ARTG>376471</ARTG></ARTGs><MinimumBenefit>238</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AA017</BillingCode><Name>4D - SEMI ABSORBABLE HERNIA MESH</Name><Description>4DMESH semi absorbable bio mesh for abdominal reinforcement inguinal, femoral and incisional hernias</Description><Size>6 x 13.5 cm 
10.5 x 14 cm 
12 x 15 cm</Size><SupplierCode>40043</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112790</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>283655</ARTG></ARTGs><MinimumBenefit>316</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS243</BillingCode><Name>Parietex™ Hydrophilic Anatomical Mesh; Parietex™ Hydrophilic 2D Mesh; Parietex™ Hydrophilic 3D Mesh</Name><Description>Parietex™ hydrophilic anatomical mesh is made of non-absorbable multifilament polyester (polyethylene terephthalate) an assembly of a 2-dimensional textile and a 3-dimensional textile. Parietex™ hydrophilic anatomical mesh is available in right or left configurations and in different shapes and sizes. Parietex™ hydrophilic 2-dimensional mesh is made of non-absorbable multifilament polyester (polyethylene terephthalate) 2-dimensional textile. This folding mesh is provided with a non-absorbable pre-placed yarn tied to the mesh. Parietex™ hydrophilic 3-dimensional mesh is made of non-absorbable multifilament polyester (polyethylene terephthalate) 3-dimensional textile. This is a pre-cut and slit mesh - the mesh presents a slit for the passage of the cord.</Description><Size>13 cm x 9 cm, 14 cm x 10 cm,  15 cm x 10 cm, 16 cm x 12 cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112790</SubGroupID><Suffix>Contoured</Suffix><ARTGs><ARTG>399214</ARTG><ARTG>399630</ARTG><ARTG>399213</ARTG></ARTGs><MinimumBenefit>185</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN162</BillingCode><Name>PROLENE Soft Polypropylene Mesh</Name><Description>Nonabsorbable Synthetic Surgical Mesh</Description><Size>Size (cm) 15x15; quantity/pack 6</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112791</SubGroupID><ARTGs><ARTG>389989</ARTG></ARTGs><MinimumBenefit>77</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS170</BillingCode><Name>Parietex™ Hydrophilic 2D Mesh; Parietex™ Hydrophilic 3D Mesh</Name><Description>Parietex™ hydrophilic 2-dimensional mesh is made of non-absorbable multifilament polyester (polyethylene terephthalate) 2-dimensional textile. Parietex™ hydrophilic 3-dimensional mesh is made of non-absorbable multifilament polyester (polyethylene terephthalate) 3-dimensional textile.</Description><Size>20 cm x 20 cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112791</SubGroupID><ARTGs><ARTG>399214</ARTG><ARTG>399630</ARTG></ARTGs><MinimumBenefit>77</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA157</BillingCode><Name>Bard Mesh</Name><Description>Flat Mesh</Description><Size>15X15cm</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112791</SubGroupID><ARTGs><ARTG>122873</ARTG></ARTGs><MinimumBenefit>77</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AA018</BillingCode><Name>4D - Semi Absorbable Hernia Mesh</Name><Description>4DMESH semi absorbable bio mesh for abdominal reinforcement inguinal, femoral and incisional hernias.</Description><Size>12 x 17 cm
17 x 17 cm</Size><SupplierCode>40043</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112791</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>283655</ARTG></ARTGs><MinimumBenefit>501</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA223</BillingCode><Name>Bard 3DMAX Mesh and Bard 3DMAX Light Mesh</Name><Description>3DMAX Mesh and 3DMAX Light Mesh for XL size for both right and left side options. 
0115312 - 3DMAX 12.4cm x 17.3cm XLG Left 
0115322 - 3DMAX 12.4cm x 17.3cm XLG Right 
0117312 - 3DMAX Light 12.2cm x 17.0cm XLG Left 
0117322 - 3DMAX Light 12.2cm x 17.0cm XLG Right</Description><Size>Extra Large Left, Extra Large Right</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112791</SubGroupID><Suffix>Contoured, Without Fixation</Suffix><ARTGs><ARTG>398770</ARTG><ARTG>376471</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Description</ChangeExplanation><MinimumBenefit>261</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS165</BillingCode><Name>Parietex™ Hydrophilic 2D Mesh; Parietex™ Hydrophilic 3D Mesh</Name><Description>Parietex™ hydrophilic 2-dimensional mesh is made of non-absorbable multifilament polyester (polyethylene terephthalate) 2-dimensional textile. The mesh is available in two versions: a standard version and a rigid version. Parietex™ hydrophilic 3-dimensional mesh is made of non-absorbable multifilament polyester (polyethylene terephthalate) 3-dimensional textile.</Description><Size>15 cm x 15 cm,</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112791</SubGroupID><ARTGs><ARTG>399214</ARTG><ARTG>399630</ARTG></ARTGs><MinimumBenefit>77</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ222</BillingCode><Name>Prolene Mesh - medium</Name><Description>Abdominal hernia surgical mesh, sterile device composed of non-absorbable undyed polypropylene fiber.</Description><Size>Size (cm) 15x15; quantity/pack 1 or 3</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112791</SubGroupID><ARTGs><ARTG>389990</ARTG></ARTGs><MinimumBenefit>77</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS122</BillingCode><Name>Parietene™ Flat Sheet Mesh; Parietene™ Lightweight Mesh</Name><Description>Parietene™ flat sheet mesh is made of non-absorbable monofilament polypropylene 2-dimensional textile. Parietene™ lightweight mesh is made of non-absorbable monofilament polypropylene 2-dimensional textile.</Description><Size>20 cm x 20 cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112791</SubGroupID><ARTGs><ARTG>421381</ARTG><ARTG>421377</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>77</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS176</BillingCode><Name>Parietene™ Flat Sheet Mesh; Parietene™ Lightweight Mesh</Name><Description>Parietene™ flat sheet mesh is made of non-absorbable monofilament polypropylene 2-dimensional textile. Parietene™ lightweight mesh is made of non-absorbable monofilament polypropylene 2-dimensional textile.</Description><Size>15 cm x 15 cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112791</SubGroupID><ARTGs><ARTG>421377</ARTG><ARTG>421381</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>77</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS171</BillingCode><Name>Parietex™ Hydrophilic 2D Mesh; Parietex™ Hydrophilic 3D Mesh</Name><Description>Parietex™ hydrophilic 2-dimensional mesh is made of non-absorbable multifilament polyester (polyethylene terephthalate) 2-dimensional textile. The mesh is available in two versions: a standard version and a rigid version. Parietex™ hydrophilic 3-dimensional mesh is made of non-absorbable multifilament polyester (polyethylene terephthalate) 3-dimensional textile.</Description><Size>30 cm x 30 cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112793</SubGroupID><ARTGs><ARTG>399214</ARTG><ARTG>399630</ARTG></ARTGs><MinimumBenefit>247</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS123</BillingCode><Name>Parietene™ Flat Sheet Mesh; Parietene™ Lightweight Mesh</Name><Description>Parietene™ flat sheet mesh is made of non-absorbable monofilament polypropylene 2-dimensional textile. Parietene™ lightweight mesh is made of non-absorbable monofilament polypropylene 2-dimensional textile.</Description><Size>30 cm x 30 cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112793</SubGroupID><ARTGs><ARTG>421377</ARTG><ARTG>421381</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>247</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ176</BillingCode><Name>Prolene Mesh</Name><Description>Large polypropylene monofilament non absorbable mesh</Description><Size>30cm x 30cm, quantity/box 3</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112793</SubGroupID><ARTGs><ARTG>389990</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>247</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN180</BillingCode><Name>PROLENE™ Soft Polypropylene Mesh</Name><Description>Non-absorbable Synthetic Surgical Mesh</Description><Size>Size (cm) 30.5x35.6, 25x25; quantity/pack 3  </Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112793</SubGroupID><ARTGs><ARTG>389989</ARTG></ARTGs><MinimumBenefit>247</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA158</BillingCode><Name>Bard Mesh</Name><Description>Flat Mesh</Description><Size>25x35.5cm</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107997</GroupID><SubGroupID>112793</SubGroupID><ARTGs><ARTG>122873</ARTG></ARTGs><MinimumBenefit>247</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ565</BillingCode><Name>ULTRAPRO Mesh</Name><Description>Composite Mesh</Description><Size>7.6cm x 15cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><ARTGs><ARTG>390525</ARTG></ARTGs><MinimumBenefit>86</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ465</BillingCode><Name>ULTRAPRO Mesh</Name><Description>ULTRAPRO Mesh S3</Description><Size>6 x 11cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><ARTGs><ARTG>390525</ARTG></ARTGs><MinimumBenefit>86</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ240</BillingCode><Name>VYPRO II Mesh</Name><Description>Composition - equal part Vicryl polyglactin yarn - non-absorbable Prolene polypropylene yarn.  Partly absorbable lightweight mesh for tension free-inguinal hernia techniques</Description><Size>Small 6 x 11cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><ARTGs><ARTG>128896</ARTG></ARTGs><MinimumBenefit>86</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS214</BillingCode><Name>PROGRIP™ Laparoscopic Self-Fixating Composite Mesh</Name><Description>Laparoscopic self-fixating composite mesh (knitted monofilament polyester with monofilament polylactic acid resorbable grips on one side and a resorbable film made of collagen from porcine origin and glycerol, on the other side)</Description><Size>10 cm x 15 cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>252653</ARTG></ARTGs><MinimumBenefit>352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MS030</BillingCode><Name>Titanized Mesh Implants [TiMESH, TiLENE, TiLENE Blue]</Name><Description>Prosthetic warp-knitted fabric made of monofil polypropylene threads with an encapsulating titanic coating</Description><Size>Weight: 16 g/m² - 65 g/m²; Surface Area: ≤ 200cm²</Size><SupplierCode>39931</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>97288</ARTG></ARTGs><MinimumBenefit>352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ466</BillingCode><Name>ULTRAPRO Mesh</Name><Description>ULTRAPRO Mesh P3</Description><Size>10 x 12cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><ARTGs><ARTG>390525</ARTG></ARTGs><MinimumBenefit>86</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ242</BillingCode><Name>VYPRO II Mesh</Name><Description>Composition - equal part Vicryl polyglactin yarn - non-absorbable Prolene polypropylene yarn.  Partly absorbable lightweight mesh for tension free-inguinal hernia techniques</Description><Size>Large 15 x 10cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><ARTGs><ARTG>128896</ARTG></ARTGs><MinimumBenefit>86</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS224</BillingCode><Name>PROGRIP™ Laparoscopic Self-Fixating Composite Mesh</Name><Description>Laparoscopic self-fixating composite right or left anatomical mesh (knitted monofilament polyester with monofilament polylactic acid resorbable grips on one side and a resorbable film made of collagen from porcine origin and glycerol, on the other side)</Description><Size>16 x 12 cm right anatomical, 
16 x 12 cm left anatomical</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><Suffix>Coated, Contoured</Suffix><ARTGs><ARTG>252653</ARTG></ARTGs><MinimumBenefit>407</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS235</BillingCode><Name>Symbotex Composite Mesh</Name><Description>Non-absorbable three-dimensional polyester composite mesh. On the opposite side, the absorbable hydrophilic film minimizes tissue attachment to the mesh in case of direct contact with the viscera.</Description><Size>Round 15 cm, 12 cm, 9 cm
Elliptical 17x10 cm
Rectangular 15x10 cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><Suffix>Coated, Contoured</Suffix><ARTGs><ARTG>270735</ARTG></ARTGs><MinimumBenefit>407</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS217</BillingCode><Name>Symbotex Composite Mesh with pre placed suture</Name><Description>Non-absorbable three-dimensional polyester composite mesh with pre placed sutures. (Non absorbable pre-placed sutures are tied to the mesh. A died marking is positioned on the center of the textile and helps center and orient the mesh.)</Description><Size>Rectangular 15x10 cm
Round 15 cm, 12 cm
Elliptical 17x10
Round 9cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><Suffix>Coated, Contoured</Suffix><ARTGs><ARTG>270737</ARTG></ARTGs><MinimumBenefit>407</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA237</BillingCode><Name>Ventralight ST</Name><Description>Bioresorbable Barrier/Permanent Mesh</Description><Size>11.4cm circle, 10.2 x 15.2cm oval</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>219332</ARTG></ARTGs><MinimumBenefit>352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ585</BillingCode><Name>Ultrapro Hernia System</Name><Description>Ultrapro Hernia System. Mesh Made From Composite of Monocryl &amp; Prolene</Description><Size>Small to Large Oval</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><Suffix>Contoured</Suffix><ARTGs><ARTG>132509</ARTG></ARTGs><MinimumBenefit>271</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA272</BillingCode><Name>Bard Onflex Mesh</Name><Description>Multi-layer, contoured polypropylene hernia repair system incorporating positioning pockets and an absorbable ring.</Description><Size>≤200cm²</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><Suffix>Contoured</Suffix><ARTGs><ARTG>398775</ARTG></ARTGs><MinimumBenefit>271</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA246</BillingCode><Name>Ventrio ST</Name><Description>Bioresorbable Barrier/Permanent Mesh</Description><Size>7.6cm circle, 11.4cm circle, 8 x 12cm oval, 11 x 14cm oval</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>219324</ARTG></ARTGs><MinimumBenefit>352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS211</BillingCode><Name>Parietex Composite Ventral Patch</Name><Description>Parietex Composite ventral patch is used for the reinforcement of soft tissues during surgical repair. It is indicated for the treatment of ventral defects (primary and incisional hernias).</Description><Size>4.6cm, 6.6cm, 8.6cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><Suffix>Coated, Contoured</Suffix><ARTGs><ARTG>258212</ARTG></ARTGs><MinimumBenefit>407</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS241</BillingCode><Name>Symbotex Skirted Composite Mesh</Name><Description>Non-absorbable three-dimensional polyester skirted composite mesh. On the opposite side, the absorbable hydrophilic film minimizes tissue attachment to the mesh in case of direct contact with the viscera. A flap attached to the reinforcement helps place and fix the mesh.</Description><Size>8 cm Round, 15x10 cm Rectangle</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><Suffix>Coated, Contoured</Suffix><ARTGs><ARTG>270736</ARTG></ARTGs><MinimumBenefit>407</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ817</BillingCode><Name>Proceed™ Ventral Patch</Name><Description>3D, sterile, self expanding, partially absorbable, flexible laminate mesh for hernia or other abdominal, fascial defect repair that require addition of a reinforcing or bridging material to obtain the desired surgical result.</Description><Size>small (4.3cm x 4.3cm)</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>161186</ARTG></ARTGs><MinimumBenefit>352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ816</BillingCode><Name>Proceed™ Ventral Patch</Name><Description>3D, sterile, self expanding, partially absorbable, flexible laminate mesh for hernia or other abdominal, fascial defect repair that require addition of a reinforcing or bridging material to obtain the desired surgical result.</Description><Size>medium (6.4cm x 6.4cm)</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>161186</ARTG></ARTGs><MinimumBenefit>352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ447</BillingCode><Name>PROCEED Surgical Mesh</Name><Description>PROCEED Surgical Mesh R1</Description><Size>3x6 inches</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>357230</ARTG></ARTGs><MinimumBenefit>352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS236</BillingCode><Name>Parietex Progrip Composite Mesh</Name><Description>Monofilament polyester with polylactic acid monofilament resorbable pins on one of the sides</Description><Size>15x9 rectangular</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>157201</ARTG></ARTGs><MinimumBenefit>352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN192</BillingCode><Name>PHYSIOMESH Open</Name><Description>Flexible Composite Mesh</Description><Size>≤200cm²</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>274361</ARTG></ARTGs><MinimumBenefit>352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ449</BillingCode><Name>PROCEED Surgical Mesh</Name><Description>PROCEED Surgical Mesh D1</Description><Size>4x8 inches</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>357230</ARTG></ARTGs><MinimumBenefit>352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ446</BillingCode><Name>PROCEED Surgical Mesh</Name><Description>PROCEED Surgical Mesh B1</Description><Size>2x4 (inches)</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>357230</ARTG></ARTGs><MinimumBenefit>352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS162</BillingCode><Name>Parietene ProGrip Mesh (FLAT)</Name><Description>Mesh with self gripping FLAT</Description><Size>15 x 9cm RECTANGLE</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>149430</ARTG></ARTGs><MinimumBenefit>352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ448</BillingCode><Name>PROCEED Surgical Mesh</Name><Description>PROCEED Surgical Mesh N1</Description><Size>4x6 inches oval</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>357230</ARTG></ARTGs><MinimumBenefit>352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN182</BillingCode><Name>Ultrapro Advanced</Name><Description>Macroporous, Partially Absorbable Mesh</Description><Size>Size (cm) 6x12, 7.6x15, 10x15;,quantity/pack 1 or 3</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><ARTGs><ARTG>390526</ARTG></ARTGs><MinimumBenefit>86</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ241</BillingCode><Name>VYPRO II Mesh</Name><Description>Composition - equal part Vicryl polyglactin yarn - non-absorbable Prolene polypropylene yarn.  Partly absorbable lightweight mesh for tension free-inguinal hernia techniques</Description><Size>Medium 12 x 10cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><ARTGs><ARTG>128896</ARTG></ARTGs><MinimumBenefit>86</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA236</BillingCode><Name>Ventralex ST</Name><Description>Bioresorbable Barrier/Permanent Mesh</Description><Size>4.3cm circle, 6.4cm circle, 8.0cm circle</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>219323</ARTG></ARTGs><MinimumBenefit>352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA226</BillingCode><Name>Bard Mesh</Name><Description>Ventralex Patch</Description><Size>4.3cm circle, 6.4cm circle, 8cm circle</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>400716</ARTG></ARTGs><MinimumBenefit>352</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ467</BillingCode><Name>ULTRAPRO Mesh</Name><Description>ULTRAPRO Mesh N3</Description><Size>10 x 15cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><ARTGs><ARTG>390525</ARTG></ARTGs><MinimumBenefit>86</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS220</BillingCode><Name>Parietex Progrip Composite Mesh</Name><Description>Pre-Cut, slit mesh with self gripping overlapping flap - right or left knitted (monofilament polyester with polylactic acid monofilament resorbable pins on one of the sides)</Description><Size>Elliptic slit 12x8cm left side, elliptic slit 12x8cm right side, elliptic slit 14x9 left side, elliptic slit right side 14x9cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><Suffix>Coated, Contoured</Suffix><ARTGs><ARTG>157201</ARTG></ARTGs><MinimumBenefit>407</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS219</BillingCode><Name>PROGRIP™ Laparoscopic Self-Fixating Composite Mesh</Name><Description>Laparoscopic self-fixating composite right or left or bilateral anatomical mesh (knitted monofilament polyester with monofilament polylactic acid resorbable grips on one side and a resorbable film made of collagen from porcine origin and glycerol, on the other side)</Description><Size>10x15 cm  Rectangular Bilateral Anatomical,  10x15 cm  Rectangular Right Anatomical, 10x15 cm  Left Anatomical,  13x09 cm  Right Anatomical, 
13x09 cm  Left Anatomical</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><Suffix>Coated, Contoured</Suffix><ARTGs><ARTG>252653</ARTG></ARTGs><MinimumBenefit>407</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS161</BillingCode><Name>Parietene ProGrip Mesh (PRE-SHAPED)</Name><Description>Pre-Cut, slit mesh with self gripping overlapping flap - right or left</Description><Size>12 x 8cm elliptic</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112794</SubGroupID><Suffix>Coated, Contoured</Suffix><ARTGs><ARTG>149430</ARTG></ARTGs><MinimumBenefit>407</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA242</BillingCode><Name>Ventralight ST with ECHO PS Positioning System</Name><Description>Bioresorbable Barrier/Permanent Mesh</Description><Size>201-400cm2</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112795</SubGroupID><Suffix>Coated, Complex delivery System</Suffix><ARTGs><ARTG>219333</ARTG></ARTGs><MinimumBenefit>911</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA304</BillingCode><Name>Ventralight™ ST Mesh with Echo 2™ Positioning System </Name><Description>Ventralight™ ST Mesh is an abdominal hernia surgical mesh of composite-polymer, indicated for use in the reconstruction of soft tissue deficiencies, such as for the repair of hernias. The Echo 2™ Positioning System is intended to facilitate the delivery and positioning of the soft tissue prosthesis during laparoscopic hernia repair.</Description><Size>11cm  10cm x 15cm  15cm  15cm x 20cm  15cm x 25cm</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112795</SubGroupID><Suffix>Coated, Complex delivery System</Suffix><ARTGs><ARTG>365351</ARTG></ARTGs><MinimumBenefit>911</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS215</BillingCode><Name>Symbotex Composite Mesh</Name><Description>Non-absorbable three-dimensional polyester composite mesh. (On the opposite side, the absorbable hydrophilic film minimizes tissue attachment to the mesh in case of direct contact with the viscera)</Description><Size>Elliptical 25x15 cm, 
Elliptical 20x12 cm
Rectangular 20x15cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112795</SubGroupID><Suffix>Coated, Contoured</Suffix><ARTGs><ARTG>270735</ARTG></ARTGs><MinimumBenefit>721</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS225</BillingCode><Name>Parietex Progrip Composite Mesh</Name><Description>Monofilament polyester with polylactic acid monofilament resorbable pins on one of the sides</Description><Size>Rectangular 15x15cm, 20x15cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112795</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>157201</ARTG></ARTGs><MinimumBenefit>721</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ450</BillingCode><Name>PROCEED Surgical Mesh</Name><Description>PROCEED Surgical Mesh M1</Description><Size>6x6 inches</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112795</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>357230</ARTG></ARTGs><MinimumBenefit>721</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS238</BillingCode><Name>Symbotex Skirted Composite Mesh</Name><Description>Non-absorbable three-dimensional polyester skirted, coated, contoured composite mesh. On the opposite side, the absorbable hydrophilic film minimizes tissue attachment to the mesh in case of direct contact with the viscera. A flap attached to the reinforcement helps place and fix the mesh.</Description><Size>20 x15 cm Rectangle</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112795</SubGroupID><Suffix>Coated, Contoured</Suffix><ARTGs><ARTG>270736</ARTG></ARTGs><MinimumBenefit>721</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS239</BillingCode><Name>Symbotex Composite Mesh with pre placed suture</Name><Description>Non-absorbable three-dimensional polyester composite mesh with pre placed sutures. (Non absorbable pre-placed sutures are tied to the mesh. A died marking is positioned on the center of the textile and helps center and orient the mesh.)</Description><Size>Rectangular 20x15 cm
Elliptical 25x15 cm, 
Elliptical 20x12 cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112795</SubGroupID><Suffix>Coated, Contoured</Suffix><ARTGs><ARTG>270737</ARTG></ARTGs><MinimumBenefit>721</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN193</BillingCode><Name>PHYSIOMESH Open</Name><Description>Flexible Composite Mesh</Description><Size>201-400cm²</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112795</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>274361</ARTG></ARTGs><MinimumBenefit>721</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MS033</BillingCode><Name>Titanized Mesh Implants (TiMESH, TiLENE, TiLENE Blue, TiLOOP Bra, TiLOOP Bra MPX)</Name><Description>Prosthetic warp-knitted fabric made of monofil polypropylene threads with an encapsulating titanic coating</Description><Size>Weight: 16 g/m² - 65 g/m² ; Surface Area: 201cm² - 400cm²</Size><SupplierCode>39931</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112795</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>97288</ARTG></ARTGs><MinimumBenefit>721</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ451</BillingCode><Name>PROCEED Surgical Mesh</Name><Description>PROCEED Surgical Mesh G1</Description><Size>6x8 inches oval</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112795</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>357230</ARTG></ARTGs><MinimumBenefit>721</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA238</BillingCode><Name>Ventralight ST</Name><Description>Bioresorbable Barrier/Permanent Mesh</Description><Size>15.2 x 20.3cm oval, 15.2 x 25.4cm oval</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112795</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>219332</ARTG></ARTGs><MinimumBenefit>721</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS218</BillingCode><Name>PROGRIP™ Laparoscopic Self-Fixating Composite Mesh</Name><Description>Laparoscopic self-fixating composite mesh (knitted monofilament polyester with monofilament polylactic acid resorbable grips on one side and a resorbable film made of collagen from porcine origin and glycerol, on the other side)</Description><Size>16 x 14 cm rectangular</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112795</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>252653</ARTG></ARTGs><MinimumBenefit>721</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AA019</BillingCode><Name>4D VENTRAL COMPOSITE MESH</Name><Description>4D VENTRAL COMPOSITE MESH</Description><Size>15 X 15 CM</Size><SupplierCode>40043</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112795</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>354550</ARTG></ARTGs><MinimumBenefit>721</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA247</BillingCode><Name>Ventrio ST</Name><Description>Bioresorbable Barrier/Permanent Mesh</Description><Size>13.8 x 17.8cm oval, 15.5 x 25.7cm oval</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112795</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>219324</ARTG></ARTGs><MinimumBenefit>721</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ173</BillingCode><Name>VICRYL Mesh</Name><Description>Polyglactin 910 - synthetic absorbable mesh.</Description><Size>15cm x 15cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112795</SubGroupID><ARTGs><ARTG>143774</ARTG></ARTGs><MinimumBenefit>137</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ468</BillingCode><Name>ULTRAPRO Mesh</Name><Description>ULTRAPRO Mesh M3</Description><Size>15 x 15cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112795</SubGroupID><ARTGs><ARTG>390525</ARTG></ARTGs><MinimumBenefit>137</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ243</BillingCode><Name>VYPRO II Mesh</Name><Description>Composition - equal part Vicryl polyglactin yarn - non-absorbable Prolene polypropylene yarn.  Partly absorbable lightweight mesh for tension free-inguinal hernia techniques</Description><Size>Extra large 15 x 15cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112795</SubGroupID><ARTGs><ARTG>128896</ARTG></ARTGs><MinimumBenefit>137</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN183</BillingCode><Name>Ultrapro Advanced</Name><Description>Macroporous, Partially Absorbable Mesh</Description><Size>Size (cm) 15x15;,quantity/pack 1 or 3</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112795</SubGroupID><ARTGs><ARTG>390526</ARTG></ARTGs><MinimumBenefit>137</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN184</BillingCode><Name>Ultrapro Advanced</Name><Description>Macroporous, Partially Absorbable Mesh</Description><Size>Size (cm) 15x30;,quantity/pack 1</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112796</SubGroupID><ARTGs><ARTG>390526</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ469</BillingCode><Name>ULTRAPRO Mesh</Name><Description>ULTRAPRO Mesh T1</Description><Size>15x30cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112796</SubGroupID><ARTGs><ARTG>390525</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA243</BillingCode><Name>Ventralight ST with ECHO PS Positioning System</Name><Description>Bioresorbable Barrier/Permanent Mesh</Description><Size>401-600cm2</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112796</SubGroupID><Suffix>Coated, Integrated Delivery System</Suffix><ARTGs><ARTG>219333</ARTG></ARTGs><MinimumBenefit>1074</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA248</BillingCode><Name>Ventrio ST</Name><Description>Bioresorbable Barrier/Permanent Mesh</Description><Size>19.6 x 24.6cm oval, 22.1 x 27.1cm oval</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112796</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>219324</ARTG></ARTGs><MinimumBenefit>966</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS222</BillingCode><Name>Parietex Progrip Composite Mesh</Name><Description>Monofilament polyester with polylactic acid monofilament resorbable pins on one of the sides</Description><Size>Rectangular 30x15cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112796</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>157201</ARTG></ARTGs><MinimumBenefit>966</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MS035</BillingCode><Name>Titanized Mesh Implants [TiMESH, TiLOOP Bra MPX]</Name><Description>Prosthetic warp-knitted fabric made of monofil polypropylene threads with an encapsulating titanic coating</Description><Size>Weight: 16 g/m² - 65 g/m² ; Surface Area: 401cm² - 600cm²</Size><SupplierCode>39931</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112796</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>97288</ARTG></ARTGs><MinimumBenefit>966</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AA020</BillingCode><Name>4D VENTRAL COMPOSITE MESH</Name><Description>4D VENTRAL COMPOSITE MESH</Description><Size>15 X 30 CM, 20 X 25 CM.</Size><SupplierCode>40043</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112796</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>354550</ARTG></ARTGs><MinimumBenefit>966</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA306</BillingCode><Name>Ventralight™ ST Mesh with Echo 2™ Positioning System</Name><Description>Ventralight™ ST Mesh is an abdominal hernia surgical mesh of composite-polymer, indicated for use in the reconstruction of soft tissue deficiencies, such as for the repair of hernias. The Echo 2™ Positioning System is intended to facilitate the delivery and positioning of the soft tissue prosthesis during laparoscopic hernia repair.</Description><Size>18cm x 23cm  20cm  20cm x 25cm  </Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112796</SubGroupID><Suffix>Coated, Integrated Delivery System</Suffix><ARTGs><ARTG>365351</ARTG></ARTGs><MinimumBenefit>1074</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ453</BillingCode><Name>PROCEED Surgical Mesh</Name><Description>PROCEED Surgical Mesh J1</Description><Size>8x12 inches</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112796</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>357230</ARTG></ARTGs><MinimumBenefit>966</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ452</BillingCode><Name>PROCEED Surgical Mesh</Name><Description>PROCEED Surgical Mesh H1</Description><Size>8x10 inches oval</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112796</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>357230</ARTG></ARTGs><MinimumBenefit>966</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN194</BillingCode><Name>PHYSIOMESH Open</Name><Description>Flexible Composite Mesh</Description><Size>401-600cm²</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112796</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>274361</ARTG></ARTGs><MinimumBenefit>966</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA239</BillingCode><Name>Ventralight ST</Name><Description>Bioresorbable Barrier/Permanent Mesh</Description><Size>17.8 x 22.9cm oval, 20.3 x 25.4cm oval</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112796</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>219332</ARTG></ARTGs><MinimumBenefit>966</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS223</BillingCode><Name>Symbotex Skirted Composite Mesh</Name><Description>Non-absorbable three-dimensional polyester skirted composite mesh. On the opposite side, the absorbable hydrophilic film minimizes tissue attachment to the mesh in case of direct contact with the viscera. A flap attached to the reinforcement helps place and fix the mesh.</Description><Size>30x20 cm Rectangle
25x20 cm Rectangle</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112796</SubGroupID><Suffix>Coated, Contoured</Suffix><ARTGs><ARTG>270736</ARTG></ARTGs><MinimumBenefit>966</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS216</BillingCode><Name>Symbotex Composite Mesh</Name><Description>Non-absorbable three-dimensional polyester mesh provides long term reinforcement of soft tissues. (On the opposite side, the absorbable
hydrophilic film minimizes tissue attachment to the mesh in case
of direct contact with the viscera.)</Description><Size>Rectangular 30x20 cm,  
Rectangular 25x20 cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112796</SubGroupID><Suffix>Coated, Contoured</Suffix><ARTGs><ARTG>270735</ARTG></ARTGs><MinimumBenefit>966</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS233</BillingCode><Name>Symbotex Composite Mesh with pre placed suture</Name><Description>Non-absorbable three-dimensional polyester composite mesh with pre placed sutures. (Non absorbable pre-placed sutures are tied to the mesh. A died marking is positioned on the center of the textile and helps center and orient the mesh.)</Description><Size>Rectangular 30x20 cm, Rectangular  25x20 cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112796</SubGroupID><Suffix>Coated, Contoured</Suffix><ARTGs><ARTG>270737</ARTG></ARTGs><MinimumBenefit>966</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ020</BillingCode><Name>Vicryl Mesh</Name><Description>1 sheet/box</Description><Size>Large - 30cm x 30cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112798</SubGroupID><ARTGs><ARTG>143774</ARTG></ARTGs><MinimumBenefit>271</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MS038</BillingCode><Name>Titanized Mesh Implants [TiLENE, TiMESH, TiLOOP Bra Pocket)</Name><Description>Prosthetic warp-knitted fabric made of monofil polypropylene threads with an encapsulating titanic coating</Description><Size>Weight: 16 g/m² - 65 g/m²; Surface Area: 601cm² - 1000cm²</Size><SupplierCode>39931</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112798</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>97288</ARTG></ARTGs><MinimumBenefit>1013</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AA021</BillingCode><Name>4D VENTRAL COMPOSITE MESH </Name><Description>4D VENTRAL COMPOSITE MESH</Description><Size>30 X 30 </Size><SupplierCode>40043</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112798</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>354550</ARTG></ARTGs><MinimumBenefit>1013</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA249</BillingCode><Name>Ventrio ST</Name><Description>Bioresorbable Barrier/Permanent Mesh</Description><Size>27.4 x 34.9cm oval</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112798</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>219324</ARTG></ARTGs><MinimumBenefit>1013</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA240</BillingCode><Name>Ventralight ST</Name><Description>Bioresorbable Barrier/Permanent Mesh</Description><Size>22.4 x 33.0cm oval</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112798</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>219332</ARTG></ARTGs><MinimumBenefit>1013</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA307</BillingCode><Name>Ventralight™ ST Mesh with Echo 2™ Positioning System </Name><Description>Ventralight™ ST Mesh is an abdominal hernia surgical mesh of composite-polymer, indicated for use in the reconstruction of soft tissue deficiencies, such as for the repair of hernias. The Echo 2™ Positioning System is intended to facilitate the delivery and positioning of the soft tissue prosthesis during laparoscopic hernia repair.</Description><Size>25cm x 33cm</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112798</SubGroupID><Suffix>Coated, Integrated Delivery System</Suffix><ARTGs><ARTG>365351</ARTG></ARTGs><MinimumBenefit>1121</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ470</BillingCode><Name>ULTRAPRO Mesh</Name><Description>ULTRAPRO Mesh L1</Description><Size>30x30cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112798</SubGroupID><ARTGs><ARTG>390525</ARTG></ARTGs><MinimumBenefit>271</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA244</BillingCode><Name>Ventralight ST with ECHO PS Positioning System</Name><Description>Bioresorbable Barrier/Permanent Mesh</Description><Size>25.4 x 33.0cm oval</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112798</SubGroupID><Suffix>Coated, Integrated Delivery System</Suffix><ARTGs><ARTG>219333</ARTG></ARTGs><MinimumBenefit>1121</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN185</BillingCode><Name>Ultrapro Advanced</Name><Description>Macroporous, Partially Absorbable Mesh</Description><Size>Size (cm) 30x30;,quantity/pack 1</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112798</SubGroupID><ARTGs><ARTG>390526</ARTG></ARTGs><MinimumBenefit>271</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN195</BillingCode><Name>PHYSIOMESH Open</Name><Description>Flexible Composite Mesh
</Description><Size>601cm²-1000cm²</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112798</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>274361</ARTG></ARTGs><MinimumBenefit>1013</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS230</BillingCode><Name>Symbotex Composite Mesh</Name><Description>Non-absorbable three-dimensional polyester composite mesh. (On the opposite side, the absorbable hydrophilic film minimizes tissue attachment to the mesh in case of direct contact with the viscera.)</Description><Size>Elliptical 40x24cm, 34x20cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112798</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>270735</ARTG></ARTGs><MinimumBenefit>1013</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ454</BillingCode><Name>PROCEED Surgical Mesh</Name><Description>PROCEED Surgical Mesh T1</Description><Size>10x13 inches oval</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112798</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>357230</ARTG></ARTGs><MinimumBenefit>1013</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS237</BillingCode><Name>Symbotex Composite Mesh with pre placed suture</Name><Description>Non-absorbable three-dimensional polyester composite mesh with pre placed sutures. (Non absorbable pre-placed sutures are tied to the mesh. A died marking is positioned on the center of the textile and helps center and orient the mesh.)</Description><Size>Elliptical 40x24cm, Elliptical 34x20 cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112798</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>270737</ARTG></ARTGs><MinimumBenefit>1013</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ456</BillingCode><Name>PROCEED Surgical Mesh</Name><Description>PROCEED Surgical Mesh L1</Description><Size>12x12 inches</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112798</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>357230</ARTG></ARTGs><MinimumBenefit>1013</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ455</BillingCode><Name>PROCEED Surgical Mesh</Name><Description>PROCEED Surgical Mesh W1</Description><Size>10x14 inches</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112798</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>357230</ARTG></ARTGs><MinimumBenefit>1013</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA305</BillingCode><Name>Ventralight™ ST Mesh with Echo 2™ Positioning System </Name><Description>Ventralight™ ST Mesh is an abdominal hernia surgical mesh of composite-polymer, indicated for use in the reconstruction of soft tissue deficiencies, such as for the repair of hernias. The Echo 2™ Positioning System is intended to facilitate the delivery and positioning of the soft tissue prosthesis during laparoscopic hernia repair</Description><Size>30cm x 35cm</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112799</SubGroupID><Suffix>Coated, Integrated Delivery System</Suffix><ARTGs><ARTG>365351</ARTG></ARTGs><MinimumBenefit>2996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA245</BillingCode><Name>Ventralight ST with ECHO PS positioning System</Name><Description>Bioresorbable Barrier/Permanent Mesh</Description><Size>30.5 x 35.6cm oval</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112799</SubGroupID><Suffix>Coated, Integrated Delivery System</Suffix><ARTGs><ARTG>219333</ARTG></ARTGs><MinimumBenefit>2996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS226</BillingCode><Name>Symbotex Composite Mesh with pre placed suture</Name><Description>Non-absorbable three-dimensional polyester composite mesh with pre placed sutures. (Non absorbable pre-placed sutures are tied to the mesh. A died marking is positioned on the center of the textile and helps center and orient the mesh.)</Description><Size>Rectangular 42x32 cm, Rectangular 37x28 cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112799</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>270737</ARTG></ARTGs><MinimumBenefit>2875</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS231</BillingCode><Name>Symbotex Composite Mesh</Name><Description>Non-absorbable three-dimensional polyester composite mesh. On the opposite side, the absorbable hydrophilic film minimizes tissue attachment to the mesh in case of direct contact with the viscera.</Description><Size>Rectangular 42x32cm,
Rectangular 37x28cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112799</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>270735</ARTG></ARTGs><MinimumBenefit>2875</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA241</BillingCode><Name>Ventralight ST</Name><Description>Bioresorbable Barrier/Permanent Mesh</Description><Size>30.5 x 35.6cm oval</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112799</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>219332</ARTG></ARTGs><MinimumBenefit>2875</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AA022</BillingCode><Name>4D VENTRAL COMPOSITE MESH</Name><Description>4D VENTRAL COMPOSITE MESH</Description><Size>30 X 50 CM</Size><SupplierCode>40043</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>107998</GroupID><SubGroupID>112799</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>354550</ARTG></ARTGs><MinimumBenefit>2875</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET092</BillingCode><PriorBillingCodes><PriorBillingCode>WC243</PriorBillingCode></PriorBillingCodes><Name>Surgisis Biodesign Anal Fistula Plug</Name><Description>Surgisis Biodesign Anal Fistula Plug is a small intestine submucosal porcine derived, rolled and shaped collagen matrix, non cross-linked, that signals the body and provides support for native tissue remodeling, healing and closure of anal fistulas</Description><Size>0.6cm Width Tapering to 0.2cm Width x 9.5cm Length. Conical Shape</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108002</GroupID><SubGroupID>112808</SubGroupID><ARTGs><ARTG>153045</ARTG></ARTGs><MinimumBenefit>903</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET093</BillingCode><PriorBillingCodes><PriorBillingCode>WC245</PriorBillingCode></PriorBillingCodes><Name>Surgisis Biodesign Recto-Vaginal Fistula Plug</Name><Description>Small intestine submucous porcine collagen matrix, non-crosslinked, supports native tissue remodelling, healing and closure of recto-vaginal fistulas. Conical shape with attached button.</Description><Size>2mm width x 5.5cm length; 4mm wide tapering to 2mm wide x 5.5cm length; 7mm wide tapering to 2mm wide x 5.5 length.</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108002</GroupID><SubGroupID>112808</SubGroupID><ARTGs><ARTG>230911</ARTG><ARTG>153046</ARTG></ARTGs><MinimumBenefit>903</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ010</BillingCode><Name>Interceed Absorbable Adhesion Barrier</Name><Description>Oxidized Regenerated Cellulose</Description><Size>7.6cm x 10.2cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108003</GroupID><SubGroupID>112809</SubGroupID><ARTGs><ARTG>137081</ARTG></ARTGs><MinimumBenefit>158</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM084</BillingCode><Name>Polyganics Vivosorb</Name><Description>A bioresorbable co polyester sheet</Description><Size>2cm x 3cm to 13cm x 20cm</Size><SupplierCode>40194</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108003</GroupID><SubGroupID>112810</SubGroupID><Suffix>Complex, Bioresorbable</Suffix><ARTGs><ARTG>148712</ARTG></ARTGs><MinimumBenefit>1173</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET051</BillingCode><Name>Surgiwrap</Name><Description>Bio Absorbable Antiadhesion Barrier</Description><Size>All sizes with and without suture holes</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108003</GroupID><SubGroupID>112810</SubGroupID><Suffix>Complex, Bioresorbable</Suffix><ARTGs><ARTG>91233</ARTG></ARTGs><MinimumBenefit>1173</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX342</BillingCode><PriorBillingCodes><PriorBillingCode>GE006</PriorBillingCode></PriorBillingCodes><Name>Seprafilm Adhesion Barrier</Name><Description>Sodium hyaluronate carbomethylcellulose membrane</Description><Size>13cm  x 15cm</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108003</GroupID><SubGroupID>112810</SubGroupID><ARTGs><ARTG>206261</ARTG></ARTGs><MinimumBenefit>312</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC618</BillingCode><Name>Medishield Anti-Adhesion Gel</Name><Description>MediShield Anti-Adhesion Gel is an adhesion barrier gel for prevention of complications after spinal surgery.  MediShield is a co-polymer gel composed of carboxymethylcellulose and polyethylene oxide.</Description><Size>3cc Syringe</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108003</GroupID><SubGroupID>112811</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>137951</ARTG></ARTGs><MinimumBenefit>1173</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FJ004</BillingCode><Name>Oxiplex/IU</Name><Description>Oxiplex/IU® is a clear, single use flowable gel. The gel is a sterile, absorbable  combination of sodium carboxymethylcellulose (CMC) and polyethylene oxide (PEO) with calcium chloride and sodium chloride in water. Oxiplex/IU is intended for use as a mechanical barrier to adhesion formation. Oxiplex/IU is intended to be used as an adjunct to intrauterine procedures for reducing the incidence, extent, and severity of adhesions.</Description><Size>1 x 10ml pre-filled syringe and vaginal applicator.</Size><SupplierCode>40380</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108003</GroupID><SubGroupID>112811</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>313985</ARTG></ARTGs><MinimumBenefit>1173</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FJ002</BillingCode><PriorBillingCodes><PriorBillingCode>LH001</PriorBillingCode></PriorBillingCodes><Name>Oxiplex Absorbable Adhesion Barrier Gel</Name><Description>Oxiplex Absorbable Adhesion Barrier gel (Oxiplex is a co-polymer gel composed of carboxymethylcellulose and polyethylene.)</Description><Size>3ml in sterile 3ml syringe</Size><SupplierCode>40380</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108003</GroupID><SubGroupID>112811</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>149294</ARTG></ARTGs><MinimumBenefit>1173</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FJ001</BillingCode><PriorBillingCodes><PriorBillingCode>LH534</PriorBillingCode></PriorBillingCodes><Name>Oxiplex/AP Absorbable Adhesion Barrier Gel</Name><Description>Combination of Polyethylene Oxide (PEO) and Sodium Carboxylmethylcellulose stabilised with Calcium and made isotonic with Sodium Chloride.  Kit contains 2 x 20ml Sterile syringes , 1 x Applicator</Description><Size>2 x 20ml Sterile Syringes, 1 x Applicator</Size><SupplierCode>40380</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108003</GroupID><SubGroupID>112811</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>152224</ARTG></ARTGs><MinimumBenefit>1173</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET082</BillingCode><Name>PureRegen Gel Sinus</Name><Description>PureRegen Gel Sinus is a gel adhesion barrier comprised of a hyaluronic acid based hydrogel. The product does not contain any medicinal, human or animal components. It is removed from the application site by natural elimination.</Description><Size>2ml, 5ml, 6ml, 8ml, 10ml, 20ml.</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108003</GroupID><SubGroupID>112811</SubGroupID><Suffix>Sinus</Suffix><ARTGs><ARTG>264407</ARTG></ARTGs><MinimumBenefit>94</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FJ003</BillingCode><PriorBillingCodes><PriorBillingCode>LM196</PriorBillingCode></PriorBillingCodes><Name>Dynavisc</Name><Description>Absorbable adhesion barrier gel</Description><Size>1 ml</Size><SupplierCode>40380</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108003</GroupID><SubGroupID>112811</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>208839</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>411</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX260</BillingCode><Name>ADEPT Adhesion Reduction Solution</Name><Description>ADEPT Adhesion Reduction Solution is a single use, sterile fluid for intraperitoneal administration. ADEPT is intended to be used as an instillate for the reduction of adhesions following gynaecologicalpelvic laparoscopic surgery of the abdominalpelvic cavity in adults</Description><Size>1500ml</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108003</GroupID><SubGroupID>112814</SubGroupID><ARTGs><ARTG>299826</ARTG></ARTGs><MinimumBenefit>226</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB383</BillingCode><Name>Histoacryl</Name><Description>Topical and Surgical Adhesive</Description><Size>0.5ml per ampoule</Size><SupplierCode>40020</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112815</SubGroupID><Suffix>Synthetic</Suffix><ARTGs><ARTG>206441</ARTG></ARTGs><MinimumBenefit>23</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH597</BillingCode><Name>LiquiBand Topical</Name><Description>Topical Skin Adhesive</Description><Size>0.25g – 0.8g ampoule</Size><SupplierCode>40192</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112815</SubGroupID><Suffix>Synthetic</Suffix><ARTGs><ARTG>151324</ARTG></ARTGs><MinimumBenefit>128</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX252</BillingCode><Name>CoSeal Surgical Sealant</Name><Description>Composition: two synthetic polyethelene glycols (PEG's), COH102 and COH206, premixed and filled into one syringe, a dilute hydrogen chloride solution and a sodium phosphate/sodium carbonate solution</Description><Size>2ml</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112815</SubGroupID><Suffix>Synthetic</Suffix><ARTGs><ARTG>181132</ARTG></ARTGs><MinimumBenefit>128</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN229</BillingCode><Name>Dermabond</Name><Description>Topical Skin Adhesive</Description><Size>Per 0.36 - 0.75ml vial</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112815</SubGroupID><Suffix>Synthetic</Suffix><ARTGs><ARTG>171563</ARTG></ARTGs><MinimumBenefit>23</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI286</BillingCode><Name>LiquiBand® Exceed™</Name><Description>Topical Tissue Adhesive with Applicator</Description><Size>0.8 mL, 0.36mL</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112815</SubGroupID><Suffix>Synthetic</Suffix><ARTGs><ARTG>266148</ARTG></ARTGs><MinimumBenefit>23</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN230</BillingCode><Name>Dermabond Prineo</Name><Description>Topical skin adhesive with self-adhering mesh</Description><Size>22 - 60cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112815</SubGroupID><Suffix>Synthetic</Suffix><ARTGs><ARTG>185773</ARTG></ARTGs><MinimumBenefit>128</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB382</BillingCode><Name>Histoacryl Flexible</Name><Description>Topical Skin Adhesive</Description><Size>0.5ml per ampoule</Size><SupplierCode>40020</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112815</SubGroupID><Suffix>Synthetic</Suffix><ARTGs><ARTG>221444</ARTG></ARTGs><MinimumBenefit>23</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI317</BillingCode><PriorBillingCodes><PriorBillingCode>SQ124</PriorBillingCode></PriorBillingCodes><Name>INDERMIL Flexifuze</Name><Description>Topical Tissue Adhesive with Applicator</Description><Size>0.75g per ampoule</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112815</SubGroupID><Suffix>Synthetic</Suffix><ARTGs><ARTG>322769</ARTG></ARTGs><MinimumBenefit>23</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE720</BillingCode><Name>Glubran 2</Name><Description>Synthetic cyanoacrylic surgical glue: N-Butyl (2) cyanoacrylate and methacryloxysulfolane co-monomer</Description><Size>0.25 ml, 0.5 ml, 1 ml</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112815</SubGroupID><Suffix>Synthetic</Suffix><ARTGs><ARTG>158438</ARTG></ARTGs><MinimumBenefit>128</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE721</BillingCode><PriorBillingCodes><PriorBillingCode>MG047</PriorBillingCode></PriorBillingCodes><Name>Glubran Tiss2</Name><Description>Tissue adhesive</Description><Size>0.25 ml, 0.35 ml, 0.50 ml</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112815</SubGroupID><Suffix>Synthetic</Suffix><ARTGs><ARTG>158442</ARTG></ARTGs><MinimumBenefit>23</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ057</BillingCode><PriorBillingCodes><PriorBillingCode>AB075</PriorBillingCode><PriorBillingCode>AB075</PriorBillingCode></PriorBillingCodes><Name>BioGlue Surgical Adhesive - 2ml Syringe System</Name><Description>Model No BG3502-5-A (BioGlue Surgical Adhesive)</Description><Size>2ml</Size><SupplierCode>40391</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112815</SubGroupID><Suffix>Biological</Suffix><ARTGs><ARTG>137751</ARTG></ARTGs><MinimumBenefit>323</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX214</BillingCode><Name>TISSEEL Two Component Fibrin Sealant Syringe</Name><Description>Active ingedients:Sealer Protein Solution &amp; Thrombin Solution - deep-frozen</Description><Size>2.0 ml (containing 1.0 ml of Sealer Protein Solution and 1.0 ml of Thrombin Solution)</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112815</SubGroupID><Suffix>Biological</Suffix><ARTGs><ARTG>147141</ARTG></ARTGs><MinimumBenefit>323</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX283</BillingCode><Name>ARTISS Fibrin Sealant 2ml</Name><Description>ARTISS is a proprietary fibrin sealant with 4UI/ml human thrombin.  It is two-component fibrin sealant made from pooled human plasma, a double virus-inactivated (vapour heated and solvent/detergent treated) and frozen (≤ -20°C) plasma derived biological agent.</Description><Size>The two components are formulated as two sterile frozen solutions.  Each solution is presented in a separate pre-loaded chamber (1ml) of a double chamber syringe.  One chamber contains sealer protein solution with aprotinin while the other chamber contains thrombin solution with calcium chloride, resulting in a 2ml total volume of product for use.</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112815</SubGroupID><Suffix>Biological</Suffix><ARTGs><ARTG>163515</ARTG></ARTGs><MinimumBenefit>323</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH596</BillingCode><Name>Liquiband Surgical</Name><Description>Surgical Adhesive</Description><Size>0.8gm ampoule</Size><SupplierCode>40192</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112815</SubGroupID><Suffix>Synthetic</Suffix><ARTGs><ARTG>151324</ARTG></ARTGs><MinimumBenefit>23</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX253</BillingCode><Name>CoSeal Surgical Sealant</Name><Description>Composition: two synthetic polyethelene glycols (PEG's), COH102 and COH206, premixed and filled into a syringe, a dilute hydrogen chloride solution and a sodium phosphate sodium carbonate solution</Description><Size>4ml</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112816</SubGroupID><Suffix>Synthetic</Suffix><ARTGs><ARTG>181132</ARTG></ARTGs><MinimumBenefit>516</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ058</BillingCode><PriorBillingCodes><PriorBillingCode>AB003</PriorBillingCode><PriorBillingCode>AB003</PriorBillingCode></PriorBillingCodes><Name>BioGlue Surgical Adhesive - 5ml Syringe System</Name><Description>Model No BG3515-5-A (BioGlue Surgical Adhesive)</Description><Size>One size only</Size><SupplierCode>40391</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112816</SubGroupID><Suffix>Biological</Suffix><ARTGs><ARTG>137751</ARTG></ARTGs><MinimumBenefit>588</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX284</BillingCode><Name>ARTISS Fibrin Sealant 4ml</Name><Description>ARTISS is a proprietary fibrin sealant with 4UI/ml human thrombin.  It is two-component fibrin sealant made from pooled human plasma, a double virus-inactivated (vapour heated and solvent/detergent treated) and frozen (≤ -20°C) plasma derived biological agent.</Description><Size>The two components are formulated as two sterile frozen solutions.  Each solution is presented in a separate pre-loaded chamber (2ml) of a double chamber syringe.  One chamber contains sealer protein solution with aprotinin while the other chamber contains thrombin solution with calcium chloride, resulting in a 4ml total volume of product for use.</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112816</SubGroupID><Suffix>Biological</Suffix><ARTGs><ARTG>163515</ARTG></ARTGs><MinimumBenefit>588</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX215</BillingCode><Name>TISSEEL Two Component Fibrin Sealant Syringe</Name><Description>Active ingedients:Sealer Protein Solution &amp; Thrombin Solution - deep-frozen</Description><Size>4.0 ml (containing 2.0 ml of Sealer Protein Solution and 2.0 ml of Thrombin Solution)</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112816</SubGroupID><Suffix>Biological</Suffix><ARTGs><ARTG>147141</ARTG></ARTGs><MinimumBenefit>588</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ056</BillingCode><PriorBillingCodes><PriorBillingCode>AB004</PriorBillingCode><PriorBillingCode>AB004</PriorBillingCode></PriorBillingCodes><Name>BioGlue Surgical Adhesive - 10ml Syringe System</Name><Description>Model No BG3510-5-A (BioGlue Surgical Adhesive)</Description><Size>One size only</Size><SupplierCode>40391</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112817</SubGroupID><Suffix>Biological</Suffix><ARTGs><ARTG>137751</ARTG></ARTGs><MinimumBenefit>1177</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX285</BillingCode><Name>ARTISS Fibrin Sealant 10ml</Name><Description>ARTISS is a proprietary fibrin sealant with 4UI/ml human thrombin.  It is two-component fibrin sealant made from pooled human plasma, a double virus-inactivated (vapour heated and solvent/detergent treated) and frozen (≤ -20°C) plasma derived biological agent.</Description><Size>The two components are formulated as two sterile frozen solutions.  Each solution is presented in a separate pre-loaded chamber (5ml) of a double chamber syringe.  One chamber contains sealer protein solution with aprotinin while the other chamber contains thrombin solution with calcium chloride, resulting in a 10ml total volume of product for use.</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112817</SubGroupID><Suffix>Biological</Suffix><ARTGs><ARTG>163515</ARTG></ARTGs><MinimumBenefit>1177</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX254</BillingCode><Name>CoSeal Surgical Sealant</Name><Description>Composition: two synthetic polyethelene glycols (PEG's), COH102 and COH206, premixed and filled into a syringe, a dilute hydrogen chloride solution and a sodium phosphate sodium carbonate solution</Description><Size>8ml</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112817</SubGroupID><Suffix>Synthetic</Suffix><ARTGs><ARTG>181132</ARTG></ARTGs><MinimumBenefit>963</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX216</BillingCode><Name>TISSEEL Two Component Fibrin Sealant Syringe</Name><Description>Active ingedients:Sealer Protein Solution &amp; Thrombin Solution - deep-frozen</Description><Size>10.0 ml (containing 5.0 ml of Sealer Protein Solution and 5.0 ml of Thrombin Solution)</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112817</SubGroupID><Suffix>Biological</Suffix><ARTGs><ARTG>147141</ARTG></ARTGs><MinimumBenefit>1177</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX263</BillingCode><Name>COSEAL Spray Accessory Kit</Name><Description>Spray Accessory kit for Coseal: A hydrogel that acts as a sealant by adhering to itself and the tissues it contacts.  COSEAL is designed to completely seal suture lines along vascular reconstructions to prevent fluids from leaking.</Description><Size>One size available</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Extender</Suffix><ARTGs><ARTG>299913</ARTG></ARTGs><MinimumBenefit>25</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX272</BillingCode><Name>TISSEEL DUPLOCATH 25cm</Name><Description> Double lumen flexible application catheter for Tisseel, a two component Fibrin Sealant containing human derived fibrinogen and thrombin.</Description><Size>A 25cm long double lumen flexible application catheter</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Extender</Suffix><ARTGs><ARTG>299913</ARTG></ARTGs><MinimumBenefit>25</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX264</BillingCode><Name>TISSEEL DUPLOTIP WITH SNAPLOCK 20g x 26.4cm</Name><Description>Two component Fibrin Sealant containing derived fibrinogen and thrombin.</Description><Size>A 26.4cm long dual umen applicator</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Extender</Suffix><ARTGs><ARTG>115590</ARTG></ARTGs><MinimumBenefit>25</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX282</BillingCode><Name>Floseal Special Applicator Tips</Name><Description>Floseal Malleable and Trimmable Applicator with Tips specifically designed for use with Floseal Haemostatic Matrix</Description><Size>14cm</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Extender</Suffix><ARTGs><ARTG>167776</ARTG></ARTGs><MinimumBenefit>25</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX265</BillingCode><Name>TISSEEL DUPLOTIP WITH SNAPLOCK   31.8 cm and 40cm</Name><Description>Duplotip for Two component Fibrin Sealant containing human derived fibrinogen and thrombin  "Black Beauty" and bariatric surgery</Description><Size>A 31.8cm long dual lumen applicator or   40 cm long dual lumen applicator</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Rigid Delivery System</Suffix><ARTGs><ARTG>115590</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE727</BillingCode><PriorBillingCodes><PriorBillingCode>MG044</PriorBillingCode></PriorBillingCodes><Name>Glubran 2 Spray Device</Name><Description>Spray device for nebulized application of Glubran 2</Description><Size>Cannula length: 5cm, 40cm, 30cm, 33cm</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Rigid Delivery System</Suffix><ARTGs><ARTG>321253</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX261</BillingCode><Name>Tisseel Duplospray MIS WITH SNAPLOCK Applicator 20cm</Name><Description>Two component Fibrin Sealant containing human derived fibrinogen and thrombin.</Description><Size>A 20cm long dual lumen metal cannula</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Extender</Suffix><ARTGs><ARTG>115590</ARTG></ARTGs><MinimumBenefit>25</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX262</BillingCode><Name>TISSEEL DUPLOCATH 180cm</Name><Description>Double lumen flexible catheters for Tisseel: Tisseel is Two component Fibrin Sealant containing human derived fibrinogen and thrombin.</Description><Size>A 180cm long double lumen flexible application catheter</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Extender</Suffix><ARTGs><ARTG>299913</ARTG></ARTGs><MinimumBenefit>25</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX271</BillingCode><Name>TISSEEL DUPLOTIP with SNAPLOCK 20g x 10.4cm</Name><Description>Two component Fibrin Sealant containing human derived fibrinogen and thrombin.</Description><Size>10.4cm long dual lumen applicator</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Extender</Suffix><ARTGs><ARTG>115590</ARTG></ARTGs><MinimumBenefit>25</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX275</BillingCode><Name>COSEAL Extended Applicator 22 cm</Name><Description>22cm extended applicator for COSEAL. Coseal, is listed on the Prostheses List, is a hydrogel that acts as a sealant by adhering to itself and the tissues it contacts.  COSEAL is designed to completely seal suture lines along vascular reconstructions to prevent fluids from leaking.</Description><Size>A 22 cm long malleable applicator</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Extender</Suffix><ARTGs><ARTG>180922</ARTG></ARTGs><MinimumBenefit>25</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE723</BillingCode><PriorBillingCodes><PriorBillingCode>MG035</PriorBillingCode></PriorBillingCodes><Name>Glubran 2 Catheter for Laparoscopy</Name><Description>Catheter for laparoscopic application of Glubran 2.</Description><Size>One size only</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Extender</Suffix><ARTGs><ARTG>162589</ARTG></ARTGs><MinimumBenefit>25</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ055</BillingCode><PriorBillingCodes><PriorBillingCode>AB065</PriorBillingCode><PriorBillingCode>AB065</PriorBillingCode></PriorBillingCodes><Name>BioGlue Delivery Tip Extension (various sizes)</Name><Description>Rigid Extender Tip (BGDTE range)</Description><Size>10cm, 27cm, 35cm</Size><SupplierCode>40391</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Laparoscopic Extender</Suffix><ARTGs><ARTG>137420</ARTG></ARTGs><MinimumBenefit>53</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX280</BillingCode><Name>Coseal Duplospray Applicator 20cm</Name><Description>COSEAL, which is listed on the Prostheses List, is a hydrogel that acts as a sealant by adhering to itself and the tissues it contacts. COSEAL is designed to completely seal suture lines along vascular reconstructions to prevent fluids from leaking. This a</Description><Size>20 cm</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Laparoscopic Extender</Suffix><ARTGs><ARTG>115590</ARTG></ARTGs><MinimumBenefit>53</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX340</BillingCode><Name>FIBRIJET® Gasless Stray Tip</Name><Description>Gasless spray tip use during open surgery. The spray tip is compatible with both Prima and legacy TISSEEL frozen syringes.</Description><Size>One size only</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Rigid Delivery System</Suffix><ARTGs><ARTG>299913</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN041</BillingCode><Name>Endoscopic Applicator</Name><Description>Rigid applicator</Description><Size>34cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Rigid Delivery System</Suffix><ARTGs><ARTG>174430</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX268</BillingCode><Name>TISSEEL DUPLOCATH 35cm MIC/MIS</Name><Description>MIS (with MIS adaptor 5mm) Double lumen flexible application catheter for Tisseel, a two component Fibrin Sealant containing human derived fibrinogen and thrombin.</Description><Size>A 35cm long double lumen flexible application catheter</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Laparoscopic Extender</Suffix><ARTGs><ARTG>299913</ARTG></ARTGs><MinimumBenefit>53</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX277</BillingCode><Name>TISSEEL DUPLOSPRAY MIS SNAPLOCK APPLICATOR 30 cm</Name><Description>Two component Fibrin Sealant containing human derived fibrinogen and thrombin.</Description><Size>A 30 cm long dual lumen metal cannula</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Laparoscopic Extender</Suffix><ARTGs><ARTG>115590</ARTG></ARTGs><MinimumBenefit>53</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX279</BillingCode><Name>Coseal Duplospray Applicator 30cm</Name><Description>COSEAL, which is listed on the Prostheses List, is a hydrogel that acts as a sealant by adhering to itself and the tissues it contacts.  COSEAL is designed to completely seal suture lines along vascular reconstructions to prevent fluids from leaking.</Description><Size>30cm</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Laparoscopic Extender</Suffix><ARTGs><ARTG>115590</ARTG></ARTGs><MinimumBenefit>53</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA266</BillingCode><Name>Progel Platinum Surgical Sealant Extender Spray Tip</Name><Description>Extender Spray tip to be used in conjunction with Progel Platinum Surgical Sealant</Description><Size>16cm, 29cm</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Rigid Delivery System</Suffix><ARTGs><ARTG>260665</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX269</BillingCode><Name>TISSEEL Easyspray Set</Name><Description>Easyspray Set for Tisseel, a two component Fibrin Sealant containing human derived fibrinogen and thrombin.</Description><Size>One size</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Extender</Suffix><ARTGs><ARTG>299913</ARTG></ARTGs><MinimumBenefit>25</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ059</BillingCode><PriorBillingCodes><PriorBillingCode>AB076</PriorBillingCode><PriorBillingCode>AB076</PriorBillingCode></PriorBillingCodes><Name>BioGlue Surgical Adhesive - Spreader Tips</Name><Description>Spreader (extender) Tips (various sizes), (Pack of 3)</Description><Size>12mm, 16mm</Size><SupplierCode>40391</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Extender</Suffix><ARTGs><ARTG>137420</ARTG></ARTGs><MinimumBenefit>25</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ061</BillingCode><PriorBillingCodes><PriorBillingCode>AB010</PriorBillingCode><PriorBillingCode>AB010</PriorBillingCode></PriorBillingCodes><Name>BioGlue Surgical Adhesive - Syringe 27CM Extender</Name><Description>Model No BGAT-27-SY (BioGlue Surgical Adhesive)</Description><Size>27cm Extender</Size><SupplierCode>40391</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Extender</Suffix><ARTGs><ARTG>137420</ARTG></ARTGs><MinimumBenefit>25</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ060</BillingCode><PriorBillingCodes><PriorBillingCode>AB009</PriorBillingCode><PriorBillingCode>AB009</PriorBillingCode></PriorBillingCodes><Name>BioGlue Surgical Adhesive - Syringe 10cm Extender</Name><Description>Model No BGAT-10-SY (BioGlue Surgical Adhesive)</Description><Size>10cm Extender</Size><SupplierCode>40391</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Extender</Suffix><ARTGs><ARTG>137420</ARTG></ARTGs><MinimumBenefit>25</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ062</BillingCode><PriorBillingCodes><PriorBillingCode>AB008</PriorBillingCode><PriorBillingCode>AB008</PriorBillingCode></PriorBillingCodes><Name>BioGlue Surgical Adhesive - Syringe Standard Applicator Tip</Name><Description>Model No BGAT-SY (BioGlue Surgical Adhesive)</Description><Size>Standard Applicator Tip</Size><SupplierCode>40391</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Applicator Tip</Suffix><ARTGs><ARTG>137420</ARTG></ARTGs><MinimumBenefit>22</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX266</BillingCode><Name>TISSEEL DUPLOSPRAY MIS APPLICATOR REPLACEMENT TIPS</Name><Description>Two component Fibrin Sealant containing human derived fibrinogen and thrombin.</Description><Size>Packs of 10 sterile packs each containing 2 tips and an installation tool</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Applicator Tip</Suffix><ARTGs><ARTG>115590</ARTG></ARTGs><MinimumBenefit>22</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX270</BillingCode><Name>COSEAL Applicator Tips 7 cm</Name><Description>Applicator tips for COSEAL. Coseal which is listed on the Prostheses List, is a hydrogel that acts as a sealant by adhering to itself and the tissues it contacts.  COSEAL is designed to completely seal suture lines along vascular reconstructions to prevent fluids from leaking.</Description><Size>A 7cm long applicator tip</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Applicator Tip</Suffix><ARTGs><ARTG>180922</ARTG></ARTGs><MinimumBenefit>22</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA267</BillingCode><Name>Progel Platinum Surgical Sealant Spray Tip</Name><Description>Spray tip to be used in conjunction with Progel Platinum Surgical Sealant</Description><Size>5cm (packs of 2)</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Applicator Tip</Suffix><ARTGs><ARTG>260665</ARTG></ARTGs><MinimumBenefit>22</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE722</BillingCode><PriorBillingCodes><PriorBillingCode>MG034</PriorBillingCode></PriorBillingCodes><Name>Glubran 2 Applicators</Name><Description>Dispensing tip/Drop control device for applying Glubran 2.</Description><Size>5-6 and 7-8 French</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Applicator Tip</Suffix><ARTGs><ARTG>162589</ARTG></ARTGs><MinimumBenefit>22</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX273</BillingCode><Name>Floseal Endoscopic Applicator</Name><Description>Used as an adjunct to haemostasis when control of bleeding by ligature or conventional surgical procedures is ineffective or impractical.</Description><Size>A 41cm - 47cm long disposable cannulated applicator, with or without malleable tip.</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Rigid Delivery System</Suffix><ARTGs><ARTG>115590</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX267</BillingCode><Name>TISSEEL DUPLOSPRAY MIS WITH SNAPLOCK APPLICATOR 40 cm</Name><Description>Two component Fibrin Sealant containing human derived fibrinogen and thrombin, with or without a malleable tip.</Description><Size>A 40 cm long dual lumen metal cannula</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Rigid Delivery System</Suffix><ARTGs><ARTG>115590</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX341</BillingCode><Name>EASYGRIP FLO-41</Name><Description>sterile, single-use endoscopic applicator device designed for single handed application, particularly  during laparoscopic and robotic procedures through an easy, precise, and controlled delivery of Floseal.</Description><Size>41cm</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Rigid Delivery System</Suffix><ARTGs><ARTG>115590</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FY002</BillingCode><PriorBillingCodes><PriorBillingCode>MQ039</PriorBillingCode></PriorBillingCodes><Name>PuraStat Applicator</Name><Description>PuraStat is used as an adjunct to haemostasis when control of bleeding by ligature or conventional surgical procedures is ineffective or impractical.</Description><Size>250mm</Size><SupplierCode>40259</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112818</SubGroupID><Suffix>Rigid Delivery System</Suffix><ARTGs><ARTG>283717</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BX335</BillingCode><Name>Peri-Strips dry with Veritas Collagen Matrix Linear Single Firing</Name><Description>Peri-Strips Dry with Veritas is a remodeable material designed to increase staple line strength for surgical repair of soft tissue deficiencies</Description><Size> 30-130mm</Size><SupplierCode>39947</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112819</SubGroupID><ARTGs><ARTG>219227</ARTG></ARTGs><MinimumBenefit>301</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JI006</BillingCode><PriorBillingCodes><PriorBillingCode>LH572</PriorBillingCode></PriorBillingCodes><Name>Steritalc</Name><Description>Sterile granules of talc implanted in pleural space to act as permanent adhesive</Description><Size>3 grams &amp; 4 grams</Size><SupplierCode>40458</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112820</SubGroupID><ARTGs><ARTG>143613</ARTG></ARTGs><MinimumBenefit>129</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA265</BillingCode><Name>Progel Platinum Surgical Sealant</Name><Description>Progel Pleural Air Leak Sealant is a single use device intended for application to visceral pleura.</Description><Size>4ml</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112821</SubGroupID><ARTGs><ARTG>262979</ARTG></ARTGs><MinimumBenefit>718</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KF001</BillingCode><PriorBillingCodes><PriorBillingCode>YN003</PriorBillingCode></PriorBillingCodes><Name>TachoSil</Name><Description>TachoSil is a broad use haemostat for intra-operative tissue management. The TachoSil sponge is off-white, with yellow colouring on the active side (coated with fibrinogen and thrombin), and is ready to use (store at room temperature).</Description><Size>One small patch: 3.0cm x 2.5cm</Size><SupplierCode>40386</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112822</SubGroupID><ARTGs><ARTG>176631</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS212</BillingCode><Name>Veriset</Name><Description>Veriset is an absorbable topical hemostatic device intended for use in surgical procedures as an adjunct to hemostatsis when conventional methods are ineffective or impractical.  Veriset does not consist of any human or animal components</Description><Size>2cm x 4cm (8cm2)</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112822</SubGroupID><ARTGs><ARTG>202060</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KF003</BillingCode><PriorBillingCodes><PriorBillingCode>YN002</PriorBillingCode></PriorBillingCodes><Name>TachoSil</Name><Description>TachoSil is a broad use haemostat for intra-operative tissue management. The TachoSil sponge is off-white, with yellow colouring on the active side (coated with fibrinogen and thrombin), and is ready to use (store at room temperature).</Description><Size>One medium patch: 4.8cm x 4.8cm</Size><SupplierCode>40386</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112823</SubGroupID><ARTGs><ARTG>176631</ARTG></ARTGs><MinimumBenefit>208</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KF002</BillingCode><PriorBillingCodes><PriorBillingCode>YN001</PriorBillingCode></PriorBillingCodes><Name>TachoSil</Name><Description>TachoSil is a broad use haemostat for intra-operative tissue management. The TachoSil sponge is off-white, with yellow colouring on the active side (coated with fibrinogen and thrombin), and is ready to use (store at room temperature).</Description><Size>One large patch: 9.5cm x 4.8cm</Size><SupplierCode>40386</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112824</SubGroupID><ARTGs><ARTG>176631</ARTG></ARTGs><MinimumBenefit>412</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS213</BillingCode><Name>Veriset</Name><Description>Veriset is an absorbable topical hemostatic device intended for use in surgical procedures as an adjunct to hemostasis when conventional methods are ineffective or impractical.  Veriset does not consist of any human or animal components.</Description><Size>5cm x 10cm (50cm2)
8 cm x 16 cm (128cm2)</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108004</GroupID><SubGroupID>112824</SubGroupID><ARTGs><ARTG>202060</ARTG></ARTGs><MinimumBenefit>412</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS225</BillingCode><Name>Speedband Superview Super 7</Name><Description>Multiple Band Ligator</Description><Size>7 bands per unit, compatible with scopes with outer diameter of 8.6mm - 11.5mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112827</SubGroupID><ARTGs><ARTG>133438</ARTG></ARTGs><MinimumBenefit>236</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC318</BillingCode><Name>ShortShot Saeed Hemorrhoidal Multi-Band Ligator</Name><Description>The ShortShot Saeed Haemorrhoidal Multi-Band Ligator is used to ligate internal haemorrhoids and is supplied with the TriView Anoscope.  </Description><Size>4 bands per ligator, 15mm in diameter</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112827</SubGroupID><ARTGs><ARTG>139361</ARTG></ARTGs><MinimumBenefit>58</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AK011</BillingCode><Name>Band Ligator</Name><Description>A surgical instrument used to apply a ligature to haemorrhoids. A ligator typically consists of a long shaft or cannula with a clamp or grip at the distal end for holding the ligature. The proximal end consists of a handle with moving parts that mechanically operate the distal clamp or grip.</Description><Size>Barrel with 5 bands</Size><SupplierCode>39961</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112827</SubGroupID><ARTGs><ARTG>308836</ARTG></ARTGs><MinimumBenefit>236</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HB001</BillingCode><Name>Haemoband</Name><Description>A preloaded, single use, 4 band ligator for haemorrhoids.</Description><Size>1 size, 4 bands</Size><SupplierCode>40352</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112827</SubGroupID><ARTGs><ARTG>136643</ARTG></ARTGs><MinimumBenefit>49</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC314</BillingCode><Name>Saeed Multi-band Ligator</Name><Description>Multiple Band Ligator</Description><Size>4, 6 or 10 bands per unit, compatible with scopes with outer diameter of 8.6mm - 14mm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112827</SubGroupID><ARTGs><ARTG>136845</ARTG></ARTGs><MinimumBenefit>236</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DH011</BillingCode><Name>KilRoid</Name><Description>KilRoid® is a disposable haemorrhoid suction ligator with and without tubing.</Description><Size>6 bands - available with and without tubing.</Size><SupplierCode>39990</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112827</SubGroupID><ARTGs><ARTG>326510</ARTG></ARTGs><MinimumBenefit>36</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FQ002</BillingCode><Name>FlexDex Gastric Bypass and Gastrectomy Kit</Name><Description>Kit includes a single-use articulating laparoscopic needle driver with seven degrees of motion and sutures</Description><Size>One size only</Size><SupplierCode>40268</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112828</SubGroupID><ARTGs><ARTG>315333</ARTG></ARTGs><MinimumBenefit>680</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ015</BillingCode><PriorBillingCodes><PriorBillingCode>ER279</PriorBillingCode><PriorBillingCode>ER279</PriorBillingCode></PriorBillingCodes><Name>OverStitchTM Endoscopic Suturing System</Name><Description>Needle Driver, Anchor Exchange and Tissue Helix Device</Description><Size>1 size only</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112829</SubGroupID><Suffix>Endoscopic System</Suffix><ARTGs><ARTG>237774</ARTG><ARTG>237773</ARTG></ARTGs><MinimumBenefit>1473</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ107</BillingCode><PriorBillingCodes><PriorBillingCode>ER280</PriorBillingCode><PriorBillingCode>ER280</PriorBillingCode></PriorBillingCodes><Name>OverStitchTM Endoscopic Suturing System - 2.0 Suture</Name><Description>Endoscopic Polyproprylene Suture with Cinch</Description><Size>2-0 suture</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112831</SubGroupID><Suffix>Endoscopic System</Suffix><ARTGs><ARTG>236906</ARTG><ARTG>245894</ARTG></ARTGs><MinimumBenefit>211</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX023</BillingCode><Name>Hem-o-Lok Polymer Non-Absorbable Ligating Clip</Name><Description>Hem-o-lok Medium (M), Medium-Large (ML) and Large (L) Polymer Clips</Description><Size>Small, Medium, Medium-Large, Large (6 clips/cartridge)</Size><SupplierCode>40451</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><Suffix>Polymeric Non-resorbable</Suffix><ARTGs><ARTG>93446</ARTG><ARTG>121043</ARTG></ARTGs><MinimumBenefit>40</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB294</BillingCode><Name>Aesculap Ligating Clips</Name><Description>Aesculap Ligating Clips- Ligation Clips Titanium;</Description><Size>PL561T- Large; 6 clips/cartridge</Size><SupplierCode>40020</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><ARTGs><ARTG>136103</ARTG></ARTGs><MinimumBenefit>10</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB297</BillingCode><Name>Aesculap Ligating Clips</Name><Description>Aesculap Ligating Clips Titanium</Description><Size>PL565T - Small; 6 clips/cartridge</Size><SupplierCode>40020</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><ARTGs><ARTG>136103</ARTG></ARTGs><MinimumBenefit>10</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB299</BillingCode><Name>Aesculap Ligating Clips</Name><Description>Aesculap Ligating Clips Titanium</Description><Size>PL567T - medium; 6 clips/cartridge</Size><SupplierCode>40020</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><ARTGs><ARTG>136103</ARTG></ARTGs><MinimumBenefit>10</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE618</BillingCode><Name>Vitalitec Titanium Hemostatic Clips</Name><Description>The SLS titanium (grade 1) hemostatic clips are designed to securely grip the vessel in order to provide a complete and final occlusion atraumatically.</Description><Size>Micro, Small, Small/Medium, Medium (9 clips per cartridge)</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><ARTGs><ARTG>194411</ARTG></ARTGs><MinimumBenefit>9</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE724</BillingCode><PriorBillingCodes><PriorBillingCode>MG045</PriorBillingCode></PriorBillingCodes><Name>Everest Ligating Clip</Name><Description>Titanium clip</Description><Size>Small, Medium, Medium-Large, Large (6 per cartridge)</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><ARTGs><ARTG>235137</ARTG></ARTGs><MinimumBenefit>10</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE617</BillingCode><Name>Vitalitec Titanium Hemostatic Clips</Name><Description>The SLS titanium (grade 1) hemostatic clips are designed to securely grip the vessel in order to provide a complete and final occlusion atraumatically.</Description><Size>Small &amp; Medium Clips (24 clips per pouch - 6 clips per cartridge, 4 cartridges per pouch)</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><ARTGs><ARTG>194411</ARTG></ARTGs><MinimumBenefit>41</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE619</BillingCode><Name>Vitalitec Titanium Hemostatic Clips</Name><Description>The SLS titanium (grade 1) hemostatic clips are designed to securely grip the vessel in order to provide a complete and final occlusion atraumatically.</Description><Size>Small and Medium (27 clips per pouch - 9 clips per cartridge, 3 cartridges per pouch)</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><ARTGs><ARTG>194411</ARTG></ARTGs><MinimumBenefit>25</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE616</BillingCode><PriorBillingCodes><PriorBillingCode>RH006</PriorBillingCode></PriorBillingCodes><Name>Vitalitec Titanium Hemostatic Clips</Name><Description>The SLS titanium (grade 1) hemostatic clips are designed to securely grip the vessel in order to provide a complete and final occlusion atraumatically.</Description><Size>Micro, Small, Small/Medium, Medium, Medium/Large and Large. 6 clips per cartridge</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><ARTGs><ARTG>194411</ARTG></ARTGs><MinimumBenefit>11</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE725</BillingCode><PriorBillingCodes><PriorBillingCode>MG046</PriorBillingCode></PriorBillingCodes><Name>Everest Ligating Clip</Name><Description>Titanium clip</Description><Size>Small, Medium (24 per cartridge)</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><ARTGs><ARTG>235137</ARTG></ARTGs><MinimumBenefit>41</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ033</BillingCode><Name>Ligaclip* Ligating Clips - titanium</Name><Description>Titanium clips contained in a plastic cartridge</Description><Size>3-5mm; 6 clips per cartridge</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><ARTGs><ARTG>122810</ARTG></ARTGs><MinimumBenefit>10</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB300</BillingCode><Name>Aesculap Ligating Clips</Name><Description>Aesculap Ligating Clips Titanium</Description><Size>PL568T - medium/large; 6 clips/cartridge</Size><SupplierCode>40020</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><ARTGs><ARTG>136103</ARTG></ARTGs><MinimumBenefit>10</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM042</BillingCode><Name>Microclip</Name><Description>Malleable titanium clip</Description><Size>1.5-2.5mm x 2-3.5mm</Size><SupplierCode>40194</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><ARTGs><ARTG>339703</ARTG></ARTGs><MinimumBenefit>2</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX025</BillingCode><Name>Hem-o-lok Polymer Non-Absorbable Ligating Clip</Name><Description>Hem-o-lok Extra-large (XL) Polymer Clips</Description><Size>Extra-large (XL) (6 clips/cartridge)</Size><SupplierCode>40451</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><Suffix>Polymeric Non-resorbable</Suffix><ARTGs><ARTG>93446</ARTG><ARTG>121043</ARTG></ARTGs><MinimumBenefit>40</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB298</BillingCode><Name>Aesculap Ligating Clips</Name><Description>Aesculap Ligating Clips Titanium</Description><Size>PL566T - small cardiopack of 24</Size><SupplierCode>40020</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><ARTGs><ARTG>136103</ARTG></ARTGs><MinimumBenefit>41</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX013</BillingCode><Name>Horizon Ligating Clips  </Name><Description>Ligation Clips Titanium </Description><Size>Large (24 per cartridge)</Size><SupplierCode>40451</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><ARTGs><ARTG>121043</ARTG><ARTG>93446</ARTG></ARTGs><MinimumBenefit>41</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX012</BillingCode><Name>Horizon Ligating Clips  </Name><SupplierCode>40451</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><ARTGs><ARTG>93446</ARTG><ARTG>121043</ARTG></ARTGs><MinimumBenefit>11</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ036</BillingCode><Name>Absolok* Extra Absorbable Ligating Clips </Name><Description>Polydioxanone clips contained in a plastic cartridge</Description><Size>Small to Extralarge</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><Suffix>Resorbable</Suffix><ARTGs><ARTG>121372</ARTG></ARTGs><MinimumBenefit>81</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ034</BillingCode><Name>Ligaclip* Ligating Clips - titanium</Name><Description>Titanium clips contained in a plastic cartridge</Description><Size>9-12 mm; 6 clips per cartage</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><ARTGs><ARTG>122810</ARTG></ARTGs><MinimumBenefit>10</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX006</BillingCode><Name>Horizon Ligating Clips  </Name><SupplierCode>40451</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><ARTGs><ARTG>121043</ARTG></ARTGs><MinimumBenefit>11</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX009</BillingCode><Name>Horizon Ligating Clips  </Name><Description>Ligation Clips Titanium </Description><Size>Medium  (24 per cartridge)</Size><SupplierCode>40451</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><ARTGs><ARTG>121043</ARTG><ARTG>93446</ARTG></ARTGs><MinimumBenefit>41</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX011</BillingCode><Name>Horizon Ligating Clips  </Name><Description>Ligation Clips Titanium </Description><Size>Medium/Large (24 per cartridge)</Size><SupplierCode>40451</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><ARTGs><ARTG>121043</ARTG><ARTG>93446</ARTG></ARTGs><MinimumBenefit>41</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ035</BillingCode><Name>Ligaclip* Ligating Clips - titanium</Name><Description>Titanium clips contained in a plastic cartridge</Description><Size>3-5 mm; 20 clips per cartridge</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><ARTGs><ARTG>122810</ARTG></ARTGs><MinimumBenefit>30</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX010</BillingCode><Name>Horizon Ligating Clips  </Name><SupplierCode>40451</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><ARTGs><ARTG>121043</ARTG><ARTG>93446</ARTG></ARTGs><MinimumBenefit>11</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX008</BillingCode><Name>Horizon Ligating Clips  </Name><SupplierCode>40451</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><ARTGs><ARTG>121043</ARTG><ARTG>93446</ARTG></ARTGs><MinimumBenefit>11</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX007</BillingCode><Name>Horizon Ligating Clips  </Name><Description>Ligation Clips Titanium </Description><Size>Small  (24 per cartridge)</Size><SupplierCode>40451</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112832</SubGroupID><ARTGs><ARTG>93346</ARTG><ARTG>121043</ARTG></ARTGs><MinimumBenefit>41</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV081</BillingCode><Name>Open Clip Applier</Name><Description>Titanium</Description><Size>25 medium size titanium clips</Size><SupplierCode>40003</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112833</SubGroupID><ARTGs><ARTG>131194</ARTG></ARTGs><MinimumBenefit>125</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE606</BillingCode><Name>Cor-Knot® Device Kit</Name><Description>The Cor-Knot Device kit contains two Cor Knot devices which deliver and crimp a titanium fastener around a suture placed using routine suture placement techniques, trimming any excess suture tails</Description><Size>Each kit contains two Cor- Knot sterile devices</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112833</SubGroupID><ARTGs><ARTG>219812</ARTG></ARTGs><MinimumBenefit>249</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE609</BillingCode><Name>Cor-Knot Mini Device Kit</Name><Description>The Cor-Knot Mini Device Kit contains two Cor-Knot Mini Devices which deliver and crimp a titanium fastener around a suture placed using routine suture placement techniques, trimming any excess suture tails.</Description><Size>2 x Cor-Knot Mini Sterile Devices (14cm length shaft) in each kit</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112833</SubGroupID><ARTGs><ARTG>219812</ARTG></ARTGs><MinimumBenefit>249</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WA011</BillingCode><Name>Instinct Plus Endoscopic Clipping Device</Name><Description>The Instinct Plus Endoscopic Clipping Device consists of a single-use clip pre-loaded on a flexible delivery system. The device is designed to be compatible with forward viewing and side viewing endoscopes. The handle of the device allows the clip to be opened, closed, rotated, and deployed at the target site. </Description><Size>Opening span up to 16mm. Catheter 7Fr, length 230cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Endoscopic</Suffix><ARTGs><ARTG>96698</ARTG></ARTGs><MinimumBenefit>125</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VM002</BillingCode><Name>Precision Clip</Name><Description>Endoscopic Hemoclip</Description><Size>Jaw Opening 13mm - 16mm</Size><SupplierCode>39936</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Endoscopic</Suffix><ARTGs><ARTG>289170</ARTG></ARTGs><MinimumBenefit>125</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET067</BillingCode><Name>OTSC Clip</Name><Description>The OTSC Clip is a superelastic Nitinol clip which compresses the tissue between its teeth. Therefore it enables hemostasis as well as closing of perforations</Description><Size>OTSC Clip is available in three sizes: 9mm, 10mm and 11mm</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Endoscopic, OTS</Suffix><ARTGs><ARTG>185057</ARTG><ARTG>185054</ARTG></ARTGs><MinimumBenefit>738</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ039</BillingCode><Name>Ligaclip* Multiple Clip Applier </Name><Description>Metal/plastic applier preloaded with titanium clips; reloadable </Description><Size>5-6mm; 20 clips per applier</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Open</Suffix><ARTGs><ARTG>122810</ARTG></ARTGs><MinimumBenefit>128</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ037</BillingCode><Name>Ligaclip* Multiple Clip Applier </Name><Description>Metal/plastic applier preloaded with titanium clips</Description><Size>3-12 mm; 20 clips per applier</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Open</Suffix><ARTGs><ARTG>122810</ARTG></ARTGs><MinimumBenefit>128</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC311</BillingCode><Name>Instinct Endoscopic Hemoclip</Name><Description>Endoscopic hemoclip used within the GI tract</Description><Size>Opening span up to 16mm.</Size><SupplierCode>40434</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Endoscopic</Suffix><ARTGs><ARTG>96698</ARTG></ARTGs><MinimumBenefit>125</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL010</BillingCode><Name>Ligation device</Name><Description>Disposable pre-assembled applier and ligating loop</Description><Size>Sheath Length 1650-2300mm</Size><SupplierCode>40122</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Endoscopic</Suffix><ARTGs><ARTG>145846</ARTG></ARTGs><MinimumBenefit>125</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ038</BillingCode><Name>Ligaclip* Multiple Clip Applier </Name><Description>Metal/plastic applier preloaded with titanium clips</Description><Size>3-12 mm; 30 clips per applier</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Open</Suffix><ARTGs><ARTG>122810</ARTG></ARTGs><MinimumBenefit>128</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI217</BillingCode><Name>Premium Surgiclip™</Name><Description>Ligation Clips - Disposable clip applier and ligating clips</Description><Size>Small, Medium, Large Clips</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Open</Suffix><ARTGs><ARTG>235587</ARTG></ARTGs><MinimumBenefit>128</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CK003</BillingCode><Name>Endox Visu-Loc Clip Applier</Name><Description>Single-use laparoscopic clip applier</Description><Size>Medium, Large</Size><SupplierCode>39965</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Laparoscopic</Suffix><ARTGs><ARTG>137044</ARTG></ARTGs><MinimumBenefit>180</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ319</BillingCode><PriorBillingCodes><PriorBillingCode>ER650</PriorBillingCode></PriorBillingCodes><Name>Apollo Endosurgery X-Tack™ Endoscopic HeliX Tacking System</Name><Description>The X-Tack™ System is intended for approximation of soft tissue in minimally invasive gastroenterology procedures (e.g. closure and healing of ESD/EMR sites, and closing of fistula, perforation or leaks).using tensioned helical tacks.     The X-Tack system comprises respective delivery systems for tacking and cinching; tethered stainless steel HeliX tacks; and a PEEK cinch system.    1. The delivery system is composed of biocompatible plastic and drives the HeliX tacks into the tissue. This is replaced with the PEEK cinching system when the defect is ready for compression.  2. The stainless steel HeliX tacks are placed around the defect with the tether providing compression when tensioned and so enabling closure.  Compression is maintained using a PEEK cinch which terminates the closing construct.  3. The PEEK cinching system is a delivery system that deploys a PEEK plug/collar to the tethering system to ensure the tissue in the defect area remains compressed.</Description><Size>160 and 235 cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Endoscopic, OTS</Suffix><ARTGs><ARTG>376194</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Organisation
Billing code transferred from ER650
Sponsor transferred from EMERGO ASIA-PACIFIC PTY. LIMITED</ChangeExplanation><MinimumBenefit>2002</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Insert</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV086</BillingCode><Name>Reflex 5mm Automatic Clip Applier</Name><Description>Autofeeding disposable clip applier. Contains 15 non absorbable polymer locking clips</Description><Size>medium/large</Size><SupplierCode>40003</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Laparoscopic</Suffix><ARTGs><ARTG>212478</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET083</BillingCode><Name>Full-Thickness Resection Device (FTRD)</Name><Description>The FTRD System Set is used for diagnostic and therapeutic full-thickness resection via flexible endoscopy in the colon and rectum. The FTRD System Set is designed to ensure that the transection of tissue happens only after the defect has been completely closed.</Description><Size>The FTRD clip is and 11mm nitinol clip.
Also supplied with the FTRD marking probe (220cm) and FTRD Grasper (220cm).</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Endoscopic, OTS</Suffix><ARTGs><ARTG>235539</ARTG></ARTGs><MinimumBenefit>2002</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV076</BillingCode><Name>Reflex ELC 530 Automatic Clip Applier</Name><Description>Titanium Endoscopic Clip Applier</Description><Size>Medium/Large, 10mm, 20 Clips</Size><SupplierCode>40003</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Laparoscopic</Suffix><ARTGs><ARTG>131194</ARTG></ARTGs><MinimumBenefit>180</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MH015</BillingCode><Name>Epix™ Disposable Laparoscopic Clip Applier w/ TiGold M/L titanium clips</Name><Description>Epix™ Disposable Laparoscopic Clip Applier w/ TiGold M/L titanium clips 5mm</Description><Size>5mm</Size><SupplierCode>40039</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Laparoscopic</Suffix><ARTGs><ARTG>116980</ARTG></ARTGs><MinimumBenefit>180</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LV144</BillingCode><Name>DuraClip™ Repositionable Hemostasis Clip</Name><Description>A single use repositionable hemostasis clip which is intended to be used for placement within the gastrointestinal tract.</Description><Size>165cm Length and 235cm Length</Size><SupplierCode>40003</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Endoscopic</Suffix><ARTGs><ARTG>274973</ARTG></ARTGs><MinimumBenefit>125</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL009</BillingCode><Name>Rotatable Clip fixing device</Name><Description>Disposable pre-loaded clip applier</Description><Size>Standard or long clip length, 9 or 11mm jaw opening</Size><SupplierCode>40122</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Endoscopic</Suffix><ARTGs><ARTG>146730</ARTG></ARTGs><MinimumBenefit>125</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE567</BillingCode><Name>Hemoclip</Name><Description>Pre-loaded Endoscopically  applied clip for the GI tract.</Description><Size>Jaw openings: 9 - 16mm;
Applicator length: 165 - 230cm.</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Endoscopic</Suffix><ARTGs><ARTG>284272</ARTG></ARTGs><MinimumBenefit>125</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS299</BillingCode><Name>Resolution 360</Name><Description>Radiopaque, single-use clip pre-loaded on a flexible, rotatable delivery system</Description><Size>11mm jaw opening</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Endoscopic</Suffix><ARTGs><ARTG>271874</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG, Size</ChangeExplanation><MinimumBenefit>125</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS379</BillingCode><Name>Resolution 360 Ultra Clip</Name><Description>Radiopaque, single-use clip pre-loaded on a flexible, rotatable delivery system</Description><Size>17mm jaw opening</Size><SupplierCode>39966</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Endoscopic</Suffix><ARTGs><ARTG>271874</ARTG></ARTGs><MinimumBenefit>125</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ186</BillingCode><Name>Ligaclip Endoscopic Multiclip Applier</Name><Description>Metal/plastic stapler with titanium clips</Description><Size>10-12 mm shaft diameter, medium to large clip</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Laparoscopic</Suffix><ARTGs><ARTG>122810</ARTG></ARTGs><MinimumBenefit>180</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ482</BillingCode><Name>LIGAMAX 5mm Endoscopic Clip Applier</Name><Description>LIGAMAX 5mm Endoscopic Clip Applier</Description><Size>Medium / Large</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Laparoscopic</Suffix><ARTGs><ARTG>122810</ARTG></ARTGs><MinimumBenefit>180</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI213</BillingCode><Name>Endo Clip</Name><Description>Laparoscopic Clip Applier</Description><Size>5mm device with various clip sizes</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Laparoscopic</Suffix><ARTGs><ARTG>182307</ARTG></ARTGs><MinimumBenefit>180</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WV002</BillingCode><Name>VIPER HemoClip </Name><Description>The Viper HemoClip Device consists of a pre-loaded, single use clip for the GI tract with one step deployment.</Description><Size>9mm, 11mm, 13mm, 16mm</Size><SupplierCode>40383</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Endoscopic</Suffix><ARTGs><ARTG>408630</ARTG></ARTGs><MinimumBenefit>125</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AK012</BillingCode><Name>Lockado Clip and SureClip  </Name><Description>An endotherapy device used in combination with a compatible flexible  endoscope for the application of haemostatic clips to the mucosal lining  of the gastrointestinal (GI) tract for endoscopic marking, haemostasis,  tissue approximation, closure of luminal perforations, and/or for treating  mucosal/submucosal defects during an endoscopic procedure.</Description><Size>8mm, 11mm, 16mm, 20mm</Size><SupplierCode>39961</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Endoscopic</Suffix><ARTGs><ARTG>261692</ARTG></ARTGs><MinimumBenefit>125</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AK008</BillingCode><Name>Ligation Loop</Name><Description>A device used in combination with a dedicated endoscope. It is intended to ligate a polyp using loop wire for haemostasis or necrosis during endoscopy. It consist of an insertion sheath, a loop wire attached at the distal end of the sheath, and a control handle and operation wire connected to both the loop wire and control handle.</Description><Size>Introducer up to 240cm long
Loop sizes 15mm-40mm</Size><SupplierCode>39961</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Endoscopic</Suffix><ARTGs><ARTG>279077</ARTG></ARTGs><MinimumBenefit>125</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OB008</BillingCode><PriorBillingCodes><PriorBillingCode>MO441</PriorBillingCode></PriorBillingCodes><Name>Angiodin Procto</Name><Description>Single-use Ultrasound Proctoscope Kit (kit includes 1 x proctoscope, 6 x braided absorbable suture thread 75 cm with 26 mm needle, and 1 x knot pusher )</Description><Size>Single item</Size><SupplierCode>40119</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Doppler Guided, Endoscopic</Suffix><ARTGs><ARTG>279583</ARTG></ARTGs><MinimumBenefit>844</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MS056</BillingCode><Name>THD Slide</Name><Description>Transanal Haemorrhoidal Dearterilisation and Pexis System</Description><Size>One Size Only</Size><SupplierCode>39931</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Doppler Guided, Endoscopic</Suffix><ARTGs><ARTG>377045</ARTG></ARTGs><MinimumBenefit>844</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET064</BillingCode><Name>AMI HAL-RAR Flexi Procedure Kit</Name><Description>Doppler guided Haemorrhoidal Arterial Ligation and Recto-Anal Repair System.
HAL Haemorrhoidal Ligating sutures, doppler/ultrasound proctoscope, flexiprobe, knot pusher</Description><Size>One size, several components</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Doppler Guided, Endoscopic</Suffix><ARTGs><ARTG>144489</ARTG></ARTGs><MinimumBenefit>844</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET068</BillingCode><Name>OTSC System</Name><Description>Has two components:
1. The OTSC Clip is a superelastic Nitinol clip which compresses the tissue between its teeth; enables hemostasis as well as closing performations.

2. Grasping and Anchoring Tool. Ovesco Twin Graspers – to approximate wound edges.. Ovesco Anchor- to grasp fibrous tissue or fistulas</Description><Size>OTSC Clip is available in three sizes: 9mm, 10mm and 11 mm.
Ovesco Twin Graspers : 165mm or 220mm
Ovesco Anchor: 165mm</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Endoscopic, OTS</Suffix><ARTGs><ARTG>185054</ARTG><ARTG>18057</ARTG><ARTG>185056</ARTG><ARTG>185058</ARTG></ARTGs><MinimumBenefit>2002</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WV001</BillingCode><PriorBillingCodes><PriorBillingCode>DE645</PriorBillingCode></PriorBillingCodes><Name>Padlock clip</Name><Description>Defect closure system</Description><Size>Diameter - 9.5 - 14mm  Length - 162cm</Size><SupplierCode>40383</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Endoscopic, OTS</Suffix><ARTGs><ARTG>295460</ARTG></ARTGs><MinimumBenefit>884</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS074</BillingCode><Name>ENDOCLIP*</Name><Description>Titanium Surgical Stapler</Description><Size>10mm (ML, M, L)-(20 clips)</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Laparoscopic</Suffix><ARTGs><ARTG>182307</ARTG></ARTGs><MinimumBenefit>180</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX024</BillingCode><Name>Weck Hem-o-lok</Name><Description>Hem-o-lok Automatic Endo Applier</Description><Size>15 Clips per applier
12 Clips per applier for Large Clips</Size><SupplierCode>40451</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112834</SubGroupID><Suffix>Laparoscopic</Suffix><ARTGs><ARTG>121043</ARTG><ARTG>93446</ARTG></ARTGs><MinimumBenefit>180</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB301</BillingCode><Name>Challenger Ligating Clips</Name><Description>Challenger Ligating Clips Titanium Multifire</Description><Size>PL572T - small/medium</Size><SupplierCode>40020</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112835</SubGroupID><ARTGs><ARTG>136103</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB016</BillingCode><Name>Challenger Ligating Clips</Name><Description>Challenger Ligating Clips Titanium Multifire</Description><Size>Medium-large</Size><SupplierCode>40020</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112835</SubGroupID><ARTGs><ARTG>136103</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB321</BillingCode><Name>Pneumatic Challenger Multifire Clips</Name><Description>Challenger TI-P SM-Ligat. Clips 12 Cartridge (PL574T)  Challenger TI-P ML-Ligat. Clips 12 Cartridge (PL579T)</Description><Size>small-medium, medium-large</Size><SupplierCode>40020</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112835</SubGroupID><ARTGs><ARTG>136103</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CK001</BillingCode><Name>Microline Pentax Disposable 10ml Titanium K2 Clip Cartridge</Name><Description>Disposable cartridge containing 19 surgical grade titanium clips delivered using a re-usable hand piece applier</Description><Size>medium/large clip</Size><SupplierCode>39965</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112835</SubGroupID><ARTGs><ARTG>129715</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GQ007</BillingCode><Name>Microline Surgical Disposable 10 Titanium K2 Clip Cartridge</Name><Description>Disposable cartridge containing 10 surgical grade titanium clips delivered using a reusable handpiece applier</Description><Size>10 Clips per cartridge</Size><SupplierCode>40254</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112835</SubGroupID><ARTGs><ARTG>326239</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GQ006</BillingCode><Name>Microline Surgical Disposable 19 Titanium K2 Clip Cartridge</Name><Description>Disposable cartridge containing 19 surgical grade titanium clips delivered using a reusable handpiece applier</Description><Size>19 Clips per cartridge</Size><SupplierCode>40254</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112835</SubGroupID><ARTGs><ARTG>326239</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ040</BillingCode><Name>Ligaclip* 20/20 Reload Unit</Name><Description>Metal reload cartridge containing titanium clips</Description><Size>5 mm; 20 clips</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112835</SubGroupID><ARTGs><ARTG>122810</ARTG></ARTGs><MinimumBenefit>52</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET065</BillingCode><Name>HAL-RAR</Name><Description>HAL-Ligating Suture, AMI HAL-Ligating suture, prosthetic component of AMI HAL-RAR Doppler System</Description><Size>One size</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108005</GroupID><SubGroupID>112836</SubGroupID><ARTGs><ARTG>180973</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA269</BillingCode><Name>Bard Absorbable Fixation System</Name><Description>Open or Laparoscopic Absorbable Fixation System</Description><Size>30 Absorbable Fastners, 15 Absorbale Fastners</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112837</SubGroupID><Suffix>Absorbable</Suffix><ARTGs><ARTG>278914</ARTG></ARTGs><MinimumBenefit>473</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN175</BillingCode><Name>SECURESTRAP Open</Name><Description>Open Absorbable Strap Fixation Device</Description><Size>Strap length 6.7mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112837</SubGroupID><Suffix>Absorbable</Suffix><ARTGs><ARTG>230205</ARTG></ARTGs><MinimumBenefit>473</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS091</BillingCode><Name>VERSA TACK* stapler</Name><Description>Titanium Surgical Stapler</Description><Size>4, 4.8mm (10 staples)</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112837</SubGroupID><ARTGs><ARTG>181429</ARTG></ARTGs><MinimumBenefit>234</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS246</BillingCode><Name>ABSORBATACK</Name><Description>Absorbable Fixation Device</Description><Size>5mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112837</SubGroupID><Suffix>Absorbable</Suffix><ARTGs><ARTG>181415</ARTG></ARTGs><MinimumBenefit>473</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN115</BillingCode><Name>SECURESTRAP™</Name><Description>5mm Absorbable Strap Fixation Device</Description><Size>5mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112837</SubGroupID><Suffix>Absorbable</Suffix><ARTGs><ARTG>193268</ARTG></ARTGs><MinimumBenefit>473</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS095</BillingCode><Name>STATTACK </Name><Description>STATTACK  Titanium Helical Tacker</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112837</SubGroupID><ARTGs><ARTG>178498</ARTG></ARTGs><MinimumBenefit>234</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA204</BillingCode><Name>SorbaFix</Name><Description>Open of Laparoscopic Absorbable Fixation System.</Description><Size>15 Fasteners; 30 Fasteners</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112837</SubGroupID><Suffix>Absorbable</Suffix><ARTGs><ARTG>170112</ARTG></ARTGs><MinimumBenefit>473</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA203</BillingCode><Name>Fixation Anchor Set</Name><Description>Open or Laparoscopic Permanent Fixation System.</Description><Size>15 Fasteners; 30 Fasteners</Size><SupplierCode>39949</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112837</SubGroupID><Suffix>Endoscopic</Suffix><ARTGs><ARTG>137898</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS045</BillingCode><Name>PROTACK*; Endoscopic Tacker Device; ENDO UNIVERSAL*</Name><Description>Endoscopic; Titanium Surgical Tacker</Description><Size>20 tacks; 30 tacks; 5mm; 4mm, 4.8mm (10 staples).</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112837</SubGroupID><Suffix>Endoscopic</Suffix><ARTGs><ARTG>181429</ARTG></ARTGs><MinimumBenefit>374</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI303</BillingCode><Name>ReliaTack™ Articulating Reloadable Fixation Device with Deep Purchase Tacks</Name><Description>Articulating, reloadable, sterile, single use fixation device pre-packaged with 29 tacks (three eight-tack deep purchase reloads, and one five tack deep purchase reload)</Description><Size>7.0 mm, 29 Tacks</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112837</SubGroupID><Suffix>Absorbable, Articulating/Roticulating</Suffix><ARTGs><ARTG>315822</ARTG></ARTGs><MinimumBenefit>653</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS227</BillingCode><Name>ReliaTack Articulating Reloadable Fixation Device</Name><Description>Articulating, reloadable, sterile, single use fixation device prepackaged with 30 standard single use, absorbable reloads</Description><Size>5.1mm, 30 tacks</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112837</SubGroupID><Suffix>Absorbable, Articulating/Roticulating</Suffix><ARTGs><ARTG>315822</ARTG></ARTGs><MinimumBenefit>653</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI216</BillingCode><Name>GIA/ILA Reloading Units</Name><Description>Single Use Loading Units</Description><Size>50mm, 60mm, 80mm, 90mm, 100mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><ARTGs><ARTG>181429</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IJ017</BillingCode><PriorBillingCodes><PriorBillingCode>ME220</PriorBillingCode></PriorBillingCodes><Name>Frankenman Linear Stapler Reloads</Name><Description>Linear stapler single use reload with titanium staples</Description><Size>32mm; 46mm; 60mm; 90mm</Size><SupplierCode>40241</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><ARTGs><ARTG>207254</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX039</BillingCode><Name>Mirus Auto Linear Stapler Staple Reloads</Name><Description>Titanium staple reloads</Description><Size>Open Length - 3.5mm-4.8mm
Close Length - 1.5mm-2.0mm
Number of Staples - 11-33</Size><SupplierCode>40179</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><ARTGs><ARTG>289171</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX038</BillingCode><Name>Mirus Disposable Linear Cutter Staple Reloads</Name><Description>Titanium staple reloads</Description><Size>Open Length - 3.8mm-4.8mm
Close Length - 1.5mm-2.0mm
Number of staples - 64-104</Size><SupplierCode>40179</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><ARTGs><ARTG>289171</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX040</BillingCode><Name>Mirus Dial Linear Stapler Staple Reloads</Name><Description>Titanium staple reloads</Description><Size>Open Length - 4.2mm
Number of Staples - 11-33</Size><SupplierCode>40179</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><ARTGs><ARTG>289171</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OB003</BillingCode><Name>Touchstone Linear Cutter Stapler Cartridge (Reloads) 80mm</Name><Description>A disposable staple cartridge used in conjunction with a matched Touchstone Linear Cutter Stapler that lays a double staggered row of staples on each side a cutting knife.  Used for extensive bowel, gastric, gynaecological and thoracic surgical stapling procedures.</Description><Size>80mm length in staple line with choice of 3.8mm, 4.2mm and 4.5mm titanium staples</Size><SupplierCode>40119</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><ARTGs><ARTG>262505</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OB010</BillingCode><Name>JustRight 5mm Reload</Name><Description>Endoscopic manual linear cutting Stapler, Single-use</Description><Size>5mm shaft diameter  25mm jaw length  20cm length</Size><SupplierCode>40119</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><ARTGs><ARTG>306951</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IJ019</BillingCode><PriorBillingCodes><PriorBillingCode>ME222</PriorBillingCode></PriorBillingCodes><Name>Frankenman Linear Cutter Reloads</Name><Description>Single use, linear cutter reload cartridge containing titanium staples</Description><Size>61mm; 81mm; 100mm</Size><SupplierCode>40241</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><ARTGs><ARTG>207254</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI455</BillingCode><Name>Tri-Staple GIA Reloading Units</Name><Description>Single use loading units</Description><Size>60mm, 80mm  </Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><ARTGs><ARTG>331482</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS081</BillingCode><Name>ENDO GIA* reloading unit</Name><Description>Titanium Surgical Stapler DLU</Description><Size>30 - 35mm; 45mm; 60mm.</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><ARTGs><ARTG>181429</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN219</BillingCode><Name>Echelon</Name><Description>Staple Reload</Description><Size>35 - 60mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><Suffix>Endoscopic, Articulating/Roticulating</Suffix><ARTGs><ARTG>234042</ARTG><ARTG>125609</ARTG><ARTG>276233</ARTG></ARTGs><MinimumBenefit>318</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS186</BillingCode><Name>Endo GIA™ Reload with TriStaple™ Technology</Name><Description>Endo GIA™ Reload with TriStaple™ Technology provides three staggered rows of staples on either side of the cut line.</Description><Size>45mm, 60mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><Suffix>Endoscopic, Articulating/Roticulating</Suffix><ARTGs><ARTG>186247</ARTG></ARTGs><MinimumBenefit>318</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ069</BillingCode><Name>AEON Endostapler Reload</Name><Description>Reload Staples</Description><Size>45mm-60mm</Size><SupplierCode>40063</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><Suffix>Endoscopic, Articulating/Roticulating</Suffix><ARTGs><ARTG>329235</ARTG></ARTGs><MinimumBenefit>318</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX037</BillingCode><Name>Mirus Endocutter Staple Reloads</Name><Description>Titanium staples</Description><Size>Open Length - 2.5mm-4.8mm
Close Length - 1.0mm-2.0mm</Size><SupplierCode>40179</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><Suffix>Endoscopic, Articulating/Roticulating</Suffix><ARTGs><ARTG>289171</ARTG></ARTGs><MinimumBenefit>318</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ475</BillingCode><Name>Proximate Contour Curved Cutter/Stapler</Name><Description>Contour Curved Cutter/Stapler 30 &amp; 40mm reload cartridges</Description><Size>Blue (3.85mm) &amp; Green (4.5mm)</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><Suffix>Curved</Suffix><ARTGs><ARTG>124512</ARTG></ARTGs><MinimumBenefit>226</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN218</BillingCode><Name>Endopath Linear Cutter</Name><Description>Staple reload</Description><Size>35-45mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><ARTGs><ARTG>132171</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN213</BillingCode><Name>Proximate Linear Stapler</Name><Description>Staple reload</Description><Size>30 to 100mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><ARTGs><ARTG>133407</ARTG><ARTG>132170</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS092</BillingCode><Name>ENDO - Herna reloading unit; VERSA TACK* reloading unit.</Name><Description>Titanium Surgical Stapler DLU</Description><Size>4mm, 4.8mm (10 staples).</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><ARTGs><ARTG>181429</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI282</BillingCode><Name>Tri-Staple™ 2.0 reloads</Name><Description>Tri-Staple™ 2.0 reloads with intelligent chip that communicates with Signia™ stapler</Description><Size>30mm, 45mm, 60mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><Suffix>Endoscopic, Articulating/Roticulating</Suffix><ARTGs><ARTG>292807</ARTG><ARTG>350112</ARTG><ARTG>350111</ARTG></ARTGs><MinimumBenefit>318</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE560</BillingCode><Name>EndoWrist Stapler Reloads (used with IS Endowrist Stapler)</Name><Description>Endowrist Stapler Reload.</Description><Size>Length of Reload : 30 - 60mm,   Staple Height: 0.75 - 2.3mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><Suffix>Endoscopic, Articulating/Roticulating</Suffix><ARTGs><ARTG>239813</ARTG></ARTGs><MinimumBenefit>318</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE472</BillingCode><Name>Endowrist Stapler 45</Name><Description>Endowrist Stapler 45 White Reload, 45 Blue Reload, 45 Green Reload</Description><Size>Length of reload: 45mm
Staple height: 2.5mm, 3.5mm, 4.3mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><Suffix>Endoscopic, Articulating/Roticulating</Suffix><ARTGs><ARTG>239813</ARTG></ARTGs><MinimumBenefit>318</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IJ021</BillingCode><PriorBillingCodes><PriorBillingCode>ME225</PriorBillingCode></PriorBillingCodes><Name>Frankenman Endoscopic Linear Cutter Reload</Name><Description>The Endoscopic Linear Cutter Reload has applications in resection, transection and/or anastomosis of tissue in open or laparoscopic procedures.</Description><Size>Cartridge Reload - 30mm, 45mm, 60mm staple lengths. Open leg length: 2.0mm - 4.5mm, closed staple height: 0.75mm - 2.0mm.</Size><SupplierCode>40241</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><Suffix>Endoscopic, Articulating/Roticulating</Suffix><ARTGs><ARTG>207254</ARTG></ARTGs><MinimumBenefit>318</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS076</BillingCode><Name>ENDO TA* reloading unit</Name><Description>Titanium Surgical Stapler DLU</Description><Size>30mm -2.5, 30mm-3.5</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><ARTGs><ARTG>182307</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI215</BillingCode><Name>PI/TA Reloading Units</Name><Description>PI/TA Disposable Surgical Loading Unit</Description><Size>30mm, 45mm, 60mm, 90mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><ARTGs><ARTG>185017</ARTG><ARTG>181429</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN220</BillingCode><Name>EES Linear Cutter</Name><Description>Staple reload</Description><Size>55-75mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><ARTGs><ARTG>155639</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OB006</BillingCode><Name>Touchstone Linear Cutter Stapler Cartridge (Reloads) 100mm</Name><Description>A disposable staple cartridge used in conjunction with a matched Touchstone Linear Cutter Stapler that lays a double staggered row of staples on each side a cutting knife.  Used for extensive bowel, gastric, gynaecological and thoracic surgical stapling procedures.</Description><Size>100mm length in staple line with choice of 3.8mm and 4.5mm titanium staples</Size><SupplierCode>40119</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112838</SubGroupID><ARTGs><ARTG>262505</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ903</BillingCode><Name>Echelon</Name><Description>Disposable stapling device</Description><Size>45-60mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112839</SubGroupID><Suffix>Endoscopic</Suffix><ARTGs><ARTG>155639</ARTG></ARTGs><MinimumBenefit>357</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN206</BillingCode><Name>Endopath Cutter</Name><Description>Cutter and Stapler</Description><Size>45mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112839</SubGroupID><Suffix>Endoscopic, Articulating/Roticulating</Suffix><ARTGs><ARTG>155639</ARTG></ARTGs><MinimumBenefit>357</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE683</BillingCode><Name>SureForm</Name><Description>Disposable stapling device</Description><Size>45mm (staple line length)  60mm (staple line length)</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112839</SubGroupID><Suffix>Endoscopic, Articulating/Roticulating, Powered</Suffix><ARTGs><ARTG>309263</ARTG></ARTGs><MinimumBenefit>447</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI227</BillingCode><Name>Signia™ Powered Intelligent Stapling System</Name><Description>Powered, articulating, endoscopic intelligent stapler with Adaptive Firing and real time technology</Description><Size>30mm, 45mm, 60mm lengths</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112839</SubGroupID><Suffix>Endoscopic, Articulating/Roticulating, Powered</Suffix><ARTGs><ARTG>287923</ARTG><ARTG>287417</ARTG><ARTG>287262</ARTG></ARTGs><MinimumBenefit>447</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN215</BillingCode><Name>Echelon</Name><Description>Disposable powered stapling device</Description><Size>35 to 60mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112839</SubGroupID><Suffix>Endoscopic, Articulating/Roticulating, Powered</Suffix><ARTGs><ARTG>195695</ARTG></ARTGs><MinimumBenefit>447</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN214</BillingCode><Name>EES Linear Cutter</Name><Description>Single use, reloadable stapler</Description><Size>55 to 75mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112839</SubGroupID><ARTGs><ARTG>155639</ARTG></ARTGs><MinimumBenefit>69</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ068</BillingCode><Name>AEON Endostapler</Name><Description>Endoscopic articulated stapler</Description><Size>Short (60mm)  Medium (160mm)  Long (260mm)</Size><SupplierCode>40063</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112839</SubGroupID><Suffix>Endoscopic, Articulating/Roticulating</Suffix><ARTGs><ARTG>329207</ARTG></ARTGs><MinimumBenefit>357</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IJ020</BillingCode><PriorBillingCodes><PriorBillingCode>ME224</PriorBillingCode></PriorBillingCodes><Name>Frankenman Endoscopic Linear Cutter</Name><Description>The Endoscopic Linear Cutter and Reloads have applications in resection, transection and/or anastomosis of tissue in open or laparoscopic procedures.</Description><Size>Stapler Unit - 280mm, 330mm, 380mm, 430mm, 480mm in 12.5mm shaft OD.  Reloadable Cartridges - 30mm, 45mm, 60mm staple lengths.</Size><SupplierCode>40241</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112839</SubGroupID><Suffix>Endoscopic, Articulating/Roticulating</Suffix><ARTGs><ARTG>205331</ARTG></ARTGs><MinimumBenefit>357</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX031</BillingCode><Name>Mirus Endocutter</Name><Description>A stapler with triple staggered rows of titanium staples used to cut and close soft tissue.</Description><Size>Small - shaft length 60mm
Medium - shaft length 160mm
Long - shaft length 260mm</Size><SupplierCode>40179</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112839</SubGroupID><Suffix>Endoscopic, Articulating/Roticulating</Suffix><ARTGs><ARTG>289071</ARTG></ARTGs><MinimumBenefit>357</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ904</BillingCode><Name>Echelon</Name><Description>Stapler</Description><Size>45 - 60mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112839</SubGroupID><Suffix>Endoscopic, Articulating/Roticulating</Suffix><ARTGs><ARTG>155639</ARTG></ARTGs><MinimumBenefit>357</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS046</BillingCode><Name>Endo GIA Stapling System</Name><Description>Endoscopic/thoroscopic</Description><Size>12mm; One size only.</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112839</SubGroupID><Suffix>Endoscopic, Articulating/Roticulating</Suffix><ARTGs><ARTG>346475</ARTG></ARTGs><MinimumBenefit>357</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS134</BillingCode><Name>DST Series EEA Or Vil</Name><Description>Accessory</Description><Size>21mm, 25mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112839</SubGroupID><Suffix>Endoscopic</Suffix><ARTGs><ARTG>178497</ARTG></ARTGs><MinimumBenefit>357</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT224</BillingCode><Name>GORE®  SEAMGUARD® Bioabsorbable Staple Line Reinforcement</Name><Description>GORE® SEAMGUARD® Reinforcement is a synthetic 100% bioabsorbable material, constructed from Polyglycolic Acid:Trimethylene Carbonate. Buttressing material is engineered to reduce perioperative leaks and bleeding in a variety of minimally invasive surgeries.</Description><Size>1BSGEC60- for 60mm Ethicon Stapler Straight, 1BSGEC60A- for 60mm Ethicon Stapler, 1BSGEC45- for 45mm Ethicon Stapler, 1BSGTRI45P- for 45mm Endo GIA Tristapler Purple, 1BSGTRI45B-  for 45mm Endo GIA Tristapler Black, 1BSGTRI60P- for 60mm Endo GIA Tristapler Purple, 1BSGTRI60B- for 60mm Endo GIA Tristapler Black</Size><SupplierCode>40435</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112840</SubGroupID><ARTGs><ARTG>153351</ARTG></ARTGs><MinimumBenefit>198</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT228</BillingCode><Name>GORE® SEAMGUARD® Bioabsorbable Staple Line Reinforcement (Circular)</Name><Description>GORE® SEAMGUARD® Reinforcement is a synthetic 100% bioabsorbable material, constructed from Polyglycolic Acid:Trimethylene Carbonate. Buttressing material is engineered to reduce perioperative leaks and bleeding in a variety of minimally invasive surgeries. Configured for a range of circular/EEA staplers- 25mm, 28mm, 29mm, 31mm, 33mm &amp; 34mm</Description><Size>Circular Seamguard is configured for a range of circular/EEA staplers- 25mm, 28mm, 29mm, 31mm, 33mm &amp; 34mm for both Johnson &amp; Johnson &amp; Medtronic Circular Staplers</Size><SupplierCode>40435</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112840</SubGroupID><ARTGs><ARTG>153352</ARTG></ARTGs><MinimumBenefit>198</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS209</BillingCode><Name>Endo GIA Reinforced Reload with Tri-Staple Technology</Name><Description>The Endo GIA Reinforced Reload with Tri-Staple Technology is an endoscopic stapler reload pre-attached with a non-woven absorbable polyglycolic acid staple line reinforcement mesh. This reinforced reload places a triple-staggered row of titanium staples and two layers of absorbable reinforcement material on either side of the cut line.</Description><Size>45mm and 60mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112840</SubGroupID><Suffix>Integrated</Suffix><ARTGs><ARTG>231041</ARTG></ARTGs><MinimumBenefit>521</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI287</BillingCode><Name>Tri-Staple  2.0 Reinforced reloads</Name><Description>Tri-Staple  2.0 Reinforced reload preloaded with polyglycolic acid staple line reinforcement mesh and with intelligent chip that communicates with Signia  stapler.</Description><Size>45mm, 60mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112840</SubGroupID><Suffix>Integrated</Suffix><ARTGs><ARTG>350110</ARTG></ARTGs><MinimumBenefit>521</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS110</BillingCode><Name>DFS Disposable Fascia Stapler</Name><Description>Stainless Steel</Description><Size>One Size Only</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><ARTGs><ARTG>180134</ARTG></ARTGs><MinimumBenefit>292</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OB005</BillingCode><Name>Touchstone Linear Cutter Stapler 100mm</Name><Description>A device that incorporates a disposable staple cartridge that lays a double staggered row of staples on each side of a cutting knife.  Used for extensive bowel, gastric, gynaecological and thoracic surgical stapling procedures.</Description><Size>100mm length in staple line with choice of 3.8mm and 4.5mm titanium</Size><SupplierCode>40119</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><ARTGs><ARTG>262505</ARTG></ARTGs><MinimumBenefit>292</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI214</BillingCode><Name>GIA™ Stapler With DST Series™</Name><Description>Single use reloadable linear cutting stapler designed with 4.8 mm, 3.8 mm, and 2.5 mm staple heights</Description><Size>2.5mm, 3.8mm, 4.8mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><ARTGs><ARTG>181272</ARTG></ARTGs><MinimumBenefit>292</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OB007</BillingCode><Name>Touchstone Prolapse Haemorrhoid Stapler</Name><Description>A surgical implanting device for placing a specific size of double staggered row of titanium staples in a circular fashion in the Anal and/or Rectal region for the circumferential excision of the prolapsed distal rectal muscosa, as described by Dr. Longo, Italy.</Description><Size>33mm and 36mm</Size><SupplierCode>40119</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><Suffix>Circular</Suffix><ARTGs><ARTG>262507</ARTG></ARTGs><MinimumBenefit>648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ056</BillingCode><Name>Proximate Articulating Linear Stapler</Name><Description>Articulating linear stapler preloaded with titanium staples</Description><Size>55mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><Suffix>Articulating/Roticulating</Suffix><ARTGs><ARTG>132167</ARTG></ARTGs><MinimumBenefit>662</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI219</BillingCode><Name>EEA Circular Stapler</Name><Description>Circular staplers</Description><Size>21mm to 34mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><Suffix>Endoscopic, Circular</Suffix><ARTGs><ARTG>178517</ARTG></ARTGs><MinimumBenefit>671</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI281</BillingCode><Name>EEA Circular Stapler with Tri Staple Technology</Name><Description>Circular staplers with 3 row staples, slope faced cartridge with a different  staple size in each staple row.</Description><Size>21mm to 33mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><Suffix>Endoscopic, Circular</Suffix><ARTGs><ARTG>293808</ARTG></ARTGs><MinimumBenefit>671</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN216</BillingCode><Name>Ethicon Intraluminal Stapler</Name><Description>Proximate and  Endopath staplers</Description><Size>21 - 33mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><Suffix>Endoscopic, Circular</Suffix><ARTGs><ARTG>124512</ARTG><ARTG>99218</ARTG></ARTGs><MinimumBenefit>671</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IJ015</BillingCode><PriorBillingCodes><PriorBillingCode>ME219</PriorBillingCode></PriorBillingCodes><Name>Frankenman Linear Cutter Stapler</Name><Description>Single use, reloadable, linear cutter stapler containing titanium staples</Description><Size>61mm; 81mm; 100mm</Size><SupplierCode>40241</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><ARTGs><ARTG>205331</ARTG><ARTG>205319</ARTG></ARTGs><MinimumBenefit>292</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX033</BillingCode><Name>Mirus Dial Linear Stapler</Name><Description>A disposable, reloadable linear stapler with dial</Description><Size>Accommodates staple line lengths of 30mm, 45mm, 60mm and 90mm.</Size><SupplierCode>40179</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><ARTGs><ARTG>289086</ARTG></ARTGs><MinimumBenefit>292</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OB009</BillingCode><Name>JustRight 5mm Stapler</Name><Description>Endoscopic manual linear cutting stapler, single use</Description><Size>5mm shaft diameter  25mm jaw length  20cm length</Size><SupplierCode>40119</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><ARTGs><ARTG>306951</ARTG></ARTGs><MinimumBenefit>292</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX032</BillingCode><Name>Mirus Disposable Linear Cutter</Name><Description>Disposable, reloadable linear cutter stapler</Description><Size>Stapling line lengths of 60mm, 80mm and 100mm</Size><SupplierCode>40179</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><ARTGs><ARTG>289076</ARTG></ARTGs><MinimumBenefit>292</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX034</BillingCode><Name>Mirus Auto Linear Stapler</Name><Description>A disposable, reloadable linear stapler</Description><Size>Accommodates staple line lengths of 30mm, 45mm, 60mm and 90mm.</Size><SupplierCode>40179</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><ARTGs><ARTG>289086</ARTG></ARTGs><MinimumBenefit>292</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OB002</BillingCode><Name>Touchstone Linear Cutter Stapler 80mm</Name><Description>A device that incorporates a disposable staple cartridge that lays a double staggered row of staples on each side of a cutting knife.  Used for extensive bowel, gastric, gynaecological and thoracic surgical stapling procedures.</Description><Size>80mm length in staple line with choice of 3.8mm, 4.2mm and 4.5mm titanium staples</Size><SupplierCode>40119</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><ARTGs><ARTG>262505</ARTG></ARTGs><MinimumBenefit>292</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET066</BillingCode><Name>Insorb Subcuticular Stapler</Name><Description>A subcuticular (dermal) surgical delivery system loaded with resorbable staples/prostheses</Description><Size>Each staple is 5mm x 3mm</Size><SupplierCode>40085</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><ARTGs><ARTG>178665</ARTG></ARTGs><MinimumBenefit>292</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS077</BillingCode><Name>ENDO GIA*</Name><Description>Titanium Surgical Stapler</Description><Size>30 - 35mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><Suffix>Endoscopic</Suffix><ARTGs><ARTG>181272</ARTG></ARTGs><MinimumBenefit>473</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS075</BillingCode><Name>ENDO TA*</Name><Description>Titanium Surgical Stapler</Description><Size>30mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><Suffix>Endoscopic</Suffix><ARTGs><ARTG>185016</ARTG></ARTGs><MinimumBenefit>473</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI212</BillingCode><Name>PI/TA Stapler</Name><Description>Disposable Surgical Stapler and Loading Unit</Description><Size>30mm, 45mm, 60mm, 90mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><ARTGs><ARTG>181434</ARTG><ARTG>185015</ARTG><ARTG>185733</ARTG></ARTGs><MinimumBenefit>292</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN217</BillingCode><Name>Proximate</Name><Description>Preloaded stapler</Description><Size>30-100mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><ARTGs><ARTG>132167</ARTG><ARTG>133406</ARTG><ARTG>132166</ARTG></ARTGs><MinimumBenefit>292</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ184</BillingCode><Name>Endopath Multi Stapler</Name><Description>Endoscopic titanium stapler with staples</Description><Size>11mm shaft diameter</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><Suffix>Endoscopic</Suffix><ARTGs><ARTG>124512</ARTG></ARTGs><MinimumBenefit>473</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ812</BillingCode><Name>CONTOUR Curved Cutter Stapler</Name><Description>Curved cutter and stapler for gastrointestinal transaction and resection.</Description><Size>40mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><Suffix>Curved</Suffix><ARTGs><ARTG>118291</ARTG></ARTGs><MinimumBenefit>559</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IJ018</BillingCode><PriorBillingCodes><PriorBillingCode>ME221</PriorBillingCode></PriorBillingCodes><Name>Frankenman Linear Stapler</Name><Description>Linear stapler preloaded with titanium staples</Description><Size>32mm; 46mm; 60mm; 90mm</Size><SupplierCode>40241</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><ARTGs><ARTG>205319</ARTG><ARTG>205331</ARTG></ARTGs><MinimumBenefit>292</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ443</BillingCode><Name>Proximate Intraluminal Stapler PPH</Name><Description>Proximate Hemorrhoidal Circular Stapler PPH</Description><Size>One Size Only</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><Suffix>Circular</Suffix><ARTGs><ARTG>99218</ARTG></ARTGs><MinimumBenefit>648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI456</BillingCode><Name>GIA Stapler with Tri-Staple technology</Name><Description>Single use, reloadable stapler</Description><Size>60mm, 80mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><ARTGs><ARTG>331481</ARTG></ARTGs><MinimumBenefit>292</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ050</BillingCode><Name>Proximate* Linear Stapler</Name><Description>Metal/Plastic linear stapler preloaded with titanium staples, manual closure</Description><Size>55 - 60mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><ARTGs><ARTG>132167</ARTG></ARTGs><MinimumBenefit>292</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS179</BillingCode><Name>EEA Haemorrhoid and Prolapse Stapler</Name><Description>Stapling instrument for control of rectal prolapse and haemorrhoid disease.</Description><Size>33mm Circular Stapling line, 3.5 mm and 4.8mm Staple leg length.</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><Suffix>Circular</Suffix><ARTGs><ARTG>178674</ARTG></ARTGs><MinimumBenefit>648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX036</BillingCode><Name>Mirus Hemorrhoids Stapler</Name><Description>Disposable stapler with 2 or 3 staggered rows of titanium staples</Description><Size>Available in models with 2 rows and 3 rows of staples</Size><SupplierCode>40179</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><Suffix>Circular</Suffix><ARTGs><ARTG>289057</ARTG></ARTGs><MinimumBenefit>648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IJ014</BillingCode><PriorBillingCodes><PriorBillingCode>ME218</PriorBillingCode></PriorBillingCodes><Name>Frankenman Haemorrhoidal (CPH) Stapler</Name><Description>Circular stapler for rectal prolapse and haemorrhoids preloaded with titanium staples</Description><Size>Outside diameter: 32.5mm; 34.5mm</Size><SupplierCode>40241</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><Suffix>Circular</Suffix><ARTGs><ARTG>205330</ARTG></ARTGs><MinimumBenefit>648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IJ016</BillingCode><PriorBillingCodes><PriorBillingCode>ME217</PriorBillingCode></PriorBillingCodes><Name>Frankenman Circular Stapler</Name><Description>Curved intraluminal stapler preloaded with titanium staples.</Description><Size>21mm; 25mm; 28mm; 32mm</Size><SupplierCode>40241</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><Suffix>Circular</Suffix><ARTGs><ARTG>292060</ARTG></ARTGs><MinimumBenefit>648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OX035</BillingCode><Name>Mirus Circular Intraluminal Stapler</Name><Description>Disposable circular stapler with mechanism to measure tissue thickness</Description><Size>Available in 2 rows and 3 rows of staples</Size><SupplierCode>40179</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><Suffix>Circular</Suffix><ARTGs><ARTG>289056</ARTG></ARTGs><MinimumBenefit>648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OB004</BillingCode><Name>Touchstone Circular Stapler</Name><Description>A surgical implanting device for placing s specific size of double staggered row of titanium staples in a circular fashion in the large bowel, small bowel or oesophagus to maintain function of the digestive tract.  A suitable size is used to match the lumen size of the patient's digestive tract</Description><Size>External dimension - 21mm, 25mm, 29mm or 33mm</Size><SupplierCode>40119</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112841</SubGroupID><Suffix>Circular</Suffix><ARTGs><ARTG>263001</ARTG></ARTGs><MinimumBenefit>648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS229</BillingCode><Name>ReliaTack™ Absorbable Tacks</Name><Description>10 x absorbable reloads to be used with ReliaTack atriculating tacking device</Description><Size>5.1mm, 10 tacks</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112842</SubGroupID><Suffix>10 Tacks, Absorbable</Suffix><ARTGs><ARTG>315822</ARTG></ARTGs><MinimumBenefit>323</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS228</BillingCode><Name>ReliaTack™ Absorbable Tacks</Name><Description>5 x absorbable reloads to be used with ReliaTack articulating tacking device</Description><Size>5.1mm, 5 tacks</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112842</SubGroupID><Suffix>5 Tacks, Absorbable</Suffix><ARTGs><ARTG>315822</ARTG></ARTGs><MinimumBenefit>162</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI304</BillingCode><Name>ReliaTack Articulating Reloadable Fixation Device with Deep Purchase Tacks (Reloads x 5)</Name><Description>5 x absorbable deep purchase reloads to be used with ReliaTack articulating tacking device</Description><Size>7.0 mm  5 Tacks</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112842</SubGroupID><Suffix>5 Tacks, Absorbable</Suffix><ARTGs><ARTG>315822</ARTG></ARTGs><MinimumBenefit>162</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI305</BillingCode><Name>ReliaTack Articulating Reloadable Fixation Device with Deep Purchase Tacks (Reloads x 8)</Name><Description>8 x absorbable deep purchase reloads to be used with ReliaTack articulating tacking device</Description><Size>7.0 mm  8 tacks</Size><SupplierCode>40151</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112842</SubGroupID><Suffix>8 Deep Purchase Tack, absorbable</Suffix><ARTGs><ARTG>315822</ARTG></ARTGs><MinimumBenefit>258</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WL001</BillingCode><PriorBillingCodes><PriorBillingCode>LH528</PriorBillingCode></PriorBillingCodes><Name>LiquiBand Fix8</Name><Description>Hernia Mesh Fixation System, preloaded into applicator</Description><Size>33 tacks</Size><SupplierCode>40403</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112843</SubGroupID><Suffix>Synthetic, Endoscopic</Suffix><ARTGs><ARTG>233374</ARTG><ARTG>314884</ARTG></ARTGs><MinimumBenefit>463</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE726</BillingCode><PriorBillingCodes><PriorBillingCode>MG048</PriorBillingCode></PriorBillingCodes><Name>Glutack</Name><Description>Catheter for controlled application of surgical adhesive.</Description><Size>25, 40, 50 drops</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112843</SubGroupID><Suffix>Synthetic, Endoscopic</Suffix><ARTGs><ARTG>313580</ARTG></ARTGs><MinimumBenefit>211</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE611</BillingCode><Name>Cor-Knot®Quick Load 6 Pouch</Name><Description>The Cor-Knot®Quick load 6 contains six single sterile Cor-Knot® Titanium Fasteners for use with the Cor-Knot® device kit</Description><Size>One size</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112844</SubGroupID><ARTGs><ARTG>219813</ARTG></ARTGs><MinimumBenefit>308</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE610</BillingCode><Name>Cor-Knot®Quick Load single</Name><Description>The Cor-Knot®Quick Load houses one sterile Cor-Knot®Titanium Fastener for use with the Cor-Knot®device kit</Description><Size>One size</Size><SupplierCode>39975</SupplierCode><CategoryID>107554</CategoryID><SubCategoryID>107595</SubCategoryID><GroupID>108006</GroupID><SubGroupID>112844</SubGroupID><ARTGs><ARTG>219813</ARTG></ARTGs><MinimumBenefit>50</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WA007</BillingCode><Name>Biodesign Otologic Repair Graft (small)</Name><Description>Implantable biologic graft intended for use in otologic procedures.</Description><Size>2 discs with diameters of 0.4 and 0.6cm or 0.6 and 0.9 cm.
2.5X2.5cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107828</GroupID><SubGroupID>112862</SubGroupID><Suffix>Porcine</Suffix><ARTGs><ARTG>300314</ARTG></ARTGs><MinimumBenefit>325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WA006</BillingCode><Name>Biodesign Otologic Repair Graft</Name><Description>Implantable biologic graft intended for use in otologic procedures.</Description><Size>5.0x5.0cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107828</GroupID><SubGroupID>112863</SubGroupID><Suffix>Porcine</Suffix><ARTGs><ARTG>300314</ARTG></ARTGs><MinimumBenefit>492</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>US021</BillingCode><Name>Vibrant Soundbridge System - Vibrating Ossicular Prosthesis VORP503</Name><Description>Part of the Vibrant Soundbridge System, VORP503 is an active implant, which is implanted into the temporal bone under the skin. The VORP 503 consists of the Floating Mass Transducer (FMT), a conductor link, the electronics (demodulator), fixation wings and a magnet surrounded by a receiver coil.</Description><Size>One size (left and right) Length: 118mm, Width: 28mm, Thickness: 4.4mm, Weight: 10.1g</Size><SupplierCode>40167</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112864</SubGroupID><ARTGs><ARTG>389014</ARTG></ARTGs><MinimumBenefit>7470</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>US029</BillingCode><Name>SAMBA 2 Audio Processor</Name><Description>Single Unit audio processor for the Vibrant Soundbridge System, worn off the ear it is held in place by magnetic attraction over the implant. Designed to function similarly as the SAMBA audio processor but with improved battery life, noise reduction, ingress protection and Intelligent Sound Adapter 2.0</Description><Size>One Size - Lo/Hi, left/right versions with various magnet strengths, length = 36.4mm, width = 30.4mm, height = 10.2mm, weight 9.3g (inc battery)</Size><SupplierCode>40167</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112864</SubGroupID><Suffix>Programmable, Wireless-enabled, Autoscan</Suffix><ARTGs><ARTG>353970</ARTG></ARTGs><MinimumBenefit>7166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>US020</BillingCode><Name>Vibrant Soundbridge System - Samba Audio Processor</Name><Description>Middle ear implant audio processor.   The Samba audio processor is the externally worn component of the Vibrant Soundbridge System and connects to the implant through magnetic attraction.  Fitting the Samba audio processor activates the Soundbridge.</Description><Size>Samba Lo, Samba Hi left and right versions, length = 35mm, width = 30mm, height = 10mm, weight &lt;9g (inc battery</Size><SupplierCode>40167</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112864</SubGroupID><Suffix>Programmable, wireless - enabled</Suffix><ARTGs><ARTG>271112</ARTG></ARTGs><MinimumBenefit>6825</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>US019</BillingCode><Name>Vibrant Soundbridge System - Vibroplasty Couplers</Name><Description>Middle ear prostheses used with the Vibrant Soundbridge System VORP implant.  Facilitate coupling between the FMT and a vibratory structure of the middle ear.</Description><Size>Functional length:  Vibroplasty-OW-Coupler - 2.50, 3.00, 3.50, 4.00mm  Vibroplasty-CliP-Coupler - 0.20, 0.50, 1.00, 1.50mm  Vibroplasty-Bell-Coupler - 0.20, 0.50, 1.00, 1.50mm  Vibroplasty-RW-Coupler - 0.85mm  Incus-Symphonix-Coupler - Left and Right (2.5 x 3.3mm)  Incus-LP-Coupler - Left and Right (2.8 x 3.8mm)   Incus-SP-Coupler (2.9 x 4.4mm)  RW-Soft-Coupler (1 x 1.5mm)  Stapes-SH-Coupler (3.5 x 4.1mm)</Size><SupplierCode>40167</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112864</SubGroupID><Suffix>Coupler</Suffix><ARTGs><ARTG>185533</ARTG></ARTGs><MinimumBenefit>350</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET072</BillingCode><Name>Eclipse Piston</Name><Description>Stapes: Nitinol, Fluroplastic</Description><Size>Diameter 0.4mm: 3.75mm - 6.00mm; Diameter 0.5mm: 3.75mm - 6.00mm;  Diameter 0.6mm: 3.75mm - 6.00mm</Size><SupplierCode>40085</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112866</SubGroupID><ARTGs><ARTG>170281</ARTG></ARTGs><MinimumBenefit>94</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI079</BillingCode><Name>Middle ear prostheses</Name><Description>Stapes</Description><Size>0.4-1.17mm x 0.9-4.0 x 4.0 x4.0-10.2mm; 4.0 - 4.75mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112866</SubGroupID><ARTGs><ARTG>125831</ARTG></ARTGs><MinimumBenefit>94</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC918</BillingCode><Name>The Big Easy Piston</Name><Description>Big Easy Range - MRI Safe, Triple Width Platinum Band, Double Width Platinum Shaft with Offset Versions</Description><Size>0.4 - 1.17mm x 0.9 - 4.0mm x 4.0 x 10.2mm; 4.0 - 4.75mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112866</SubGroupID><ARTGs><ARTG>125831</ARTG></ARTGs><MinimumBenefit>94</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UP003</BillingCode><PriorBillingCodes><PriorBillingCode>LM332</PriorBillingCode></PriorBillingCodes><Name>Stapes</Name><Description>a) NiTiBOND   b) Soft CliP   c) K-Piston   d) Angular Piston   e) CliP Piston aWengen   f) CliP Piston MVP  g) Lenticle Cup</Description><Size>a) Diameter - 0.4 or 0.6mm in lengths - 3.5 to 5.5mm   b)  Diameter - 0.4 or 0.6mm in lengths 3.5 to 5.5mm   c) Diameter - 0.4 or 0.6mm in lengths 3.5 to 10mm   d) Diameter 0.4 or 0.6mm in lengths 4.25, 4.5, 4.75mm   e) Diameter - 0.4mm or 0.6mm in lengths 3.5 to 5.5mm   f) Diameter 0.4 or 0.6mm in lengths - 5 to 6.25mm  g) lengths - 3 to 4.5mm</Size><SupplierCode>40260</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112866</SubGroupID><ARTGs><ARTG>119746</ARTG></ARTGs><MinimumBenefit>94</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL012</BillingCode><Name>Canal Wall Prosthesis</Name><Description>Grote, HA</Description><Size>Small - Large</Size><SupplierCode>40122</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112866</SubGroupID><ARTGs><ARTG>123372</ARTG></ARTGs><MinimumBenefit>94</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL091</BillingCode><Name>Stapes</Name><Description>Causse Pistons,  Cawthorne Pistons,  Fisch-Type Pistons,  Fluoroplastic Pistons,  McGee Pistons,  Richards Platinum Fluoroplastic Pistons,  Schuknecht Pistons,  Schuknecht Malleus Attached Pistons  SMart Pistons,  SMart 360 Pistons  SMart Malleus</Description><Size>Diameter: 0.3mm to 0.8mm  Functional Length: 3.5mm to 6.5mm</Size><SupplierCode>40122</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112866</SubGroupID><ARTGs><ARTG>123372</ARTG></ARTGs><MinimumBenefit>94</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL089</BillingCode><Name>Stapes</Name><Description>De La Cruz
House-Type
Lippy Modified
Classic
Richards Bucket Handle</Description><Size>Various</Size><SupplierCode>40122</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112866</SubGroupID><ARTGs><ARTG>123372</ARTG></ARTGs><MinimumBenefit>94</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL014</BillingCode><Name>Ossicular Prosthesis</Name><Description>Attic Defect Plate, HA</Description><Size>7-14mm</Size><SupplierCode>40122</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112866</SubGroupID><ARTGs><ARTG>123372</ARTG></ARTGs><MinimumBenefit>94</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC919</BillingCode><Name>Middle Ear Prosthesis</Name><Description>Malleus</Description><Size>0.6 - 4.0mm x 2.7 - 5.0mm x 1.5 - 10.0mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112867</SubGroupID><ARTGs><ARTG>125831</ARTG></ARTGs><MinimumBenefit>167</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET073</BillingCode><Name>Eclipse Malleus Piston</Name><Description>Malleus &amp; Stapes: Nitinol, Fluoroplastic</Description><Size>Diamater 0.6mm: 5.5mm-8.00mm</Size><SupplierCode>40085</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112868</SubGroupID><ARTGs><ARTG>170281</ARTG></ARTGs><MinimumBenefit>227</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RC010</BillingCode><Name>Stapes Prosheses</Name><Description>For reconstruction of the sound conduction chain between middle ear and inner ear through replacement of the stapes. The body of the implant consists of a columella (which in some product versions can be shortened) and a flat band. The columella is inserted in the opened Vestibulum auris through the trepanated stapes foot-plate. The flat band is placed around the long process of the incus. The implants are available in various versions and materials:
• Titanium: Columella and flat band made of titanium;
• Platinum/PTFE: Columella made of polytetrafluoroethylene (PTFE), flat band made of platinum (Pt);
• Nitinol/PTFE: Columella made of polytetrafluoroethylene (PTFE), flat band made of nitinol.</Description><Size>Stapes Prostheses Nitinol/PTFE, 1 piece, sterile, Wire diam: 0.2 mm, PTFE shaft diam: 0.4 &amp; 0.6 mm, Incus diam. small standard, large; length 5.25, 5.50, 5.75, 7.00 (shortenable)
Stapes Prostheses Platinum/PTFE, 1 piece, sterile; piston diam. 0.4 &amp; 0.6 mm; length 5.25, 5.50, 5.75, 7.00 (shortenable), 10.00 (shortenable)
Stapes Prostheses Titanium, 1 piece, sterile; piston diam. 0.4 &amp; 0.6 mm; length 5.25, 5.50, 5.75, 8.00 (shortenable)</Size><SupplierCode>39997</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112868</SubGroupID><ARTGs><ARTG>290802</ARTG></ARTGs><MinimumBenefit>227</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RC012</BillingCode><Name>PORP - Partial Ossicular Replacement Prosthesis</Name><Description>Partial implant made of titanium, for reconstructing a (partially) destroyed middle ear ossicular chain (chain of sound transmission) between the stapes and the tympanic membrane level in fixed and variable lengths. 
Fixed - The implant body is a single piece and was made from a single part only, i.e. it has no susceptible material bonding points such as weld seams. The implant can be subdivided into three areas: 1.) the implant bell that is offered in 2 embodiments: Unslitted and slitted; 2.) the implant shaft; 3.) the perforated implant plate. The implant plate can be arranged centrically (round) towards the implant shaft or eccentrically (oval). In the eccentric version (oval), an additional groove has been worked into the plate to improve receiving the malleus handle. 
Variable - The implant body consists of two parts, a shortenable shaft that is firmly bound to the prosthesis bell, and a prosthesis plate that has been provided with a borehole in its underside. The borehole has been dimensionally designed in such a way that it can receive the shaft after the latter has been adapted lengthwise to the respective situation in the middle ear. 
The surface of the predefined contact point (upper side of implant plate and inner side of the bell) is roughened in order to facilitate better bonding to the eardrum resp. the stapes head.</Description><Size>Central Head with slitted Bell - shaft diam. 0.3mm, Length 0.5 - 3.5mm
Offset Head with slitted Bell - shaft diam. 0.3mm, Length 0.5 - 3.5mm
Central Head with Complete Bell - shaft diam. 0.3mm, Length 0.5 - 3.5mm
Partial Titanium Implant with Separate Head, shaft 0 0.3 mm, Length 5.5-2.5mm (variable)
Partial Titanium Implant with Separate Head, shaft 0 0.3 mm, Length 5.5-2.0mm (variable)</Size><SupplierCode>39997</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112868</SubGroupID><ARTGs><ARTG>290802</ARTG></ARTGs><MinimumBenefit>227</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UP002</BillingCode><PriorBillingCodes><PriorBillingCode>LM329</PriorBillingCode></PriorBillingCodes><Name>Partial Ossicle Replacement</Name><Description>a) TTP Tuebingen Type bell   b) CliP Dresden Type   c) Malleus   d) Angular Plester   e) Angular CliP   f) TTP - Vario Bell TTP - Variac System, Partial  g) CliP Partial FlexBAL  h) Duesseldorf Type Partial</Description><Size>a) length 1.75 to 3.5mm  b) length 1.75 to 3.5mm   c) length 1.75 to 3.5mm   d) length 2.25 or 3.25mm   e) length 2.25 or 3.25mm   f) one size  g) length 1.75 to 3.5mm  h) length 1.75 to 4.5mm</Size><SupplierCode>40260</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112868</SubGroupID><ARTGs><ARTG>119746</ARTG></ARTGs><MinimumBenefit>227</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UP004</BillingCode><PriorBillingCodes><PriorBillingCode>LM338</PriorBillingCode></PriorBillingCodes><Name>Stapes</Name><Description>Stapes Prosthesis</Description><Size>Ø 0.4mm, Ø 0.5mm &amp; Ø 0.6mm  Lengths 3.50mm - 5.50mm</Size><SupplierCode>40260</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112868</SubGroupID><ARTGs><ARTG>119746</ARTG></ARTGs><MinimumBenefit>227</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL093</BillingCode><Name>Ossicular Prosthesis - Incus/Stapes</Name><Description>a) Applebaum Incudostapedial Joint  b) Goldenberg Incus  c) Wehrs Incus (Single &amp; Double Notch)  d) Wehrs II Incus-Stapes (Single Notch)  e) Kartush Incus-Stapes Strut  f) Goldenberg Incus-Stapes g)Applebaum Incus Replacement System</Description><Size>a) small - large  b) one size only  c) short, average, medium  d) short, average, medium, long  e) short, medium, long  f) one size only</Size><SupplierCode>40122</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112868</SubGroupID><ARTGs><ARTG>123372</ARTG></ARTGs><MinimumBenefit>227</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL094</BillingCode><Name>Ossicular Prosthesis - PORP</Name><Description>Drum-to-Stapes  Goldenberg Malleable   Modified  Off-Centered  Sheehy Modified</Description><Size>Various</Size><SupplierCode>40122</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112868</SubGroupID><ARTGs><ARTG>123372</ARTG></ARTGs><MinimumBenefit>227</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL088</BillingCode><Name>Ossicular Prosthesis - PORP</Name><Description>Shea
Micron Monolithic</Description><Size>Various sizes</Size><SupplierCode>40122</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112868</SubGroupID><ARTGs><ARTG>123372</ARTG></ARTGs><MinimumBenefit>227</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI076</BillingCode><Name>Middle Ear Prostheses</Name><Description>Partial Ossicular Reconstruction Implant - malleus + incus</Description><Size>0.6-2.5 x 2.2-8.8 x 3.5 -10mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112868</SubGroupID><ARTGs><ARTG>125831</ARTG></ARTGs><MinimumBenefit>227</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>US033</BillingCode><Name>Passive Middle Ear Implant (partial tympanoplasty prosthesis and stapesplasty prosthesis)</Name><Description>The MED-EL passive middle ear implant – tympanoplasty and stapesplasty ossicular replacement prostheses are made of titanium with a bendable shaft (and headplate of the tympanoplasty prosthesis). MRI conditional up to 7.0 Tesla</Description><Size>mXACT, mCLIP, mCLIP ARC, mXACT PRO - FL 0.75-3.50mm;   mAXIS(Ø 0.4/0.5/0.6 x FL 3.50-5.50mm), mLOOP (Ø 0.4/0.6 x FL 3.50-10.00mm), mZAM (Ø 0.4/0.5/0.6 x FL 3.50-5.50mm), mFIX (Ø 0.4/0.6 x FL 3.50-5.50mm), </Size><SupplierCode>40167</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112868</SubGroupID><ARTGs><ARTG>393386</ARTG><ARTG>393392</ARTG></ARTGs><MinimumBenefit>227</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RC011</BillingCode><Name>TORP - Total Ossicular Replacement Prosthesis</Name><Description>Total implant made of titanium, for reconstructing a destroyed middle-air ossicular chain (chain of sound transmission) between the footplate of the stirrup bone and the plane of the eardrum.
The implants are available in fixed length and adjustable versions for shortening. The implant can be subdivided into three areas: 1.) the implant shoe; 2.) the implant shaft; 3.) the perforated implant plate. The implant plate can be arranged centrically (round) towards the implant shaft or eccentrically (oval). In the eccentric version (oval, fixed length only), an additional groove has been worked into the plate to improve receiving the malleus handle. The surface of the predefined contact points (upper side of implant plate and implant shoe) is roughened in order to facilitate better bonding to the eardrum resp. the stapes footplate. To improve the adaptation of the implant plate to the plane of the eardrum, the angle between the implant plate and shaft can be optimally adapted because the shaft below the implant plate tapers off (onwards from a total length of 3.5 mm). The product is available in different lengths. The length information is stated both on the outer package as well as on the product’s sterile packaging.</Description><Size>Fixed Length
Central Head shaft diam. 0.3 mm Length 3.00 mm
Central Head shaft diam. 0.3 mm Length 3.50 mm
Central Head shaft diam. 0.3 mm Length 4.00 mm
Central Head shaft diam. 0.3 mm Length 4.25 mm
Central Head shaft diam. 0.3 mm Length 4.50 mm
Central Head shaft diam. 0.3 mm Length 4.75 mm
Central Head shaft diam. 0.3 mm Length 5.00 mm
Central Head shaft diam. 0.3 mm Length 5.50 mm
Central Head shaft diam. 0.3 mm Length 6.00 mm
Central Head shaft diam. 0.3 mm Length 6.50 mm
Central Head shaft diam. 0.3 mm Length 7.00 mm
Offset Head shaft diam. 0.3 mm Length 3.00 mm
Offset Head shaft diam. 0.3 mm Length 3.50 mm
Offset Head shaft diam. 0.3 mm Length 4.00 mm
Offset Head shaft diam. 0.3 mm Length 4.25 mm
Offset Head shaft diam. 0.3 mm Length 4.50 mm
Offset Head shaft diam. 0.3 mm Length 4.75 mm
Offset Head shaft diam. 0.3 mm Length 5.00 mm
Offset Head shaft diam. 0.3 mm Length 5.50 mm
Offset Head shaft diam. 0.3 mm Length 6.00 mm
Offset Head shaft diam. 0.3 mm Length 6.50 mm
Offset Head shaft diam. 0.3 mm Length 7.00 mm
Shortenable
Total Titanium Implant with Separate Shoe shaft diam. 0.4 mm Length 7.8-2.8 
mm
Total Titanium Implant with Separate Shoe shaft diam. 0.4 mm Length 7.8-2.3 
mm
Total Titanium Implant with Separate Shoe shaft diam. 0.4 mm Length 7.8-3.5 
mm
Total Titanium Implant with Separate Shoe shaft diam. 0.4 mm Length 7.8-3.0 
mm
Adjustable Titanium Implant with Separate Shoe, shaft diam. 0.4 mm Length 7.8-2.8 mm
Adjustable Titanium Implant with Separate Shoe, shaft diam. 0.4 mm Length 7.8-2.3 mm</Size><SupplierCode>39997</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112869</SubGroupID><ARTGs><ARTG>290802</ARTG></ARTGs><MinimumBenefit>343</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KG014</BillingCode><Name>ALTO Prosthesis</Name><Description>Adjustable Length Titanium Ossicular Chain Reconstruction Prosthesis</Description><Size>Head Size: 1.5mm x 2.5mm / 2mm x 2.5mm / 2mm x 3.3mm / 2.5mm x 3.5mm / 4mm x 3.25mm.  Length: 0.75mm -  8.6mm.  Distal Diameter: 0.4mm - 1.45mm.</Size><SupplierCode>40199</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112869</SubGroupID><ARTGs><ARTG>170281</ARTG></ARTGs><MinimumBenefit>343</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UP001</BillingCode><PriorBillingCodes><PriorBillingCode>LM328</PriorBillingCode></PriorBillingCodes><Name>Total Ossicle Replacement</Name><Description>a) TTP Tuebingen Type Aerial Type   b) TTB-Vario Aerial    c) TTP Variac System Total   d) Malleus Notch Prosthesis   e) Regensburg Type Total Prosthesis  f) Malleus Replacement  g) Duesseldorf Type Total  h) Omega Connector</Description><Size>a) Length - 3 to to 7mm   b) one size only  c) one size only   d) Length - 3 to 7mm   e) Length - 4 to 5mm  f) one size only  g) lengths - 3 to 7mm  h) length - 0.5mm</Size><SupplierCode>40260</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112869</SubGroupID><ARTGs><ARTG>119747</ARTG></ARTGs><MinimumBenefit>343</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI075</BillingCode><Name>Middle Ear Prostheses</Name><Description>Total Ossicular Reconstruction Implants</Description><Size>0.6-0.8mm x 3.0-4.0mm x 7.0-8.0mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112869</SubGroupID><ARTGs><ARTG>125831</ARTG></ARTGs><MinimumBenefit>343</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL092</BillingCode><Name>Ossicular Prosthesis - PORP/TORP</Name><Description>Black Spanner Strut  Black Oval-Top PORP/Universal/TORP  Micron Adjustable Titanium PORP/TORP  Causse Modified TORP  Fisch-Type TORP  Shea TORP   Sheehy Modified TORP Sheey TORP (Improved), Micron All Titanium Monolithic TOPR/PORP</Description><Size>Shaft diameter from 0.6mm to 4mm  Length from 1.5m to 10.9mm</Size><SupplierCode>40122</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112869</SubGroupID><ARTGs><ARTG>123372</ARTG></ARTGs><MinimumBenefit>343</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>US034</BillingCode><Name>Passive Middle Ear Implant (total tympanoplasty prosthesis)</Name><Description>The MED-EL passive middle ear implant – tympanoplasty ossicular  replacement prosthesis is made of titanium with a bendable shaft and headplate. MRI conditional up to 7.0 Tesla</Description><Size>mXACT (Offcenter and Center) and mXACT PRO - FL 3.00-7.00mm</Size><SupplierCode>40167</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112869</SubGroupID><ARTGs><ARTG>393391</ARTG><ARTG>393387</ARTG></ARTGs><MinimumBenefit>343</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL073</BillingCode><Name>Dornhoffer Prostheses</Name><Description>Hydroxyapetite head/HAPEX shaft PORP and TORP</Description><Size>0.8mm Shaft Dia TORP, 1.3mm Shaft Diameter PORP</Size><SupplierCode>40122</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107829</GroupID><SubGroupID>112869</SubGroupID><ARTGs><ARTG>123372</ARTG></ARTGs><MinimumBenefit>343</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO087</BillingCode><Name>Cochlear™ Baha® 6 Max Sound Processor </Name><Description>The Baha 6 Max is Cochlear’s next generation off-the-ear (OTE) sound processor for use with Cochlear Baha 'Connect' and 'Attract' Implantable Bone Conduction Hearing Systems with a fitting range up to 55dB HL. Baha 6 Max has broader bandwidth at higher frequencies, iOS and Android smartphone direct streaming and smaller, lighter and more discreet OTE technology.</Description><Size>1 x SP size with 2 options of the snap coupling sizes</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107834</GroupID><SubGroupID>112870</SubGroupID><Suffix>Programmable, Wireless-enabled</Suffix><ARTGs><ARTG>123987</ARTG></ARTGs><MinimumBenefit>6484</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>US030</BillingCode><Name>SAMBA 2 BB Audio Processor</Name><Description>Single Unit audio processor for the Bonebridge System, worn off the ear it is held in place by magnetic attraction over the implant. Designed to function similarly as the SAMBA BB audio processor with improved battery life, noise reduction, ingress protection  and Intelligent Sound Adapter 2.0</Description><Size>One Size - left/right versions with various magnet strengths, length = 36.4mm, width = 30.4mm, height = 10.2mm, weight 9.3g (inc battery)</Size><SupplierCode>40167</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107834</GroupID><SubGroupID>112870</SubGroupID><Suffix>Programmable, Wireless-enabled, Autoscan</Suffix><ARTGs><ARTG>353072</ARTG></ARTGs><MinimumBenefit>6808</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO077</BillingCode><Name>Cochlear Baha 5 Power Sound Processor</Name><Description>The Cochlear Baha 5 Power sound processor is a powerful (up to 55dB HL), wireless-enabled, smartphone compatible, fully programmable, digital sound processor for the Cochlear Baha 'Connect' and 'Attract' Implantable Bone Conduction Hearing Systems.</Description><Size>One size</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107834</GroupID><SubGroupID>112870</SubGroupID><Suffix>Programmable, Wireless-enabled</Suffix><ARTGs><ARTG>123987</ARTG></ARTGs><MinimumBenefit>6484</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO076</BillingCode><Name>Cochlear Baha 5 SuperPower Sound Processor</Name><Description>The Cochlear Baha 5 SuperPower sound processor is a powerful (up to 65dB HL) wireless-enabled, smartphone compatible, fully programmable, digital sound processor for the Baha Implantable Bone Conduction Hearing System. It is intended to be fitted as a head worn split system - it comprises a behind-the-ear (BTE) Sound Processing Unit, an Actuator unit, and a Cable between the BTE and the Actuator unit.</Description><Size>One size</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107834</GroupID><SubGroupID>112870</SubGroupID><Suffix>Programmable, Wireless-enabled</Suffix><ARTGs><ARTG>123987</ARTG></ARTGs><MinimumBenefit>6484</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>US017</BillingCode><Name>Bonebridge Samba BB Audio Processor</Name><Description>The Samba BB is a wireless enabled audio processor and the externally worn component of the Bonebridge System.  It connects to the implant through magnetic attraction. Fitting the Samba BB audio processor activates the Bonebridge.</Description><Size>left and right versions, length = 35mm, width = 30mm, height = 10mm, weight &lt;9g (inc battery)</Size><SupplierCode>40167</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107834</GroupID><SubGroupID>112870</SubGroupID><Suffix>Programmable, Wireless-enabled</Suffix><ARTGs><ARTG>270912</ARTG></ARTGs><MinimumBenefit>6484</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OI032</BillingCode><Name>Ponto 3 Sound Processor</Name><Description>A wireless enabled - fully programmable head worn sound processor for bone conduction hearing systems with full smart phone capabilities. Optional Superpower model, delivering higher output across the entire bandwidth.</Description><Size>Ponto 3: 34x21x11mm
Ponto 3 Power: 34x21x14mm
Ponto 3 SuperPower: 34x21x14mm</Size><SupplierCode>40034</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107834</GroupID><SubGroupID>112870</SubGroupID><Suffix>Programmable, Wireless-enabled</Suffix><ARTGs><ARTG>198104</ARTG></ARTGs><MinimumBenefit>6484</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OI039</BillingCode><Name>Ponto 5 Mini &amp; SuperPower</Name><Description>A wireless enabled - fully programmable head worn sound processor for bone conduction hearing systems with directionality paradigm offering analysis, balancing &amp; noise removal, IFTTT; together with programmable &amp; direct to smart phone capacity and remote care possibilities. Has the ability to detect, and prevent feedback from occurring. Ponto 5 Mini &amp; Ponto 5 SuperPower have the ability to be programmed using DSL (Desired Sensation Level) which is particularly beneficial to the paediatric population.  </Description><Size>26 x 19 x 11 mm - Ponto 5 Mini  31 x 21 x 15 mm - Ponto 5 SuperPower</Size><SupplierCode>40034</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107834</GroupID><SubGroupID>112870</SubGroupID><Suffix>Programmable, Wireless-enabled</Suffix><ARTGs><ARTG>198860</ARTG></ARTGs><MinimumBenefit>6484</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OI038</BillingCode><Name>Ponto 4 </Name><Description>A wireless enabled - fully programmable head worn sound processor for bone conduction hearing systems with directionality paradigm offering analysis, balancing &amp; noise removal, IFTTT; together with programmable &amp; direct to smart phone capacity.</Description><Size>One size (26 x 19 x 11 mm)</Size><SupplierCode>40034</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107834</GroupID><SubGroupID>112870</SubGroupID><Suffix>Programmable, Wireless-enabled</Suffix><ARTGs><ARTG>198860</ARTG></ARTGs><MinimumBenefit>6484</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO075</BillingCode><Name>Cochlear Baha 5 Sound Processor</Name><Description>The Cochlear Baha 5 Sound Processor (26,mm x 19mm x12mm) is a wireless-enabled smartphone compatible fully programmable head-word digital sound processor for the Baha Implantable Bone Conduction Hearing System</Description><Size>One size (26mm x 19 mm x 12 mm)</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107834</GroupID><SubGroupID>112870</SubGroupID><Suffix>Programmable, Wireless-enabled</Suffix><ARTGs><ARTG>123987</ARTG></ARTGs><MinimumBenefit>6484</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO063</BillingCode><Name>Cochlear ™ Baha® BIA400 Implant with Abutment</Name><Description>Pre-mounted self-tapping titanium implant with TiOblast™ surface and coated Abutment with hydroxyapatite (HA) coating for Baha FAST surgery</Description><Size>4mm implant with pre-mounted 6mm, 8mm, 10mm, or 12mm , or 14mm abutment</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107834</GroupID><SubGroupID>112871</SubGroupID><Suffix>Abutment &amp; Fixture, HA</Suffix><ARTGs><ARTG>123984</ARTG></ARTGs><MinimumBenefit>2087</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO068</BillingCode><Name>Cochlear™ Baha® BIM400 Implant Magnet</Name><Description>The Cochlear Baha BIM400 is an implantable magnet that lies completely under the skin</Description><Size>One size</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107834</GroupID><SubGroupID>112871</SubGroupID><Suffix>Magnetic Coupling</Suffix><ARTGs><ARTG>123984</ARTG></ARTGs><MinimumBenefit>1059</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>US026</BillingCode><Name>BCI 602 Lifts (1mm)</Name><Description>BCI 602 Lifts (1mm) can be implanted together with the Bonebridge BCI 602, attached to the fixation wings of the BCI 602, serving as a spacer to increase distance between the fixation wings and the skull bone.</Description><Size>1mm</Size><SupplierCode>40167</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107834</GroupID><SubGroupID>112871</SubGroupID><Suffix>Lifts</Suffix><ARTGs><ARTG>329049</ARTG></ARTGs><MinimumBenefit>196</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>US027</BillingCode><Name>Bone Conduction Implant Kit,  BCI 602 Kit</Name><Description>The BCI 602 Implant is an Active transcutaneous bone conduction implant consisting of attachment magnet, receiver coil, Bone Conduction-Floating Mass Transducer (BC-FMT) with electronics, bendable transition to FMT, implanted under intact skin. Included with the BCI 602 implant in the BCI602 Kit are 2 Self-Drilling Cortical Screws, an emergency screw and Surgical Screwdriver SD 2, as well as the BCI 602 Sizer Kit.</Description><Size>one size - 28.3 (w) x 64.3 (l) x 8.6 (h) mm</Size><SupplierCode>40167</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107834</GroupID><SubGroupID>112871</SubGroupID><Suffix>Implanted Transducer, Magnetic Coupler</Suffix><ARTGs><ARTG>389050</ARTG></ARTGs><MinimumBenefit>2222</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OI026</BillingCode><Name>Ponto Abutment and Implant</Name><Description>Bone anchor implant and abutment with connection screw</Description><Size>Diameter: 3.75 - 4.5mm
Length: Fixture 3 - 4mm, Abutment 6 -14mm</Size><SupplierCode>40034</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107834</GroupID><SubGroupID>112871</SubGroupID><Suffix>Abutment &amp; Fixture</Suffix><ARTGs><ARTG>198759</ARTG></ARTGs><MinimumBenefit>1833</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO062</BillingCode><Name>Cochlear™ Baha®  BA400 DermaLock™ Abutment</Name><Description>Titanium abutment with hydroxyapatite (HA) coating</Description><Size>6mm, 8mm, 10mm, 12mm, 14mm</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107834</GroupID><SubGroupID>112871</SubGroupID><Suffix>HA</Suffix><ARTGs><ARTG>123984</ARTG></ARTGs><MinimumBenefit>1059</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI194</BillingCode><Name>Sophono Alpha Bone Conduction Hearing System, Implant</Name><Description>Alpha Implant</Description><Size>-</Size><SupplierCode>40151</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107834</GroupID><SubGroupID>112871</SubGroupID><Suffix>Abutment &amp; Fixture</Suffix><ARTGs><ARTG>272642</ARTG></ARTGs><MinimumBenefit>1833</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO050</BillingCode><Name>Baha BA210 Abutment</Name><Description>Titanium abutments compatible with hexagonal coupling Baha implants</Description><Size>5.5mm and 8.5mm</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107834</GroupID><SubGroupID>112871</SubGroupID><Suffix>Abutment</Suffix><ARTGs><ARTG>123984</ARTG></ARTGs><MinimumBenefit>850</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OI025</BillingCode><Name>Ponto Abutment</Name><Description>Bone anchor abutment with connection screw</Description><Size>Length: 6 - 14mm
Straight and angled</Size><SupplierCode>40034</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107834</GroupID><SubGroupID>112871</SubGroupID><Suffix>Abutment</Suffix><ARTGs><ARTG>198759</ARTG></ARTGs><MinimumBenefit>850</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OI024</BillingCode><Name>Ponto Implant</Name><Description>Bone anchor implant</Description><Size>Diameter: 3.75 - 4.5mm
Length: 3 - 4mm</Size><SupplierCode>40034</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107834</GroupID><SubGroupID>112871</SubGroupID><Suffix>Fixture</Suffix><ARTGs><ARTG>198759</ARTG></ARTGs><MinimumBenefit>983</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OI030</BillingCode><Name>Ponto BHX Implant</Name><Description>A laser-ablated titanium surface implant using Biohelix™ (BHX).</Description><Size>Length: 3mm, 4mm</Size><SupplierCode>40034</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107834</GroupID><SubGroupID>112871</SubGroupID><Suffix>Fixture &amp; Concave</Suffix><ARTGs><ARTG>198759</ARTG></ARTGs><MinimumBenefit>1028</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OI031</BillingCode><Name>Ponto BHX Implant and Abutment</Name><Description>A laser-ablated titanium surface implant using Biohelix™ (BHX) and abutment
with connection screw.</Description><Size>Diameter: 3.75 - 4.5mm
Length: Fixture 3 - 4mm
Abutment: 6 -14mm</Size><SupplierCode>40034</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107834</GroupID><SubGroupID>112871</SubGroupID><Suffix>Abutment, Fixture &amp; Concave</Suffix><ARTGs><ARTG>198759</ARTG></ARTGs><MinimumBenefit>1916</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO051</BillingCode><Name>Baha® BI300 Implant</Name><Description>Titanium self-tapping implant with TiOblast surface of the Baha 3 system</Description><Size>3mm and 4 mm</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107834</GroupID><SubGroupID>112871</SubGroupID><Suffix>Fixture &amp; Concave</Suffix><ARTGs><ARTG>123984</ARTG></ARTGs><MinimumBenefit>1028</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO054</BillingCode><Name>Baha Cover Screw conical</Name><Description>Titanium cover screw of the Baha BI300 implant system used in the two-stage surgery.</Description><Size>One size</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107834</GroupID><SubGroupID>112872</SubGroupID><ARTGs><ARTG>123984</ARTG></ARTGs><MinimumBenefit>135</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OI028</BillingCode><Name>Ponto Cover Screw</Name><Description>Cover screw</Description><Size>One size only</Size><SupplierCode>40034</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107834</GroupID><SubGroupID>112872</SubGroupID><ARTGs><ARTG>198759</ARTG></ARTGs><MinimumBenefit>135</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OI027</BillingCode><Name>Ponto Healing Cap</Name><Description>Cover screw</Description><Size>One size only</Size><SupplierCode>40034</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107834</GroupID><SubGroupID>112872</SubGroupID><ARTGs><ARTG>198868</ARTG></ARTGs><MinimumBenefit>135</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO064</BillingCode><Name>Cochlear ™ Nucleus® CP910 Sound Processor Hybrid™ Mode (Initial)</Name><Description>The Cochlear Nucleus CP910 Sound processor in "Hybrid Mode" facilitates electroacoustic stimulation of the cochlea</Description><Size>There is only one size of the processing unit and coil.  There are two sizes for the battery holder and cover.</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112874</SubGroupID><Suffix>Electroacoustic, AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>216062</ARTG></ARTGs><MinimumBenefit>12796</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO090</BillingCode><Name>Cochlear™ Nucleus® 8 (CP1110) Sound Processor - Hybrid™ Mode (initial)</Name><Description>The Nucleus 8 (CP1110) - Hybrid Mode is a behind-the-ear (BTE) sound processor that is designed to function in a similar manner to the Nucleus 7 (CP1000) Sound Processor but with improved features such as smaller size, new directional noise reduction algorithm (SmartSound® iQ 2 with SCAN 2), Bluetooth® LE Audio Ready technology and automate function. The sound processor consists of the processing unit, Slimline™ coil, magnet and battery module. The Nucleus 8 in hybrid mode facilitates acoustic stimulation in the cochlea.</Description><Size>There is one size of the sound processor unit with 3 battery options and 7 different magnet strengths.</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112874</SubGroupID><Suffix>Electroacoustic, AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>394472</ARTG><ARTG>394471</ARTG><ARTG>394470</ARTG></ARTGs><MinimumBenefit>12796</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>US014</BillingCode><Name>SONNET EAS Audio Processor (initial)</Name><Description>Audio processor worn behind the ear with dual omnidirectional microphone, water-resistance, datalogging, Automatic Sound Management, wireless connectivity to assistive listening devices, electric and electric acoustic stimulation modes</Description><Size>One size</Size><SupplierCode>40167</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112874</SubGroupID><Suffix>Electroacoustic</Suffix><ARTGs><ARTG>232487</ARTG></ARTGs><MinimumBenefit>12303</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BD031</BillingCode><Name>Naida CI M90 / Sky CI M90 Sound Processor</Name><Description>Naida CI M90 Sound Processor  The Naída CI M90 and Sky CI M90 Sound Processors are behind-the-ear (BTE) sound processors for use with an Advanced Bionics cochlear implant. They feature direct connectivity to wireless accessories and Bluetooth® technology enabled devices. They offers multiple power options and wearing options for the user. The system is designed to provide useful hearing to individuals with severe-to-profound hearing loss. The coupling can be included to enable electro-acoustic stimulation. The Sky CI M90 Sound Processor is for paediatric application</Description><Size>27.5 x 29.2 x 9.2 (sound processor only)</Size><SupplierCode>40052</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112874</SubGroupID><Suffix>AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>411570</ARTG><ARTG>411571</ARTG></ARTGs><MinimumBenefit>11392</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>US032</BillingCode><Name>RONDO 3 Audio Processor (initial)</Name><Description>A Single Unit off-the-ear (OTE) audio processor for the MED-EL CI System, integrating two omni-directional microphones, coil, indicator LED, magnet &amp; electronics package, held in place over the implant by magnetic attraction. It features an integrated wirelessly rechargeable battery providing up to 24hr battery life, link monitoring, increased water resistance (IP68), datalogging, Adaptive Intelligence, Automatic Sound Management, wireless connectivity to assistive listening devices.</Description><Size>One size - L 44.8 mm, W 35.7 mm, H 11.6 mm  (with 5 magnet strengths and 2 cover options)  </Size><SupplierCode>40167</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112874</SubGroupID><Suffix>AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>355351</ARTG></ARTGs><MinimumBenefit>11392</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO080</BillingCode><Name>Kanso®, Cochlear™ Nucleus® CP950 Sound Processor (Initial)</Name><Description>An off-the-ear sound processor with two built-in directional microphones, wireless connectivity, and equivalent functionality to the Cochlear N6 behind-the-ear sound processor in a fully integrated single unit, enclosing radiofrequency (RF) coil, supplying power, and signals to internal implant.</Description><Size>One size (40.9 mm x 35.2 mm x 11.4 mm)</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112874</SubGroupID><Suffix>AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>282194</ARTG></ARTGs><MinimumBenefit>11392</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO071</BillingCode><Name>Cochlear ™ Nucleus® CP920 Sound Processor (Initial)</Name><Description>The Cochlear Nucleus CP920 Sound Processor is a behind-the-ear sound processor with two built-in directional micophones.</Description><Size>There is only one size of the processing unit and coil.  There are two sizes for battery holder and cover.</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112874</SubGroupID><Suffix>AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>216063</ARTG></ARTGs><MinimumBenefit>11392</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO088</BillingCode><Name>Kanso® 2, Cochlear™ Nucleus® CP1150 Sound Processor (Initial)</Name><Description>The CP1150 Sound Processor (Kanso 2) is Cochlear’s next generation off-the-ear (OTE) style sound processor. Kanso 2 has the benefits of the latest sound processing technologies of the behind-the-ear (BTE) Cochlear™ Nucleus® 7  (N7). Compared to Kanso 1, Kanso 2 provides improved hearing performance in noise due to Spatial NR, and improved hearing experience and reduced user cost through buttonless interface, iOs and Android smartphone direct streaming and a rechargeable battery.  The initial Kanso 2 Kit provides multiple magnet strengths and range of battery charging options.</Description><Size>One size, multiple magnet strengths and range of battery charging options</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112874</SubGroupID><Suffix>AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>351996</ARTG></ARTGs><MinimumBenefit>11392</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BD023</BillingCode><Name>Naida CI Q90 Sound Processor (Initial Order)</Name><Description>The Naida CI Q90 Sound processor is a BTE Sound Processor to communicates with the internally implanted HiRes Family implants. It facilitates electro-acoustic stimulation of the cochlea, as well as being compatible with a range of wireless devices.</Description><Size>There is one size of the sound processor unit with 4 battery options/sizes.</Size><SupplierCode>40052</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112874</SubGroupID><Suffix>AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>282255</ARTG></ARTGs><MinimumBenefit>11392</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO069</BillingCode><Name>Cochlear ™ Nucleus® CP910 Sound Processor (Initial)</Name><Description>The Cochlear Nucleus CP910 Sound Processor is a behind-the-ear sound processor two built-in directional microphones</Description><Size>There is only one size of the processing unit and coil.  There are two sizes for battery holder and cover.</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112874</SubGroupID><Suffix>AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>216062</ARTG></ARTGs><MinimumBenefit>11392</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OI036</BillingCode><Name>Neuro 2 Sound Processor</Name><Description>The behind the ear Neuro 2 sound processor performs with the Neuro Zti cochlear implants. It consists of two microphones allowing for 3 automatic adaptive directionality modes, voice tracker and wind noise reduction features.   Its benefits include: smaller and more cosmetically appealing design and rechargeable batteries.    The processor is placed on the auricle of the either one of the patient's ears and an external antenna transmits the acoustic signal processed by the processor, by means of electromagnetic induction, to the internal component implanted beneath the skin and secured onto the mastoid.</Description><Size>One size</Size><SupplierCode>40034</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112874</SubGroupID><ARTGs><ARTG>316140</ARTG></ARTGs><MinimumBenefit>6610</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO081</BillingCode><Name>Cochlear™ Nucleus® CP1000 Sound Processor - Hybrid™ Mode (initial)</Name><Description>The CP1000 (Nucleus 7, N7) - Hybrid Mode is a behind-the-ear (BTE) sound processor that is designed to function in a similar manner to the CP900 series (CP910/920) (Nucleus 6, N6) sound processor but with new architectural design, which provides improved battery life and MFi wireless connectivity directly with iOS devices via Smart App. The CP1000 in hybrid mode facilitates acoustic stimulation in the cochlea.</Description><Size>There is one size of the sound processor unit with 3 battery options and 7 different magnet strengths.</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112874</SubGroupID><Suffix>Electroacoustic, AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>292000</ARTG></ARTGs><MinimumBenefit>12796</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO066</BillingCode><Name>Cochlear™ Nucleus® CP920 Sound Processor - Hybrid™ Mode (Initial)</Name><Description>The Cochlear Nucleus CP920 Sound Processor in "Hybrid Mode" facilitates electroacoustic stimulation of the cochlea</Description><Size>There is only one size of the processing unit and coil. There are two sizes for battery holder and cover.</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112874</SubGroupID><Suffix>Electroacoustic, AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>216063</ARTG></ARTGs><MinimumBenefit>12796</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BD027</BillingCode><Name>Naida CI Electric Acoustic Solution</Name><Description>The Naida CI Q90 sound processor is one part of a cochlear implant system that enables hearing. The other necessary parts of the system are the  implantable Cochlear Stimulator (ICS), headpiece and headpiece cable. The sound processor consists of two parts: the sound processor and battery power source. The Naida CI Q90 is compatible with the Naida CI Acoustic Earhook, supplying both electric and acoustic stimulation.</Description><Size>The Naida CI Sound Processor comes in one size. The Naida CI Acoustic Earhook comes in 5 length options, and is available for left and right ear (10 configurations).</Size><SupplierCode>40052</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112874</SubGroupID><Suffix>Electroacoustic, AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>282255</ARTG><ARTG>300028</ARTG></ARTGs><MinimumBenefit>12796</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>US025</BillingCode><Name>SONNET 2 EAS Audio Processor</Name><Description>Audio processor with electric and electric acoustic stimulation modes, worn behind the ear with dual omnidirectional microphone, water-resistance, enhanced datalogging and signal processing, Adaptive Intelligence, Automatic Sound Management, wireless connectivity to assistive listening devices</Description><Size>one size with 3 battery options and various magnet strengths</Size><SupplierCode>40167</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112874</SubGroupID><Suffix>Electroacoustic, AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>319472</ARTG></ARTGs><MinimumBenefit>12796</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OI037</BillingCode><Name>Neuro 2 Sound Processor Replacement</Name><Description>The behind the ear Neuro 2 sound processor performs with the Neuro Zti cochlear implants. It consists of two microphones allowing for three automatic adaptive directionality modes, voice tracker and wind noise reduction features.     Its benefits include: smaller and more cosmetically appealing design and rechargeable batteries.    The processor is placed on the auricle of the either one of the patient's ears and an external antenna transmits the acoustic signal processed by the processor, by means of electromagnetic induction, to the internal component implanted beneath the skin and secured onto the mastoid.</Description><Size>One size</Size><SupplierCode>40034</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112875</SubGroupID><Suffix>Generation 4</Suffix><ARTGs><ARTG>316140</ARTG></ARTGs><MinimumBenefit>7648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BD028</BillingCode><Name>Naida CI Electric Acoustic Solution</Name><Description>The Naida CI Q90 sound processor is one part of a cochlear implant system that enables  hearing. The other necessary parts of the system are the implantable Cochlear Stimulator  (ICS), headpiece and headpiece cable. The sound processor consists of two parts: the  sound processor and battery power source. The Naida CI Q90 is compatible with the Naida CI Acoustic Earhook, supplying both electric and acoustic stimulation.</Description><Size>The Naida CI Sound Processor comes in one size. The Naida CI Acoustic Earhook comes  in 5 length options, and is available for left and right ear (10 configurations).</Size><SupplierCode>40052</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112875</SubGroupID><Suffix>Electroacoustic, AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>282255</ARTG><ARTG>300028</ARTG></ARTGs><MinimumBenefit>9078</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO067</BillingCode><Name>Cochlear™ Nucleus® CP920 sound Processor - Hybrid™ Mode (Replacement)</Name><Description>The Cochlear Nucleus CP920 Sound Processor in "Hybrid Mode" facilatates electroacoustic stimulation of the cochlea.</Description><Size>There is only one size of the processing unit and coil. There are two sizes for battery holder and cover.</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112875</SubGroupID><Suffix>Electroacoustic, AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>216063</ARTG></ARTGs><MinimumBenefit>9078</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO086</BillingCode><Name>Kanso® 2, Cochlear™ Nucleus® CP1150 Sound Processor (Replacement)</Name><Description>The CP1150 Sound Processor (Kanso 2) is Cochlear’s next generation off-the-ear (OTE) style sound processor. Kanso 2 has the benefits of the latest sound processing technologies of the behind-the-ear (BTE) Cochlear™ Nucleus® 7. Compared to Kanso 1, Kanso 2 provides improved hearing performance in noise due to Spatial NR, and improved hearing experience and reduced user cost through buttonless interface, iOs and Android smartphone direct streaming and a rechargeable battery. The Replacement Kanso 2 Kit provides a single magnet and battery charging option.</Description><Size>One size, single magnet and battery charging option  </Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112875</SubGroupID><Suffix>AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>351996</ARTG></ARTGs><MinimumBenefit>8114</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO072</BillingCode><Name>Cochlear ™ Nucleus® CP920 Sound Processor (Replacement)</Name><Description>The Cochlear Nucleus CP920 Sound Processor  is a behind-the-ear sound processor with two built-in directional microphones. It has no accessory port for cables.</Description><Size>There is only one size of the processing unit and coil.  There are two sizes for battery holder and cover.</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112875</SubGroupID><Suffix>AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>216063</ARTG></ARTGs><MinimumBenefit>8114</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO079</BillingCode><Name>Kanso®, Cochlear ™ Nucleus® CP950 Sound Processor (Replacement)</Name><Description>An off-the-ear sound processor with two built-in directional microphones, wireless connectivity, and equivalent functionality to the Cochlear N6 behind-the-ear sound processor in a fully integrated single unit, enclosing radiofrequency (RF) coil, supplying power, and signals to internal implant.</Description><Size>One size (40.9 mm x 35.2 mm x 11.4 mm)</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112875</SubGroupID><Suffix>AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>282194</ARTG></ARTGs><MinimumBenefit>8114</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO070</BillingCode><Name>Cochlear ™ Nucleus® CP910 Sound Processor (Replacement)</Name><Description>The Cochlear Nucleus CP910 Sound Processor is a behind-the-ear sound processor with two built-in directional microphones</Description><Size>CO049</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112875</SubGroupID><Suffix>AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>216062</ARTG></ARTGs><MinimumBenefit>8114</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>US015</BillingCode><Name>SONNET Audio Processor (Replacement)</Name><Description>Audio processor worn behind the ear with dual omnidirectional microphones, water-resistance, data logging, Automatic Sound Management, wireless connectivity to assistive listening devices</Description><Size>One size</Size><SupplierCode>40167</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112875</SubGroupID><Suffix>Generation 4</Suffix><ARTGs><ARTG>232486</ARTG></ARTGs><MinimumBenefit>7648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BD015</BillingCode><Name>Neptune Sound Processor replacement part is the external part of the cochlear implant system. Also includes Neptune Connect</Name><Description>The Neptune Processor is an external component of the HiRes Bionic Ear System. The processor is intended to deliver HiResolution sound to a cochlear implant. Also includes Neptune Connect.</Description><Size>One size. 
Processor: H x W X D: 26 x 18 x 60mm
Neptune Connect Size:  H x W x D: 17 x 18 x 58mm</Size><SupplierCode>40052</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112875</SubGroupID><Suffix>Generation 4</Suffix><ARTGs><ARTG>198825</ARTG></ARTGs><MinimumBenefit>7648</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>US016</BillingCode><Name>SONNET EAS Audio Processor (replacement)</Name><Description>Audio processor worn behind the ear with dual omnidirectional microphones, water-resistance, data logging, Automatic Sound Management, wireless connectivity to assistive listening devices, electric and electric acoustic stimulation modes</Description><Size>One size</Size><SupplierCode>40167</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112875</SubGroupID><Suffix>Electroacoustic</Suffix><ARTGs><ARTG>232487</ARTG></ARTGs><MinimumBenefit>8612</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO065</BillingCode><Name>Cochlear™ Nucleus CP910 Sound Processor Hybrid™ Mode (Replacement)</Name><Description>The Cochlear Nucleus CP910 Sound Processor in "Hybrid Mode" facilitates electroacoustic stimulation to the cochlea</Description><Size>There is only one size of the processing unit and coil.  There are two sizes for the battery holder.</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112875</SubGroupID><Suffix>Electroacoustic, AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>216062</ARTG></ARTGs><MinimumBenefit>9078</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO082</BillingCode><Name>Cochlear™ Nucleus® CP1000 Sound Processor - Hybrid™ Mode (replacement)</Name><Description>The CP1000 (Nucleus 7, N7) - Hybrid Model is a behind-the-ear (BTE) sound processor that is designed to function in a similar manner to the CP900 series (CP910/920) (Nucleus 6, N6) sound processor but with new architectural design, which provides improved battery life and MFi wireless connectivity directly with iOS devices via Smart App. The CP1000 in hybrid mode facilitates acoustic stimulation in the cochlea.</Description><Size>There is one size of the sound processor unit with 3 battery options and 7 different magnet strengths.</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112875</SubGroupID><Suffix>Electroacoustic, AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>292000</ARTG></ARTGs><MinimumBenefit>9078</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>US024</BillingCode><Name>SONNET 2 EAS Audio Processor (replacement)</Name><Description>Audio processor with electric and electric acoustic stimulation modes, worn behind the ear with dual omnidirectional microphone, water-resistance, enhanced datalogging and signal processing, Adaptive Intelligence, Automatic Sound Management, wireless connectivity to assistive listening devices</Description><Size>one size with 3 battery options and various magnet strengths</Size><SupplierCode>40167</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112875</SubGroupID><Suffix>Electroacoustic, AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>319472</ARTG></ARTGs><MinimumBenefit>9078</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CO091</BillingCode><Name>Cochlear™ Nucleus® 8 (CP1110) Sound Processor - Hybrid™ Mode (replacement)</Name><Description>The Nucleus 8 (CP1110) - Hybrid Mode is a behind-the-ear (BTE) sound processor that is designed to function in a similar manner to the Nucleus 7 (CP1000) Sound Processor but with improved features such as smaller size, new directional noise reduction algorithm (SmartSound® iQ 2 with SCAN 2), Bluetooth® LE Audio Ready technology and automate function. The sound processor consists of the processing unit, Slimline™ coil, magnet and battery module. The Nucleus 8 in hybrid mode facilitates acoustic stimulation in the cochlea.</Description><Size>There is one size of the sound processor unit with 3 battery options and 7 different magnet strengths.</Size><SupplierCode>40005</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112875</SubGroupID><Suffix>Electroacoustic, AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>394472</ARTG><ARTG>394471</ARTG><ARTG>394470</ARTG></ARTGs><MinimumBenefit>9078</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BD032</BillingCode><Name>Naida CI M90 / Sky CI M90 Sound Processor</Name><Description>Naida CI M90 Sound Processor The Naída CI M90 and Sky CI M90 Sound Processors are behind-the-ear (BTE) sound processors for use with an Advanced Bionics cochlear implant. They feature direct connectivity to wireless accessories and Bluetooth® technology enabled devices. They offers multiple power options and wearing options for the user. The system is designed to provide useful hearing to individuals with severe-to profound hearing loss. The Sky CI M90 Sound Processor is for paediatric application</Description><Size>27.5 x 29.2 x 9.2 (processor only)  Size H x W x D in Millimeters</Size><SupplierCode>40052</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112875</SubGroupID><Suffix>AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>411570</ARTG><ARTG>411571</ARTG></ARTGs><MinimumBenefit>8114</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BD025</BillingCode><Name>Naida CI Q90 Sound Processor (Replacement Order)</Name><Description>The Naida CI Q90 sound processor is one part of a cochlear implant system that enables hearing. The other necessary parts of the system are the Implantable Cochlear Stimulator (ICS), headpiece and headpiece cable. The sound processor consists of two parts: the sound processor and battery power source. There are four battery options, including four sizes of Lithium Ion rechargeable PowerCel™ batteries. This facilitates electro-acoustic stimulation to the cochlear and wireless capability.</Description><Size>There is only one size of the sound processing unitl.  There are four sizes of the battery.</Size><SupplierCode>40052</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112875</SubGroupID><Suffix>AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>282255</ARTG><ARTG>300028</ARTG></ARTGs><MinimumBenefit>8114</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>US031</BillingCode><Name>RONDO 3 Audio Processor (Replacement)</Name><Description>A Single Unit off-the-ear (OTE) audio processor for the MED-EL CI System, integrating two omni-directional microphones, coil, indicator LED, magnet &amp; electronics package, held in place over the implant by magnetic attraction. It features an integrated wirelessly rechargeable battery providing up to 24hr battery life, link monitoring, increased water  resistance (IP68), datalogging, Adaptive Intelligence, Automatic Sound Management, wireless connectivity to assistive listening devices.</Description><Size>One size - L 44.8 mm, W 35.7 mm, H 11.6 mm (with 5 magnet strengths and 2 cover options)</Size><SupplierCode>40167</SupplierCode><CategoryID>107552</CategoryID><SubCategoryID>107579</SubCategoryID><GroupID>107836</GroupID><SubGroupID>112875</SubGroupID><Suffix>AutoScan, 2.4GHz Wireless</Suffix><ARTGs><ARTG>355351</ARTG></ARTGs><MinimumBenefit>8114</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HQ003</BillingCode><Name>SURGITIME Titanium Mesh</Name><Description>Titanium Surgitime is a non absorbable titanium mesh made of pure titanium (ASTM F-67). It comes in many different lengths, widths, thicknesses and hole diameters. It assist bone neoformation, acting as a barrier hindering the migration of epithelial cells and of the conjunctive tissues, thus avoiding competition with the bone graft.</Description><Size>34x25mm- Thickness 0.04mm/Round hole 0,15mm  34x25mm- Thickness 0.04mm/Round hole 0,85mm  34x25mm- Thickness 0,08mm/Round hole 0,85mm</Size><SupplierCode>40238</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112877</SubGroupID><ARTGs><ARTG>247013</ARTG></ARTGs><MinimumBenefit>161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT027</BillingCode><Name>Martin Level One Fixation</Name><Description>Mesh, Titanium</Description><Size>&lt;0.2mm thick, 1 to 10cm² area</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112877</SubGroupID><ARTGs><ARTG>109878</ARTG></ARTGs><MinimumBenefit>161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT026</BillingCode><Name>Martin Level One Fixation</Name><Description>Mesh, Titanium</Description><Size>&lt;0.2mm, 51 to 100cm² area</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112878</SubGroupID><ARTGs><ARTG>109878</ARTG></ARTGs><MinimumBenefit>371</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB407</BillingCode><Name>Aesculap Neuro Plating System</Name><Description>Cranial Fixation Mesh Plate</Description><Size>28.8 - 48.8 mm x 14.5 - 25.2.2 mm    Thickness 0.3mm to 0.4mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112879</SubGroupID><ARTGs><ARTG>388668</ARTG></ARTGs><MinimumBenefit>341</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY577</BillingCode><Name>AO/ASIF Plate</Name><Description>Titanium contourable mesh; Orbital &amp; Pre-Shaped</Description><Size>&lt;0.5mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112879</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>707</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT034</BillingCode><Name>Martin Level One Fixation</Name><Description>Mesh, Titanium</Description><Size>0.2 to 0.49mm thick, 1 to 10cm² area</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112879</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>109878</ARTG></ARTGs><MinimumBenefit>707</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT022</BillingCode><Name>SCS Interlink Plate </Name><Description>Titanium mesh plate - pre-shaped</Description><Size>0.4mm thick, 1 - 10cm2</Size><SupplierCode>40227</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112879</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>339425</ARTG></ARTGs><MinimumBenefit>707</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT031</BillingCode><Name>Martin Level One Fixation</Name><Description>Mesh, Titanium</Description><Size>0.2 to 0.49mm thick, 1 to 10cm² area</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112879</SubGroupID><ARTGs><ARTG>109878</ARTG></ARTGs><MinimumBenefit>341</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK008</BillingCode><PriorBillingCodes><PriorBillingCode>UQ009</PriorBillingCode></PriorBillingCodes><Name>OsteoMed Plating &amp; Fixation System</Name><Description>Micro, Mini, Maxi</Description><Size>0.2-0.49mm thick, 11-50cm²</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112880</SubGroupID><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>584</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH508</BillingCode><Name>Martin Osteosynthesis 1.5mm System Mesh thin 50cm2</Name><Description>Mesh, Titanium</Description><Size>0.2-0.49mm thick, 11-50cm2</Size><SupplierCode>40192</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112880</SubGroupID><ARTGs><ARTG>202851</ARTG></ARTGs><MinimumBenefit>584</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB410</BillingCode><Name>Aesculap Neuro Plating System</Name><Description>Cranial Fixation Mesh Plate</Description><Size>40.2mm x 50.2mm    Thickness 0.3mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112880</SubGroupID><ARTGs><ARTG>388668</ARTG></ARTGs><MinimumBenefit>584</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY578</BillingCode><Name>AO/ASIF Plate</Name><Description>Titanium contourable mesh; Mastoid, Cranial &amp; Pre-Shaped</Description><Size>0.2mm-0.49mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112880</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>725</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO129</BillingCode><Name>MODUS Mesh </Name><Description>Pre-shaped, contourable Titanium Mesh, Sterile </Description><Size>0.25-0.44mm thick, 11-50cm²</Size><SupplierCode>40165</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112880</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>350271</ARTG></ARTGs><MinimumBenefit>725</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT021</BillingCode><Name>SCS Interlink Plate</Name><Description>Titanium mesh plate - pre-shaped</Description><Size>0.4mm thick, 11-50cm2</Size><SupplierCode>40227</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112880</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>339425</ARTG></ARTGs><MinimumBenefit>725</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW528</BillingCode><Name>Stryker Neuro Mesh Plates</Name><Description>Titanium malleable mesh plates for cranial reconstruction</Description><Size>0.2-0.49mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112880</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>203105</ARTG><ARTG>214470</ARTG><ARTG>214471</ARTG><ARTG>214472</ARTG><ARTG>295882</ARTG></ARTGs><MinimumBenefit>725</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT060</BillingCode><Name>Martin Level One Fixation</Name><Description>Mesh, Titanium</Description><Size>0.9-0.49mm thick, 11-50cm²</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112880</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>109878</ARTG></ARTGs><MinimumBenefit>725</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC889</BillingCode><Name>TiMesh</Name><Description>Square-rectangular Gridmesh Panel</Description><Size>11 to 25 cm2 area</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112880</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>584</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC914</BillingCode><Name>TiMesh Titanium Rigid Fixation Bone Grafting and Plating System</Name><Description>FlexMesh 1.5mm System. Composition: Titanium</Description><Size>26 to 50 cm2 area; 0.3mm thick</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112880</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>584</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI645</BillingCode><Name>W Lorenz Osteosynthesis System</Name><Description>Mesh panel, 1.5mm System Titanium</Description><Size>(41-83) x (39-54mm) (0.3 or 0.2mm)</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112880</SubGroupID><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>584</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO128</BillingCode><Name>MODUS Mesh </Name><Description>Titanium Mesh, Sterile </Description><Size>0.2-0.49mm thick, 51-200cm²</Size><SupplierCode>40165</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112881</SubGroupID><ARTGs><ARTG>350271</ARTG></ARTGs><MinimumBenefit>1229</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH024</BillingCode><Name>W Lorenz Osteosynthesis System</Name><Description>Pre-contoured Neuro Mesh, titanium</Description><Size>163 x 115 x 0.3mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112881</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>211079</ARTG></ARTGs><MinimumBenefit>1300</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC524</BillingCode><Name>TiMesh</Name><Description>Isogrid Panel</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112881</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>1229</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY488</BillingCode><Name>AO/ASIF Plate</Name><Description>Titanium Contourable mesh plate</Description><Size>&lt;0.5mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112881</SubGroupID><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>1229</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC890</BillingCode><Name>TiMesh</Name><Description>Square-rectangular Gridmesh Panel</Description><Size>51 to 100 cm2 area</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112881</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>1229</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC525</BillingCode><Name>TiMesh</Name><Description>Sugar Mesh Panel / Grid</Description><Size>11 x 7.5cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112881</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>1229</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI084</BillingCode><Name>TiMesh Rigid Fixation Bone Grafting and Plating System</Name><Description>FlexMesh 1.0 - 1.5mm system. Composition: Titanium</Description><Size>51 to 100cm² area, 0.3mm thickness</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112881</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>1229</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK582</BillingCode><Name>Stryker Leibinger Plating System</Name><Description>Craniofacial Titanium Mesh System</Description><Size>0.2 - 0.49mm thick, 51 - 200cm²</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112881</SubGroupID><ARTGs><ARTG>295882</ARTG></ARTGs><MinimumBenefit>1229</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT047</BillingCode><Name>Martin Level One Fixation</Name><Description>Mesh, Titanium &amp; 3D</Description><Size>0.2-0.49mm thick, 51-200cm²</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112881</SubGroupID><ARTGs><ARTG>109878</ARTG></ARTGs><MinimumBenefit>1229</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK009</BillingCode><PriorBillingCodes><PriorBillingCode>UQ010</PriorBillingCode></PriorBillingCodes><Name>OsteoMed Plating &amp; Fixation System</Name><Description>Plates</Description><Size>0.2-0.49mm thick, 51-200cm²</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112881</SubGroupID><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>1229</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH512</BillingCode><Name>Martin Osteosynthesis 1.5mm System 3D Mesh 200cm2</Name><Description>3D Mesh, Titanium</Description><Size>0.2-0.49mm thick, 51-200cm2</Size><SupplierCode>40192</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112881</SubGroupID><ARTGs><ARTG>202851</ARTG></ARTGs><MinimumBenefit>1229</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK010</BillingCode><PriorBillingCodes><PriorBillingCode>UQ047</PriorBillingCode></PriorBillingCodes><Name>OsteoMed Plating &amp; Fixation System</Name><Description>Plates</Description><Size>111 x 191mm Mesh Plate, Mesh &gt; 200cm2 area.</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112882</SubGroupID><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>1462</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC387</BillingCode><Name>TiMesh Rigid Fixation Bone Grafting and Plating System</Name><Description>Titanium, Square Grid Mesh</Description><Size>Large</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112882</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>1462</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY786</BillingCode><Name>AO/ASIF Plate</Name><Description>Titanium Contourable mesh, Cranial Neuro</Description><Size>&lt;0.5mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112882</SubGroupID><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>1462</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ441</BillingCode><Name>Titanium Mesh</Name><Description>Titanium Mesh Sterile</Description><Size>0.2mm thickness, 15cm x 15cm</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112882</SubGroupID><ARTGs><ARTG>143829</ARTG></ARTGs><MinimumBenefit>1462</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC389</BillingCode><Name>TiMesh Rigid Fixation Bone Grafting and Plating System</Name><Description>Titanium, Square Grid Mesh</Description><Size>Small</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112883</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>307</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT023</BillingCode><Name>SCS Interlink Plate</Name><Description>Titanium mesh plate - pre-shaped</Description><Size>0.6mm thick, 1 - 10cm2</Size><SupplierCode>40227</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112883</SubGroupID><ARTGs><ARTG>339425</ARTG></ARTGs><MinimumBenefit>307</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT039</BillingCode><Name>Martin Level One Fixation</Name><Description>Mesh Titanium</Description><Size>0.5-0.8mm thick, 1-10cm²</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112883</SubGroupID><ARTGs><ARTG>109878</ARTG></ARTGs><MinimumBenefit>307</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT031</BillingCode><Name>SCS Titanium Mesh</Name><Description>Titanium mesh</Description><Size>0.6mm thick; 11-50cm2</Size><SupplierCode>40227</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112884</SubGroupID><ARTGs><ARTG>339425</ARTG></ARTGs><MinimumBenefit>388</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH023</BillingCode><Name>W Lorenz Osteosynthesis System</Name><Description>Panel, Regular or Small Grid. Titanium</Description><Size>80mm x 53mm x 0.6mm thick and 85mm x 53mm x 0.6mm thick</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112884</SubGroupID><ARTGs><ARTG>211079</ARTG></ARTGs><MinimumBenefit>388</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT062</BillingCode><Name>Martin Level One Fixation</Name><Description>Mesh, Titanium</Description><Size>0.5-0.8mm thick, 11-50cm²</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112884</SubGroupID><ARTGs><ARTG>109878</ARTG></ARTGs><MinimumBenefit>388</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT024</BillingCode><Name>SCS Interlink Plate</Name><Description>Titanium mesh plate - pre-shaped</Description><Size>0.6mm thick, 11-50cm2</Size><SupplierCode>40227</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112884</SubGroupID><ARTGs><ARTG>339425</ARTG></ARTGs><MinimumBenefit>388</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH509</BillingCode><Name>Martin Osteosynthesis 1.5mm System Mesh 50cm2</Name><Description>Mesh, Titanium</Description><Size>0.5-0.8mm thick, 11-50cm2</Size><SupplierCode>40192</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112884</SubGroupID><ARTGs><ARTG>202851</ARTG></ARTGs><MinimumBenefit>388</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK011</BillingCode><PriorBillingCodes><PriorBillingCode>UQ013</PriorBillingCode></PriorBillingCodes><Name>OsteoMed Plating &amp; Fixation System</Name><Description>Plates</Description><Size>0.5-0.8mm thick, 11-50cm²</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112884</SubGroupID><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>388</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO131</BillingCode><Name>MODUS Mesh</Name><Description>Titanium Mesh, Sterile </Description><Size>0.5-0.8mm thick, 11-50cm²</Size><SupplierCode>40165</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112884</SubGroupID><ARTGs><ARTG>350271</ARTG></ARTGs><MinimumBenefit>388</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC915</BillingCode><Name>TiMesh Titanium Rigid Fixation Bone Grafting and Plating System</Name><Description>FlexMesh 1.5mm System. Composition: Titanium</Description><Size>26 to 50 cm2 area; 0.6mm thick</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112884</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>388</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI085</BillingCode><Name>TiMesh Rigid Fixation Bone Grafting and Plating System</Name><Description>FlexMesh 1.0 - 2.2mm system. Composition : Titanium</Description><Size>51 to 100cm² area, 0.6mm thickness</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112885</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>1146</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK012</BillingCode><PriorBillingCodes><PriorBillingCode>UQ014</PriorBillingCode></PriorBillingCodes><Name>OsteoMed Plating &amp; Fixation System</Name><Description>Plates</Description><Size>90 x 90mm Osteoform Mesh, Mesh 51 to 100cm2 area.</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112885</SubGroupID><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>1146</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT023</BillingCode><Name>Martin Level One Fixation</Name><Description>Mesh, Titanium</Description><Size>0.50 to 0.80mm thick, 51 to 100cm² area</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112885</SubGroupID><ARTGs><ARTG>109878</ARTG></ARTGs><MinimumBenefit>1146</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT030</BillingCode><Name>SCS Titanium Mesh </Name><Description>Titanium mesh</Description><Size>0.6mm thick; 51-200cm2</Size><SupplierCode>40227</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112885</SubGroupID><ARTGs><ARTG>339425</ARTG></ARTGs><MinimumBenefit>1146</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN243</BillingCode><Name>MatrixNEURO</Name><Description>Preformed mesh</Description><Size>0.6mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112885</SubGroupID><ARTGs><ARTG>313407</ARTG></ARTGs><MinimumBenefit>1146</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC877</BillingCode><Name>TiMesh Rigid Fixation Bone Grafting and Plating System</Name><Description>Titanium, Mesh</Description><Size>51 to 100 cm2 area, 0.6mm thickness</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112885</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>1146</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY579</BillingCode><Name>AO/ASIF Plate</Name><Description>Titanium mesh</Description><Size>0.5mm-0.8mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112885</SubGroupID><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>1146</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH510</BillingCode><Name>Martin Osteosynthesis 1.5mm System Mesh 64cm2</Name><Description>Mesh, Titanium</Description><Size>0.5-0.8mm thick, 51-200cm2</Size><SupplierCode>40192</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112885</SubGroupID><ARTGs><ARTG>202851</ARTG></ARTGs><MinimumBenefit>1146</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO130</BillingCode><Name>MODUS Mesh </Name><Description>Titanium Mesh, Sterile </Description><Size>0.5-0.8mm thick, 51-200cm²</Size><SupplierCode>40165</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112885</SubGroupID><ARTGs><ARTG>350271</ARTG></ARTGs><MinimumBenefit>1146</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST250</BillingCode><Name>Leibinger Titanium Implant System</Name><Description>Mesh: Micro, Dumbach, Dynamic</Description><Size>Diameter 1.0mm - 2.3mm; Up to 90 x 90mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112885</SubGroupID><ARTGs><ARTG>295882</ARTG></ARTGs><MinimumBenefit>1146</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB408</BillingCode><Name>Aesculap Neuro Plating System</Name><Description>Cranial fixation system, internal fracture, non biodegradable.</Description><Size>50 x 50mm and 100 x 100mm, 0.6mm Mesh</Size><SupplierCode>40020</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112885</SubGroupID><ARTGs><ARTG>388668</ARTG></ARTGs><MinimumBenefit>1146</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB416</BillingCode><Name>Aesculap Neuro Plating System</Name><Description>Cranial fixation system, internal fracture, non biodegradable</Description><Size>150x 150 mm, 200 x 200 mm, 0.6mm Mesh</Size><SupplierCode>40020</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112886</SubGroupID><ARTGs><ARTG>388668</ARTG></ARTGs><MinimumBenefit>2072</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH511</BillingCode><Name>Martin Osteosynthesis 1.5mm System Mesh 200cm2</Name><Description>Mesh, Titanium</Description><Size>0.5-0.8mm thick, &gt;200cm2</Size><SupplierCode>40192</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112886</SubGroupID><ARTGs><ARTG>202851</ARTG></ARTGs><MinimumBenefit>2072</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK013</BillingCode><PriorBillingCodes><PriorBillingCode>UQ015</PriorBillingCode></PriorBillingCodes><Name>OsteoMed Plating &amp; Fixation System</Name><Description>Plates</Description><Size>125 x 180mm Mesh Plate, 150 x 300mm Mesh Plate, Mesh &gt;200cm2 area.</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112886</SubGroupID><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>2072</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH492</BillingCode><Name>Standard Approach Mesh</Name><Description>Pre-contoured titanium mesh implants for 11 standard approaches.</Description><Size>0.6mm thick</Size><SupplierCode>40192</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112886</SubGroupID><ARTGs><ARTG>202842</ARTG></ARTGs><MinimumBenefit>2072</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY785</BillingCode><Name>AO/ASIF Plate</Name><Description>Titanium Contourable Mesh, Cranial Neuro</Description><Size>0.5mm-0.8mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112886</SubGroupID><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>2072</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI083</BillingCode><Name>TiMesh Titanium rigid Fixation Bone Grafting and Plating System</Name><Description>FlexMesh 1.5mm - 2.2mm system. Composition: Titanium</Description><Size>148 - 154mm x 148 - 154mm, 0.6mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112886</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>2072</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT032</BillingCode><Name>SCS Titanium Mesh </Name><Description>Titanium mesh: 2D, 3D, pre-moulded 2D, pre-moulded 3D</Description><Size>0.6mm thick; &gt;200cm2</Size><SupplierCode>40227</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109349</GroupID><SubGroupID>112886</SubGroupID><ARTGs><ARTG>339425</ARTG></ARTGs><MinimumBenefit>2072</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ687</BillingCode><Name>PDS Plates</Name><Description>Absorbable synthetic (poly-p-dioxanone) plate/foil</Description><Size>0.25 x 30 x 40mm
0.5 x 30 x 40mm
0.25 x 40 x 50mm
0.5 x 40 x 50mm
0.15 x 30 x 40mm
0.15 x 40 x 50mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109350</GroupID><SubGroupID>112888</SubGroupID><ARTGs><ARTG>165926</ARTG></ARTGs><MinimumBenefit>502</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT032</BillingCode><Name>Martin Level One Fixation Resorb x &amp; SonicWeld</Name><Description>Mesh PDLLA (resorbable)</Description><Size>0.20 to 0.49mm thick, 1 to 10 cm2 area</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109350</GroupID><SubGroupID>112889</SubGroupID><ARTGs><ARTG>143326</ARTG></ARTGs><MinimumBenefit>432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WU003</BillingCode><PriorBillingCodes><PriorBillingCode>VK019</PriorBillingCode></PriorBillingCodes><Name>Inion GTR Biodegradable System</Name><Description>PLGA/TMC Copolymer: membrane &amp; tacks</Description><Size>a) 30 x 40mm membrane kit; b) 6 tack kit and applicator</Size><SupplierCode>40389</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109350</GroupID><SubGroupID>112890</SubGroupID><ARTGs><ARTG>95697</ARTG></ARTGs><MinimumBenefit>654</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT013</BillingCode><Name>Martin Level One Fixation Resorb x &amp; SonicWeld Rx</Name><Description>Mesh, PDLLA (resorbable)</Description><Size>0.20 to 0.49mm thick, 26 to 50cm² area</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109350</GroupID><SubGroupID>112891</SubGroupID><ARTGs><ARTG>143326</ARTG></ARTGs><MinimumBenefit>992</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT058</BillingCode><Name>Martin Level One Fixation Resorb X &amp; SonicWeld RX</Name><Description>Mesh, PDLLA (resorbable)</Description><Size>0.50 to 0.80mm thick, 1 to 10cm²</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109350</GroupID><SubGroupID>112893</SubGroupID><ARTGs><ARTG>14336</ARTG></ARTGs><MinimumBenefit>577</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY544</BillingCode><Name>PolyMax Rapid-Resorbable Fixation System</Name><Description>Mesh Plate</Description><Size>0.5-0.8mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109350</GroupID><SubGroupID>112894</SubGroupID><ARTGs><ARTG>167547</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WU004</BillingCode><PriorBillingCodes><PriorBillingCode>VK023</PriorBillingCode></PriorBillingCodes><Name>CPS Bioabsorbable Fixation System</Name><Description>CPS Systems and Baby System Plates.  Polylactic Acid Trimethylene Carbonate Copolymer</Description><Size>1.5-2.5 mesh plate, 7 x 7 holes; 1.5mm baby mesh plate 7 x 7 holes</Size><SupplierCode>40389</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109350</GroupID><SubGroupID>112894</SubGroupID><ARTGs><ARTG>154546</ARTG></ARTGs><MinimumBenefit>907</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT046</BillingCode><Name>Martin Level One Fixation</Name><Description>Mesh PDLLA resorbable</Description><Size>0.5-0.8mm thick, 26-50cm²</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109350</GroupID><SubGroupID>112895</SubGroupID><ARTGs><ARTG>143326</ARTG></ARTGs><MinimumBenefit>1182</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY547</BillingCode><Name>PolyMax Rapid-Resorbable Fixation System</Name><Description>Mesh Plate</Description><Size>0.5-0.8mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109350</GroupID><SubGroupID>112896</SubGroupID><ARTGs><ARTG>167547</ARTG></ARTGs><MinimumBenefit>1865</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT048</BillingCode><Name>Martin Level One Fixation</Name><Description>Mesh PDLLA resorbable</Description><Size>0.5-0.8mm thick, 101-200cm²</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109350</GroupID><SubGroupID>112897</SubGroupID><ARTGs><ARTG>143326</ARTG></ARTGs><MinimumBenefit>2018</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WM004</BillingCode><Name>Osteoplug</Name><Description>A bone void filler indicated for the repair of neurosurgical burr holes and other cranial  defects. It is used to aid closure of post trephination burr hole defects.</Description><Size> Length 8-100(mm): Width 2-10(mm) Height 4-5 (mm)</Size><SupplierCode>39935</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109350</GroupID><SubGroupID>112898</SubGroupID><ARTGs><ARTG>334286</ARTG></ARTGs><MinimumBenefit>569</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WM001</BillingCode><Name>Osteomesh</Name><Description>A scaffold bone void filler used to fill cranial defects.</Description><Size>Length (mm) 20-60 Height (mm) 1-5 Width (mm) 10-30  </Size><SupplierCode>39935</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109350</GroupID><SubGroupID>112898</SubGroupID><ARTGs><ARTG>334285</ARTG></ARTGs><MinimumBenefit>569</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT044</BillingCode><Name>Martin Level One Fixation</Name><Description>Mesh PDLLA resorbable</Description><Size>&gt;0.8mm thick, 1-10cm²</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109350</GroupID><SubGroupID>112898</SubGroupID><ARTGs><ARTG>143326</ARTG></ARTGs><MinimumBenefit>569</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WM005</BillingCode><Name>Osteoplug-C</Name><Description>A Bone void filler indicated for the repair of neurosurgical burr holes.</Description><Size>Length 8-15 (mm):  Width 8-15 (mm):Height 4-5 (mm)</Size><SupplierCode>39935</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109350</GroupID><SubGroupID>112898</SubGroupID><ARTGs><ARTG>334287</ARTG></ARTGs><MinimumBenefit>569</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT015</BillingCode><Name>Martin Level One Fixation Resorb x &amp; SonicWeld Rx</Name><Description>Mesh, PDLLA (resorbable)</Description><Size>&gt;0.80mm thick, 11 to 25cm² area</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109350</GroupID><SubGroupID>112899</SubGroupID><ARTGs><ARTG>143326</ARTG></ARTGs><MinimumBenefit>617</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WM002</BillingCode><Name>Osteomesh</Name><Description>A scaffold bone void filler used to fill cranial defects</Description><Size>Length (mm): 35-60 Height (mm): 1-5 Width (mm): 15-50</Size><SupplierCode>39935</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109350</GroupID><SubGroupID>112899</SubGroupID><ARTGs><ARTG>334285</ARTG></ARTGs><MinimumBenefit>617</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WM003</BillingCode><Name>Osteomesh</Name><Description>A scaffold bone void filler used to fill cranial defects.</Description><Size>Length (mm): 80-100 Height (mm): 1-5 Width (mm): 30-60</Size><SupplierCode>39935</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109350</GroupID><SubGroupID>112900</SubGroupID><ARTGs><ARTG>334285</ARTG></ARTGs><MinimumBenefit>987</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT045</BillingCode><Name>Martin Level One Fixation</Name><Description>Mesh PDLLA resorbable</Description><Size>&gt;0.8mm thick, 26-50cm²</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109350</GroupID><SubGroupID>112900</SubGroupID><ARTGs><ARTG>143326</ARTG></ARTGs><MinimumBenefit>987</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST516</BillingCode><Name>Stryker Leibinger Resorbable Fixation System</Name><Description>Resorbable plate: blank panel Tripolymer</Description><Size>55x55mm </Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109350</GroupID><SubGroupID>112900</SubGroupID><ARTGs><ARTG>151009</ARTG></ARTGs><MinimumBenefit>987</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WM006</BillingCode><Name>Osteomesh</Name><Description>A scaffold bone void filler used to fill cranial defects</Description><Size>Length 100 (mm): Height 1-5(mm):  Width 100(mm): </Size><SupplierCode>39935</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109350</GroupID><SubGroupID>112901</SubGroupID><ARTGs><ARTG>334285</ARTG></ARTGs><MinimumBenefit>1130</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT049</BillingCode><Name>Martin Level One Fixation</Name><Description>Mesh PDLLA resorbable</Description><Size>&gt;0.8mm thick, 101-200cm2</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109350</GroupID><SubGroupID>112902</SubGroupID><ARTGs><ARTG>143326</ARTG></ARTGs><MinimumBenefit>1953</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY699</BillingCode><Name>SynPOR</Name><Description>Anatomical Porous Polyethylene with Titanium</Description><Size>08.mm - 1.5mm thick</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109351</GroupID><SubGroupID>112903</SubGroupID><ARTGs><ARTG>190454</ARTG></ARTGs><MinimumBenefit>775</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW444</BillingCode><Name>E-POR Biomaterial/ Panel - Porous Polyethlene Titanium Mesh Composite</Name><Description>Panel - Porous Polyethylene Titanium Mesh Composite</Description><Size>0.5mm-0.8mm thick, 76mm x 50mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109351</GroupID><SubGroupID>112904</SubGroupID><ARTGs><ARTG>144994</ARTG></ARTGs><MinimumBenefit>840</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY697</BillingCode><Name>SynPOR</Name><Description>Porous Polyethylene with Titanium</Description><Size>&gt; 08.mm thick</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109351</GroupID><SubGroupID>112905</SubGroupID><ARTGs><ARTG>190454</ARTG></ARTGs><MinimumBenefit>991</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MV020</BillingCode><Name>BVital Form RCM </Name><Description>Resorbable Collagen Dental Membrane</Description><Size>(15-30)mm x (20-40)mm sheet</Size><SupplierCode>40146</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112906</SubGroupID><ARTGs><ARTG>376528</ARTG></ARTGs><MinimumBenefit>224</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB014</BillingCode><Name>Jason membrane</Name><Description>Resorbable collagen membrane for dental regeneration</Description><Size>15 x 20mm, 20 x 30mm, 30 x 40mm</Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112906</SubGroupID><ARTGs><ARTG>307644</ARTG></ARTGs><MinimumBenefit>224</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FV011</BillingCode><Name>Ossix Plus</Name><Description>Ossix Plus is a resorbable collagen membrane intended for use during the process of guided bone regeneration (GBR) and guided tissue regeneration (GTR) as a biodegradable barrier.     </Description><Size>15 x 25mm, 25 x 30mm, 30 x 40mm</Size><SupplierCode>40265</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112906</SubGroupID><ARTGs><ARTG>380301</ARTG></ARTGs><MinimumBenefit>224</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB034</BillingCode><Name>mucoderm®</Name><Description>mucoderm® is a collagen matrix of porcine derived dermis indicated for dental regeneration of soft tissue defects and regenerating soft tissues around teeth or dental implants to act as a scaffold and assist in the revascularisation of the tissue.    </Description><Size>15x20mm  20x30mm  30x40mm  </Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112906</SubGroupID><ARTGs><ARTG>353073</ARTG></ARTGs><MinimumBenefit>224</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VQ001</BillingCode><Name>CelGro Dental and Striate+</Name><Description>Resorbable collagen barrier membrane</Description><Size>15mm x 20mm, 20 x 30mm, 30mm x 40mm, 40mm x 50mm</Size><SupplierCode>40240</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112906</SubGroupID><ARTGs><ARTG>384272</ARTG><ARTG>352137</ARTG></ARTGs><MinimumBenefit>224</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FV012</BillingCode><Name>OSSIX Volumax</Name><Description>A resorbable collagen membrane intended for use during the process of guided bone regeneration (GBR) and guided tissue regeneration (GTR) as a biodegradable barrier.</Description><Size>10 x 12.5mm  15 x 25mm  25 x 30mm  10 x 40mm</Size><SupplierCode>40265</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112906</SubGroupID><ARTGs><ARTG>380302</ARTG></ARTGs><MinimumBenefit>224</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GI020</BillingCode><Name>Geistlich Bio-Gide Shape</Name><Description>Geistlich Bio-Gide Shape is intended to be used as a barrier membrane in the regeneration of bone defects and used after bone grafting procedures in extraction sockets.
Because of its elasticity, Geistlich Bio-Gide Shape should be used in combination with void-filling bone graft materials such as autologous bone or bone substitutes (e.g. Geistlich Bio-Oss / Geistlich Bio-Oss Collagen) whenever possible.
The porous surface, facing the bone, allows the ingrowth of bone-forming cells. The dense surface, facing the soft tissue, prevents the ingrowth of fibrous tissue into the bone defect.</Description><Size>14 x 24 mm</Size><SupplierCode>40366</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112906</SubGroupID><ARTGs><ARTG>287902</ARTG></ARTGs><MinimumBenefit>224</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HD029</BillingCode><Name>BioHorions Mem-Lok RCM</Name><Description>Mem-Lok Resorbable Collagen Matrix is engineered from highly purified, Type I bovine collagen to provide a predictable resorption period and ensure optimal bone regeneration in periodontal, implantology or maxillofacial surgery.</Description><Size>15mm x 20mm  20mm x 30mm  30mm x 40mm</Size><SupplierCode>40347</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112906</SubGroupID><ARTGs><ARTG>196055</ARTG></ARTGs><MinimumBenefit>224</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT033</BillingCode><Name>Martin Level One Fixation Resorb x &amp; SonicWeld</Name><Description>Reconstruction sheet not mesh PDLLA (resorbable)</Description><Size>25x25mm-0.1mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112906</SubGroupID><ARTGs><ARTG>143326</ARTG></ARTGs><MinimumBenefit>224</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HD027</BillingCode><Name>BioHorizons Mem-Lok Pliable </Name><Description>Mem-Lok Pliable is a strong, conformable collagen barrier membrane manufactured from highly purified porcine tissue. Predictable resorption time is 12-16 weeks. Used for guided bone regeneration and periodontal tissue regeneration in oral and maxillofacial surgery.</Description><Size>15mm x 20mm  20mm x 30mm  30mm x 40mm</Size><SupplierCode>40347</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112906</SubGroupID><ARTGs><ARTG>300312</ARTG></ARTGs><MinimumBenefit>224</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW005</BillingCode><Name>OsseoGuard Resorbable Collagen Membrane</Name><Description>Dental Resorbable Collagen Membrane</Description><Size>15mm x 20mm, 20mm x 30mm, 30mm x 40mm</Size><SupplierCode>39969</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112906</SubGroupID><ARTGs><ARTG>154041</ARTG></ARTGs><MinimumBenefit>224</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW009</BillingCode><Name>Biomend &amp; Biomend Extend Collagen Membrane</Name><Description>Absorbable Collagen membrane</Description><Size>15mm x 20mm
20mm x 30mm
30mm x 40mm</Size><SupplierCode>39969</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112906</SubGroupID><ARTGs><ARTG>159200</ARTG><ARTG>159199</ARTG></ARTGs><MinimumBenefit>224</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GI014</BillingCode><Name>Geistlich Mucograft,  Geistlich Mucograft Seal</Name><Description>Collagen Matrix</Description><Size>15mm x 20mm, 20mm x 30mm, diameter 8mm, diameter 12mm</Size><SupplierCode>40366</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112906</SubGroupID><ARTGs><ARTG>229991</ARTG><ARTG>229995</ARTG></ARTGs><MinimumBenefit>224</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GI021</BillingCode><Name>Geistlich Bio-Gide</Name><Description>Geistlich Bio-Gide is a collagen membrane containing porcine collagen in a bilayer structure. It is used for guided bone regeneration and peridontal tissue regeneration in oral and maxillofacial surgery.</Description><Size>13 x 25 mm, 25 x 25 mm, 30 x 40 mm</Size><SupplierCode>40366</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112906</SubGroupID><ARTGs><ARTG>230084</ARTG></ARTGs><MinimumBenefit>224</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GI019</BillingCode><Name>Geistlich Bio-Gide Perio / Geistlich Bio-Gide Compressed</Name><Description>Geistlich Bio-Gide Perio and Geistlich Bio-Gide Compressed are collagen membranes containing porcine collagen in a bilayer structure. Geistlich Bio-Gide Perio is used for guided bone regeneration and is especially indicated for periodontal bone defects in oral and maxillofacial surgery.
Geistlich Bio-Gide Compressed is intended to be used as a barrier membrane in the regeneration of bone defects.</Description><Size>16 x 22 mm, 13 x 25 mm, 20 x 30 mm</Size><SupplierCode>40366</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112906</SubGroupID><ARTGs><ARTG>230085</ARTG><ARTG>294333</ARTG></ARTGs><MinimumBenefit>224</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IC004</BillingCode><Name>ZenGuard</Name><Description>ZenGuard Resorbable Membrane is a conformable Collagen Membrane derived from purified porcine peritoneum to aid in wound healing</Description><Size>15x 20mm
20x 30mm
30x 40mm</Size><SupplierCode>40338</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112906</SubGroupID><ARTGs><ARTG>300185</ARTG></ARTGs><MinimumBenefit>224</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NR015</BillingCode><Name>creos xenoprotect</Name><Description>creos xenoprotect is a resorbable dental membrane. A resorbable collagen membrane is used for guided bone regeneration (GBR) and guided tissue regeneration (GTR) procedures.  It's composed of a network of interwoven, highly purified porcine collagen and elastin fibers, providing the membrane with high mechanical strength.</Description><Size>15 x 20mm  25 x 30mm  30 x 40mm</Size><SupplierCode>40132</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112906</SubGroupID><ARTGs><ARTG>297240</ARTG></ARTGs><MinimumBenefit>224</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OK007</BillingCode><Name>Neomem FLEXPLUS</Name><Description>Resorbable Collagen Membrane</Description><Size>15 x 20mm, 20 x 30mm, 30 x 40mm  </Size><SupplierCode>40176</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112906</SubGroupID><ARTGs><ARTG>317977</ARTG></ARTGs><MinimumBenefit>224</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IF003</BillingCode><Name>Regaurde Resorbable Collagen Membrane</Name><Description>Collagen dental regeneration membrane</Description><Size>15x20mm, 20x30mm, 30x40mm</Size><SupplierCode>40248</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112906</SubGroupID><ARTGs><ARTG>216324</ARTG></ARTGs><MinimumBenefit>224</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NJ013</BillingCode><Name>NeoGen Collagen membrane</Name><Description>NeoGen Collagen Flex is a bioresorbable, implantable collagen material that is intended for use in oral surgical procedures as a resorbable membrane material for use in simultaneous use of guided bine regeneration (GBR) - membrane and implants; augmentation around implants placed in immediate extraction sockets; augmentation around implants placed in delayed extraction sockets; localized ridge augmentation for later implantation; alveolar ridge reconstruction for prosthetic treatment; filling of bone defects after root resection, cystectomy or removal of retained teeth; guided bone regeneration in dehiscence defects and guided tissue regeneration procedures in periodontal defects</Description><Size>Small 20mm x15mm  Medium 30mm x 20mm  Large 40mm x 30mm</Size><SupplierCode>40137</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112906</SubGroupID><ARTGs><ARTG>372711</ARTG></ARTGs><MinimumBenefit>224</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE812</BillingCode><PriorBillingCodes><PriorBillingCode>VL009</PriorBillingCode></PriorBillingCodes><Name>Su-Por Ultra Thin, Membrane, Flor-Tec, Channel Sheet</Name><Description>An implantable device intended to support, contour, and provide structure for the craniofacial anatomy during reconstructive and plastic surgery procedures. Made of high-density polyethylene material with an interconnecting pore structure that supports tissue ingrowth. The device is available in various shapes and can be cut by the surgeon to meet the patient's specific needs.</Description><Size>2.5mm, 3.5mm. 4.0mm, 0.85mm, 1.5mm, 3.0mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112907</SubGroupID><ARTGs><ARTG>335454</ARTG></ARTGs><MinimumBenefit>234</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW418</BillingCode><Name>Barrier Sheet: Barrier Sheet - Orbital Floor</Name><Description>Porus Polyethylene. Barrier  sheet - Rectangle, models 8312 and 9312. Orbital floor implants, models 8305 and 9305</Description><Size> Barrier  sheet - Rectangle: 50 x 76  x 1mm, 50 x 76 x 1.6mm: 50 x 76 x 1mm, 50 x 76 x 1.6mm.  Orbital Floor: 38 x 50 x 1mm, 38 x 50 x 1.6mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112907</SubGroupID><ARTGs><ARTG>257032</ARTG></ARTGs><MinimumBenefit>234</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW416</BillingCode><Name>Micro Thin Sheet</Name><Description>Model/s 8438, 83020, 83022, 83029</Description><Size>8438: 30 x 50 x 0.4mm,  83020: 38 x 50 x 0.25mm, 83022: 38 x 50 x 0.35mm, 83029: 38 x 50 x 0.45mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112907</SubGroupID><ARTGs><ARTG>152165</ARTG></ARTGs><MinimumBenefit>234</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY696</BillingCode><Name>SynPOR</Name><Description>Porous Polyethylene</Description><Size>0.45mm - 3.0mm thick</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112907</SubGroupID><ARTGs><ARTG>190454</ARTG></ARTGs><MinimumBenefit>234</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK517</BillingCode><Name>Sheet - Barrier Single Channel Sheet.</Name><Description>Porus Polyethylene. Barrier Single Channel Sheet, Model 9527.</Description><Size>Barrier Single Channel: 38 x 50 x 0.85mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112907</SubGroupID><ARTGs><ARTG>257016</ARTG></ARTGs><MinimumBenefit>234</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW672</BillingCode><PriorBillingCodes><PriorBillingCode>HW426</PriorBillingCode><PriorBillingCode>HW427</PriorBillingCode><PriorBillingCode>SK513</PriorBillingCode><PriorBillingCode>SK516</PriorBillingCode></PriorBillingCodes><Name>Ultra Thin Sheet</Name><Description>Porus Polyethylene</Description><Size>38-127 x 50-178 x 0.85mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112907</SubGroupID><ARTGs><ARTG>257032</ARTG></ARTGs><MinimumBenefit>234</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW417</BillingCode><Name>Sheet</Name><Description>Porus Polyethylene. Models 6330, 6331, 8662, 9562. Micro single channel sheet, model 9528. Barrier microplate single channel sheet, model 9527 Medpor Titan Implant Sheets Plain, Barrier &amp; Double Barrier, and Medpor Titan Orbital floor and wall sheets 8102</Description><Size>Sheets 6330: 38 x 50 x 1.5mm, 6331: 50 x 76 x 1.5mm, 8662: 76 x 127 x 1.5mm, 9862: 38 x 50 x 3mm. Microplate single channel Sheet 9528: 38 x 50 x 0.85mm. Barrier microplate single channel Sheet 9527: 38 x 50 x 0.85mm. Titan implant sheets 81020: 76 x 50 x</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112907</SubGroupID><ARTGs><ARTG>152165</ARTG></ARTGs><MinimumBenefit>234</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW506</BillingCode><Name>Stryker MEDPOR Implant</Name><Description>Porous Polyethylene Mesh</Description><Size>Block</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112908</SubGroupID><ARTGs><ARTG>152165</ARTG></ARTGs><MinimumBenefit>804</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE805</BillingCode><PriorBillingCodes><PriorBillingCode>VL001</PriorBillingCode></PriorBillingCodes><Name>Su-Por Flexible Block</Name><Description>An implantable device intended to support, contour, and provide structure for the craniofacial anatomy during reconstructive and plastic surgery procedures. Made of high density polyethylene material with an interconnecting pore structure that supports tissue ingrowth. The device is available in various shapes and can be cut by the surgeon to meet the patient's specific needs.</Description><Size>13 x 38 x 3mm, 25 x 50 x 6mm, 13 x 38 x 9.5mm  25 x 50 x 3mm, 25 x 50 x 6mm, 25 x 50 x 9.5mm  38 x 63 x 3mm, 38 x 63 x 6mm, 38 x 63 x 9.5mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109352</GroupID><SubGroupID>112908</SubGroupID><ARTGs><ARTG>335454</ARTG></ARTGs><MinimumBenefit>804</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WT004</BillingCode><Name>EvoFix Low Profile</Name><Description>Titanium craniofacial fixation plates </Description><Size>&lt;0.5mm thickness, &lt;4 holes</Size><SupplierCode>40396</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112909</SubGroupID><ARTGs><ARTG>314801</ARTG></ARTGs><MinimumBenefit>63</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY561</BillingCode><Name>Matrix</Name><Description>Simple shaped plates</Description><Size>&lt; 4 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112909</SubGroupID><ARTGs><ARTG>298355</ARTG></ARTGs><MinimumBenefit>63</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK014</BillingCode><PriorBillingCodes><PriorBillingCode>UQ011</PriorBillingCode></PriorBillingCodes><Name>Plates</Name><Description>Micro, Midface &amp; Mini</Description><Size>Straight Plate - 2 Hole, Plate &lt; 4 holes.</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112909</SubGroupID><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>63</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB411</BillingCode><Name>Aesculap Neuro Plating System</Name><Description>Cranial fixation system, internal fracture, non biodegradable. Consists of screws, plates.</Description><Size>Plate Neuro, 2 hole, 12.4 - 15.4mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112909</SubGroupID><ARTGs><ARTG>388668</ARTG></ARTGs><MinimumBenefit>63</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT026</BillingCode><Name>SCS Interlink Plate - 2-hole</Name><Description>Titanium 2-hole plate</Description><Size>0.4mm x 15mm, 0.4mm x 17mm</Size><SupplierCode>40227</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112909</SubGroupID><ARTGs><ARTG>339425</ARTG></ARTGs><MinimumBenefit>63</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY562</BillingCode><Name>Matrix</Name><Description>Micro X, Frame plates</Description><Size>4  - 7 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112910</SubGroupID><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>137</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WT001</BillingCode><Name>EvoFix Low Profile Burrhole Plate</Name><Description>Titanium craniofacial fixation plates</Description><Size>&lt;0.5mm thick, 4-7 holes</Size><SupplierCode>40396</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112910</SubGroupID><Suffix>Burr</Suffix><ARTGs><ARTG>314801</ARTG></ARTGs><MinimumBenefit>155</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN196</BillingCode><Name>Matrix Plate</Name><Description>Burr Hole Plates</Description><Size>12 to 24mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112910</SubGroupID><Suffix>Burr</Suffix><ARTGs><ARTG>298355</ARTG></ARTGs><MinimumBenefit>155</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT010</BillingCode><Name>Martin Level One Fixation</Name><Description>Plate, titanium</Description><Size>&lt;0.5mm thick, 4 to 7 holes</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112910</SubGroupID><Suffix>Burr</Suffix><ARTGs><ARTG>96619</ARTG></ARTGs><MinimumBenefit>155</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT028</BillingCode><Name>SCS Interlink Plate - Burr Hole/Drainage Burr Hole</Name><Description>Titanium burr hole plate, drainage burr hole plate </Description><Size>0.4mm thick; Diameter: 12mm, 16mm, 18mm, 22mm, </Size><SupplierCode>40227</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112910</SubGroupID><Suffix>Burr</Suffix><ARTGs><ARTG>339425</ARTG></ARTGs><MinimumBenefit>155</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH495</BillingCode><Name>Martin Level One Fixation</Name><Description>Plate, titanium</Description><Size>&lt;0.5mm thick, 4 to 7 holes</Size><SupplierCode>40192</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112910</SubGroupID><Suffix>Burr</Suffix><ARTGs><ARTG>202851</ARTG></ARTGs><MinimumBenefit>155</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB412</BillingCode><Name>Aesculap Neuro Plating System</Name><Description>Cranial fixation system, internal fracture, non biodegradable.  Consists of screws, plates.</Description><Size>Plate Neuro, 4 - 7 hole,   Dimensions: 11.0 - 30.3mm x 3.4 - 24.3mm  Diameters: 18.4 - 30.9mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112910</SubGroupID><ARTGs><ARTG>388668</ARTG></ARTGs><MinimumBenefit>137</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WT002</BillingCode><Name>EvoFix Low Profile Various</Name><Description>Titanium craniofacial fixation plates</Description><Size>&lt;0.5mm thick, 4-7 holes</Size><SupplierCode>40396</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112910</SubGroupID><ARTGs><ARTG>314801</ARTG></ARTGs><MinimumBenefit>137</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH504</BillingCode><Name>Martin Osteosynthesis 1.5mm System 8-15 hole plate</Name><Description>Plate, Titanium</Description><Size>&lt;0.5mm thick, 8-15 holes</Size><SupplierCode>40192</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112911</SubGroupID><ARTGs><ARTG>202851</ARTG></ARTGs><MinimumBenefit>193</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY563</BillingCode><Name>Matrix</Name><Description>Micor Orbital curved plate</Description><Size>12 hole</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112911</SubGroupID><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>193</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB414</BillingCode><Name>Aesculap Neuro Plating System</Name><Description>Cranial fixation system, internal fracture, non biodegradable. Consists of screws, plates.</Description><Size>Plate Neuro, 8 - 10 hole, 28mm - 43.9mm x 3.4mm - 14mm.  </Size><SupplierCode>40020</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112911</SubGroupID><ARTGs><ARTG>388668</ARTG></ARTGs><MinimumBenefit>193</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY558</BillingCode><Name>Matrix</Name><Description>Micro Adaption, Strut Plates</Description><Size>18-20 hole</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112912</SubGroupID><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>283</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB413</BillingCode><Name>Aesculap Neuro Plating System</Name><Description>Cranial fixation system, internal fracture, non biodegradable.  </Description><Size>One size</Size><SupplierCode>40020</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112912</SubGroupID><ARTGs><ARTG>388668</ARTG></ARTGs><MinimumBenefit>283</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH506</BillingCode><Name>Martin Osteosynthesis 1.5mm System 16-32 hole plate</Name><Description>Plate, Titanium</Description><Size>&lt;0.5mm thick, 16-32 holes</Size><SupplierCode>40192</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112912</SubGroupID><ARTGs><ARTG>202851</ARTG></ARTGs><MinimumBenefit>283</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW497</BillingCode><Name>Stryker Leibinger Plating System</Name><Description>Fracture or reconstruction plates</Description><Size>0.5 - 0.99mm thick, &amp;lt;4 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112913</SubGroupID><ARTGs><ARTG>200615</ARTG><ARTG>295882</ARTG></ARTGs><MinimumBenefit>76</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK015</BillingCode><PriorBillingCodes><PriorBillingCode>UQ016</PriorBillingCode></PriorBillingCodes><Name>Plates</Name><Description>Micro, Midface &amp; Mini</Description><Size>Straight Plate - 2 Hole, Plate &lt; 4 holes.</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112913</SubGroupID><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>76</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH502</BillingCode><Name>Martin Osteosynthesis 1.5mm System 2 hole plate</Name><Description>Plate, 0.6mm thick, titanium</Description><Size>2-4 hole</Size><SupplierCode>40192</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112913</SubGroupID><ARTGs><ARTG>202851</ARTG></ARTGs><MinimumBenefit>76</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT027</BillingCode><Name>SCS Interlink Plate - 2-hole</Name><Description>Titanium 2-hole plate</Description><Size>0.6mm x 15mm, 0.6mm x 17mm</Size><SupplierCode>40227</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112913</SubGroupID><ARTGs><ARTG>339425</ARTG></ARTGs><MinimumBenefit>76</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT024</BillingCode><Name>Martin Micro Plate Osteosynthesis System</Name><Description>1.5mm system Straight Plate Titanium</Description><Size>2 hole, 0.6mm profile</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112913</SubGroupID><ARTGs><ARTG>96620</ARTG></ARTGs><MinimumBenefit>76</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI677</BillingCode><Name>W Lorenz Osteosynthesis System</Name><Description>Plate, Neuro Straight, 1.5mm System, Titanium</Description><Size>2 hole (medium or long)</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112913</SubGroupID><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>76</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY512</BillingCode><Name>AO/ASIF Plate</Name><Description>Rapid resorbable reconstruction plate</Description><Size>&lt;4 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112913</SubGroupID><Suffix>Resorbable</Suffix><ARTGs><ARTG>167547</ARTG></ARTGs><MinimumBenefit>144</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC867</BillingCode><Name>TiMesh Rigid Fixation Bone Grafting and Plating System</Name><Description>Titanium, Plate</Description><Size>Ohata Tristar 8.4 10mm, &lt; 4 hole</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112913</SubGroupID><Suffix>Burr</Suffix><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>112</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC908</BillingCode><Name>Timesh</Name><Description>Rigid Straight Plates</Description><Size>&lt; 4 holes</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112913</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>76</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ007</BillingCode><PriorBillingCodes><PriorBillingCode>AT078</PriorBillingCode><PriorBillingCode>AT078</PriorBillingCode></PriorBillingCodes><Name>Anatomics Fixation Straight Plates</Name><Description>Titanium fixation straight plates</Description><Size>2 Holes
Thickness - 0.6mm
Length - 15mm</Size><SupplierCode>40481</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112913</SubGroupID><ARTGs><ARTG>288564</ARTG></ARTGs><MinimumBenefit>76</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC872</BillingCode><Name>TiMesh Rigid Fixation Bone Grafting and Plating System</Name><Description>Titanium, Straight Plate</Description><Size>&lt; 4 holes</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112913</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>76</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK019</BillingCode><PriorBillingCodes><PriorBillingCode>UQ017</PriorBillingCode></PriorBillingCodes><Name>Plates</Name><Description>Micro, Midface, Mini, Maxi, BSSO, TR BSSO</Description><Size>0.5-0.99mm thick, 4-7 holes</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ006</BillingCode><PriorBillingCodes><PriorBillingCode>AT079</PriorBillingCode><PriorBillingCode>AT079</PriorBillingCode></PriorBillingCodes><Name>Anatomics Fixation Double-Y Plates</Name><Description>Titanium craniofacial fixation plates</Description><Size>6 Holes
Thickness - 0.6mm
Length - 17mm</Size><SupplierCode>40481</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><ARTGs><ARTG>288564</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ060</BillingCode><Name>Lyka Smith Jeil Le Forte Plates 4-7 Holes</Name><Description>Titanium plates in a variety of shapes for reconstruction</Description><Size>Thickness - 0.5-0.8mm   4-7 Holes</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><ARTGs><ARTG>310093</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO095</BillingCode><Name>MODUS Orthognathics</Name><Description>Indication-specific solutions for maxillary and mandibular orthognathic surgeries</Description><Size>1.5mm - 29mm</Size><SupplierCode>40165</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>350270</ARTG><ARTG>350271</ARTG><ARTG>181396</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC909</BillingCode><Name>Timesh</Name><Description>Rigid Straight Plates</Description><Size>4 - 7 holes</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC885</BillingCode><Name>TiMesh Rigid Fixation Bone Grafting and Plating System</Name><Description>Titanium, H Plate</Description><Size>4 - 7 hole</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC576</BillingCode><Name>Timesh</Name><Description>Double Y Plates</Description><Size>3 Hole - 2.5mm - 7mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC393</BillingCode><Name>TiMesh Rigid Fixation Bone Grafting and Plating System</Name><Description>Titanium, Z Plate Left and Right</Description><Size>4 hole - 5mm, 9.5mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC519</BillingCode><Name>TiMesh</Name><Description>Squareplate</Description><Size>4 holes x 1mm - 4 holes x 2.2mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT014</BillingCode><Name>Martin Level One Fixation</Name><Description>Plate, titanium</Description><Size>0.5-0.99mm thick, 4-7 holes</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>96619</ARTG><ARTG>96620</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI348</BillingCode><Name>W Lorenz Osteosynthesis System</Name><Description>L-Plate, 2mm System, Left or Right. Titanium</Description><Size>2 x 2 hole, Mini or Low Profile</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><ARTGs><ARTG>119508</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI621</BillingCode><Name>W Lorenz Osteosynthesis System</Name><Description>Plate, L , 2.5mm or 2m system, Titanium</Description><Size>2 x2 or 3x3 hole</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI605</BillingCode><Name>W Lorenz Osteosynthesis System</Name><Description>Plate, Matrix, 1.0 or 1.5mm System, Titanium</Description><Size>6 hole</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC520</BillingCode><Name>TiMesh</Name><Description>X Plate</Description><Size>4 holes x 1mm - 4 holes x 2.2mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ063</BillingCode><Name>Lyka Smith Jeil Le Forte Locking Plates 4-7 Holes</Name><Description>Titanium locking plates of various shapes for reconstruction</Description><Size>4-7 holes  Thickness - 0.5-0.99mm</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>310093</ARTG></ARTGs><MinimumBenefit>190</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY504</BillingCode><Name>AO/ASIF Plate</Name><Description>Rapid resorbable reconstruction plate</Description><Size>4-7 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><Suffix>Resorbable</Suffix><ARTGs><ARTG>167547</ARTG></ARTGs><MinimumBenefit>195</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW499</BillingCode><Name>Delta Resorbable Fixation System</Name><Description>Craniofacial Resorbable Fixation Plates</Description><Size>0.5 -0.99mm thick, 4 - 7 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><Suffix>Resorbable</Suffix><ARTGs><ARTG>151009</ARTG><ARTG>72659</ARTG></ARTGs><MinimumBenefit>195</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT029</BillingCode><Name>SCS Interlink Plate - Burr Hole/Drainage Burr Hole</Name><Description>Titanium burr hole plate, drainage burr hole plate </Description><Size>0.6mm thick; Diameter: 12mm, 16mm, 18mm, 22mm</Size><SupplierCode>40227</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><Suffix>Burr</Suffix><ARTGs><ARTG>339425</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY319</BillingCode><Name>AO/ASIF Plate</Name><Description>Low profile neurosurgical plate, burr hole</Description><Size>4-7 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><Suffix>Burr</Suffix><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC868</BillingCode><Name>TiMesh Rigid Fixation Bone Grafting and Plating System</Name><Description>Titanium, Plate</Description><Size>Fan Blade 11-18mm, Mesh 11-25mm, 4 - 7 hole</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><Suffix>Burr</Suffix><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ003</BillingCode><PriorBillingCodes><PriorBillingCode>AT080</PriorBillingCode><PriorBillingCode>AT080</PriorBillingCode></PriorBillingCodes><Name>Anatomics Burr Hole Plates</Name><Description>Titanium burr hole plate</Description><Size>Thickness - 0.6mm
Diameter - 18-22mm</Size><SupplierCode>40481</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><Suffix>Burr</Suffix><ARTGs><ARTG>288564</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ST141</BillingCode><Name>Leibinger Titanium Implant System</Name><Description>Leibinger Burr Hole Cover: curved  Titanium</Description><Size>7, 10, 14mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><Suffix>Burr</Suffix><ARTGs><ARTG>200615</ARTG><ARTG>295882</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA096</BillingCode><PriorBillingCodes><PriorBillingCode>BI353</PriorBillingCode><PriorBillingCode>BI721</PriorBillingCode></PriorBillingCodes><Name>W Lorenz Osteosynthesis System</Name><Description>Plate, Burr Hole, 1mm, 1.5mm, 2mm system  </Description><Size>13mm-25mm  </Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><Suffix>Burr</Suffix><ARTGs><ARTG>128458</ARTG><ARTG>128460</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK016</BillingCode><PriorBillingCodes><PriorBillingCode>UQ018</PriorBillingCode></PriorBillingCodes><Name>Plates</Name><Description>Micro, Mini, Maxi</Description><Size>Burr Hole Plates, Calvarium Plate - Small &amp; Large - Calvarium Plate, Plates 4 to 7 Holes</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><Suffix>Burr</Suffix><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW500</BillingCode><Name>Stryker Leibinger Plating System</Name><Description>Craniofacial Fixation Plates ,Locking</Description><Size>0.5 - 0.9mm thick, 4 -7 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>295882</ARTG><ARTG>200615</ARTG></ARTGs><MinimumBenefit>190</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK017</BillingCode><PriorBillingCodes><PriorBillingCode>UQ044</PriorBillingCode></PriorBillingCodes><Name>Plates</Name><Description>Micro, Mini, Maxi</Description><Size>Gap Plates, Plates 4 to 7 holes</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY582</BillingCode><Name>AO/ASIF Plate</Name><Description>Titanium adaption plate</Description><Size>4-7 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI591</BillingCode><Name>W Lorenz Osteosynthesis System</Name><Description>Chin Plates, Paulus, 2mm System, Titanium</Description><Size>4 - 12mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>240</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ081</BillingCode><PriorBillingCodes><PriorBillingCode>WH007</PriorBillingCode></PriorBillingCodes><Name>Materialise Standard+ Solutions - Plates</Name><Description>Titanium plate</Description><Size>0.5-0.99mm thick, 4-7 holes</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><Suffix>Compression</Suffix><ARTGs><ARTG>377044</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK018</BillingCode><PriorBillingCodes><PriorBillingCode>UQ019</PriorBillingCode></PriorBillingCodes><Name>OsteoMed Plating &amp; Fixation System</Name><Description>Compression Plates - Micro, Mini &amp; Maxi</Description><Size>Micro: 2 x 3 Hole Compression T Plate, Oblique Left &amp; Right Compression T Plate, 4 Hole Straight Compression Plate; 5 Hole Straight Plate, 13mm Left &amp; Right L Plate, 19mm T Plate, 2 x 3 Hole Quad Plate; Mini: 4 Hole Left &amp; Right L Plate, 4 Hole Left &amp; Rig</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><Suffix>Compression</Suffix><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY581</BillingCode><Name>AO/ASIF Plate</Name><Description>Titanium adaption plate</Description><Size>4-7 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><Suffix>Compression</Suffix><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH507</BillingCode><Name>Martin Osteosynthesis 1.5mm System Burr hole plate</Name><Description>Burr Hole Plate, Titanium</Description><Size>0.6mm thick, 4-7 holes</Size><SupplierCode>40192</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><Suffix>Burr</Suffix><ARTGs><ARTG>202851</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH362</BillingCode><Name>Lorenz Plating System</Name><Description>Neuro Gap Plate, Titanium</Description><Size>25mm - 45mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI620</BillingCode><Name>W Lorenz Osteosynthesis System</Name><Description>Plate, Straight, low profile, 2.0mm System, Titanium</Description><Size>4 - 8 hole</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI617</BillingCode><Name>W Lorenz Osteosynthesis System</Name><Description>Plate, Straight, 1mm System. Titanium</Description><Size>4 hole</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT057</BillingCode><Name>Martin Level One Fixation</Name><Description>Plate Titanium</Description><Size>0.5 to 0.99mm thick, 4 - 7 holes</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><ARTGs><ARTG>96619</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC870</BillingCode><Name>TiMesh Rigid Fixation Bone Grafting and Plating System</Name><Description>Titanium, Y Plate Double and Single</Description><Size>4 - 7 hole</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC875</BillingCode><Name>TiMesh Rigid Fixation Bone Grafting and Plating System</Name><Description>Titanium, T Plate</Description><Size>4 - 7 hole</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW498</BillingCode><Name>Stryker Leibinger Plating System</Name><Description>Craniofacial Fixation Plates</Description><Size>0.5 - 0.99mm thick, 4 -7 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><ARTGs><ARTG>295882</ARTG><ARTG>200615</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH503</BillingCode><Name>Martin Osteosynthesis 1.5mm System 4-7 hole plate</Name><Description>Plate, 0.6mm thick, Titanium</Description><Size>4-7 hole</Size><SupplierCode>40192</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><ARTGs><ARTG>202851</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI656</BillingCode><Name>W Lorenz Osteosynthesis System</Name><Description>Plate, Orbital, 1.5mm, 2.0mm System, Titanium</Description><Size>6 hole</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI627</BillingCode><Name>W Lorenz Osteosynthesis System</Name><Description>Plate, Straight, 1.5mm System, Titanium</Description><Size>4 or 6 hole</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW677</BillingCode><Name>Stryker Mini Plating System</Name><Description>Craniomaxillofacial reconstruction fixation plates. </Description><Size>0.5-0.99mm thick, 4-7 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><ARTGs><ARTG>200615</ARTG><ARTG>295882</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI625</BillingCode><Name>W Lorenz Osteosynthesis System</Name><Description>Plate, Y, Double Y, X, 1.5mm System or 2.0mm System, Titanium</Description><Size>One size only</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC883</BillingCode><Name>TiMesh Rigid Fixation Bone Grafting and Plating System</Name><Description>Titanium, L Plate (Left and right configurations)</Description><Size>4 to 7 holes</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112914</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI719</BillingCode><Name>W Lorenz Osteosynthesis System</Name><Description>Neuro Sub-Temporal Plate, Titanium</Description><Size>medium</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY583</BillingCode><Name>AO/ASIF Plate</Name><Description>Titanium adaption plate</Description><Size>8-32 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><Suffix>Compression</Suffix><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>195</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ062</BillingCode><Name>Lyka Smith Jeil Le Forte Plates 8-32 Holes</Name><Description>Titanium plates in a variety of shapes for reconstruction</Description><Size>Thickness 0.5 - 0.8mm  8-20 Holes</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><ARTGs><ARTG>310093</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC876</BillingCode><Name>TiMesh Rigid Fixation Bone Grafting and Plating System</Name><Description>Titanium, T Plate</Description><Size>8 - 15 hole</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI091</BillingCode><Name>TiMesh</Name><Description>Rigid Straight Plate</Description><Size>8 -32 holes</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC678</BillingCode><Name>TiMesh Rigid Fixation Bone Grafting and Plating System</Name><Description>Titanium, Universal Plate</Description><Size>12h</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ083</BillingCode><PriorBillingCodes><PriorBillingCode>WH010</PriorBillingCode></PriorBillingCodes><Name>Materialise Standard+ Solutions - Plates</Name><Description>Titanium plate</Description><Size>0.5-0.99mm thick, 8-32 holes</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><Suffix>Compression</Suffix><ARTGs><ARTG>377044</ARTG></ARTGs><MinimumBenefit>195</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC869</BillingCode><Name>TiMesh Rigid Fixation Bone Grafting and Plating System</Name><Description>Titanium, Plate</Description><Size>Ohata Kerf Cover, 5 - 32 hole</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><Suffix>Burr</Suffix><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>403</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK355</BillingCode><Name>Universal Neuro Titanium Low Profile Plate</Name><Description>Titanium Low Profile plates used for the fixation of cranial bone flaps</Description><Size>Small, large, 20mm burr hole, 16 hole without bar</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><Suffix>Burr</Suffix><ARTGs><ARTG>200615</ARTG><ARTG>295882</ARTG></ARTGs><MinimumBenefit>403</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO127</BillingCode><Name>MODUS Intermaxillary Fixation System </Name><Description>Titanium Arch Bar </Description><Size>One size </Size><SupplierCode>40165</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>350314</ARTG></ARTGs><MinimumBenefit>259</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ061</BillingCode><Name>Lyka Smith Jeil Le Forte Locking Plates 8-32 holes</Name><Description>Titanium locking plates for craniofacial reconstruction</Description><Size>Thickness - 0.8mm  Holes - 8-32</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>310093</ARTG></ARTGs><MinimumBenefit>259</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK020</BillingCode><PriorBillingCodes><PriorBillingCode>UQ021</PriorBillingCode></PriorBillingCodes><Name>Plates</Name><Description>Micro, Mini, Maxi</Description><Size>Quad Plates, Medium 2 x 4 Hole Quad Plate, Plates 8 to 15 holes</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><Suffix>3D</Suffix><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>205</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW503</BillingCode><Name>Delta Resorbable fixation System</Name><Description>Craniofacial Resorbable Fixation Plates</Description><Size>0.5 - 0.99mm thick, 8 -32 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><Suffix>Resorbable</Suffix><ARTGs><ARTG>151009</ARTG><ARTG>72659</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY584</BillingCode><Name>AO/ASIF Plate</Name><Description>Rapid resorbable reconstruction plate</Description><Size>8-32 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><Suffix>Resorbable</Suffix><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO096</BillingCode><Name>MODUS Orthognathic</Name><Description>Indication-specific solutions for maxillary and mandibular orthognathic surgeries. Le-Fort, Split, Grid, Bar plates, Sagittal split, X-Shaped, L-shaped, Z-shaped, T-shaped, Y-Shaped, straight plates, square, rectangular </Description><Size>0.5-0.7mm Thick, 8-32 Holes </Size><SupplierCode>40165</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>350271</ARTG><ARTG>350270</ARTG></ARTGs><MinimumBenefit>273</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY585</BillingCode><Name>AO/ASIF Plate</Name><Description>Titanium adaption plate</Description><Size>8-32 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>273</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT037</BillingCode><Name>Martin Level One Fixation</Name><Description>Plate Titanium</Description><Size>0.5-0.99mm thick, 8-32 holes</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>96619</ARTG></ARTGs><MinimumBenefit>273</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK345</BillingCode><Name>Leibinger Titanium Implant System - Universal CMF Plate</Name><Description>Le Fort 1 Plate, Right/Left</Description><Size>11hole, Advancement 2 - 10mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>295882</ARTG><ARTG>200615</ARTG></ARTGs><MinimumBenefit>273</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ082</BillingCode><PriorBillingCodes><PriorBillingCode>WH016</PriorBillingCode></PriorBillingCodes><Name>Materialise Standard+ Solutions - Plates</Name><Description>Titanium plate, Complex shape</Description><Size>0.5-0.99mm thick, 8-32 holes</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>377044</ARTG></ARTGs><MinimumBenefit>273</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW504</BillingCode><Name>Stryker Leibinger Plating System</Name><Description>Craniofacial Locking Fixation Plates</Description><Size>0.5 - 0.99mm thick, 8 -32 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>295882</ARTG><ARTG>200615</ARTG></ARTGs><MinimumBenefit>259</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI923</BillingCode><Name>OmniMax Arch Bar</Name><Description>Arch Bar</Description><Size>One size</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>211079</ARTG></ARTGs><MinimumBenefit>259</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW486</BillingCode><Name>Stryker Leibinger Hybrid MMF Plate</Name><Description>SMARTLOCK Hybrid MMF Plate, Locking  System - Universal SMARTLOCK Hybrid MMF  Component - MMF Plate</Description><Size>One size - 9 Hole Straight Plate, for maxilla and Mandible</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>200615</ARTG></ARTGs><MinimumBenefit>259</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC886</BillingCode><Name>TiMesh Rigid Fixation Bone Grafting and Plating System</Name><Description>Titanium, H Plate</Description><Size>8-15 hole</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC871</BillingCode><Name>Ti Mesh Rigid Fixation Bone Grafting and Plating System</Name><Description>Titanium ,Straight Plate</Description><Size>8 - 32 holes</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC884</BillingCode><Name>TiMesh Rigid Fixation Bone Grafting and Plating System</Name><Description>Titanium, L Plate (Left and right configurations)</Description><Size>8 - 15 hole</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI773</BillingCode><Name>W Lorenz Osteosynthesis System</Name><Description>Neuro sub-temporal plate, 1.5 system, titanium</Description><Size>Small</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI641</BillingCode><Name>W Lorenz Osteosynthesis System</Name><Description>Plate, Matrix.  1mm System, 1.5mm System. Titanium</Description><Size>2 x 4 hole</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI658</BillingCode><Name>W Lorenz Osteosynthesis System</Name><Description>Plate, Orbital. 1.5mm System, 2mm System. Titanium</Description><Size>8-10 hole</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA079</BillingCode><PriorBillingCodes><PriorBillingCode>BI985</PriorBillingCode><PriorBillingCode>BI989</PriorBillingCode></PriorBillingCodes><Name>W Lorenz Osteosynthesis System</Name><Description>straight plates</Description><Size>8-32 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW502</BillingCode><Name>Stryker Leibinger Plating System</Name><Description>Craniofacial Fixation Plates</Description><Size>0.5 - 0.99mm thick, 8 -32 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><ARTGs><ARTG>262485</ARTG><ARTG>295882</ARTG><ARTG>200615</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK021</BillingCode><PriorBillingCodes><PriorBillingCode>UQ020</PriorBillingCode></PriorBillingCodes><Name>Plates</Name><Description>Micro, Midface, Mini, Maxi</Description><Size>0.5-0.99mm thick, 8-32 holes</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH505</BillingCode><Name>Martin Osteosynthesis 1.5mm System 8-32 hole plate</Name><Description>Plate, 0.6mm thick, Titanium</Description><Size>8-32 hole</Size><SupplierCode>40192</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112915</SubGroupID><ARTGs><ARTG>202851</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY514</BillingCode><Name>AO/ASIF Plate</Name><Description>Rapid resorbable reconstruction plate</Description><Size>&gt;32 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112916</SubGroupID><Suffix>Resorbable</Suffix><ARTGs><ARTG>167547</ARTG></ARTGs><MinimumBenefit>342</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK022</BillingCode><PriorBillingCodes><PriorBillingCode>UQ012</PriorBillingCode></PriorBillingCodes><Name>Plates</Name><Description>Micro, Mini</Description><Size>40 Hole Straight Plate, Mesh 18 row, Plate &gt;32 holes.</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112916</SubGroupID><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>271</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WU005</BillingCode><PriorBillingCodes><PriorBillingCode>VK026</PriorBillingCode></PriorBillingCodes><Name>CPS Bioabsorbable Fixation System</Name><Description>CPS Systems and Baby System Plates.  Polylactic Acid Trimethylene Carbonate Copolymer</Description><Size>1.5-2.5mm plates:- 2-10 hole plates and extended, c-plate &amp; x-plate 7 hole, H-plate 8 hole, orthognathic hole and L-plate L &amp; R 7 hole</Size><SupplierCode>40389</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112917</SubGroupID><Suffix>Resorbable</Suffix><ARTGs><ARTG>154544</ARTG></ARTGs><MinimumBenefit>203</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ084</BillingCode><PriorBillingCodes><PriorBillingCode>WH011</PriorBillingCode></PriorBillingCodes><Name>Materialise Standard+ Solutions - Plates</Name><Description>Titanium plate</Description><Size>1.0-1.99mm thick, &amp;lt;4 holes</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112917</SubGroupID><ARTGs><ARTG>377044</ARTG></ARTGs><MinimumBenefit>107</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY317</BillingCode><Name>AO/ASIF Plate</Name><Description>Titanium Plate - straight</Description><Size>1.6mm Profile, 2-4 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112917</SubGroupID><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>107</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT009</BillingCode><Name>Martin Level One Fixation</Name><Description>Plate, titanium</Description><Size>1 to 1.99mm thick, &lt;4 holes</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112917</SubGroupID><ARTGs><ARTG>96619</ARTG></ARTGs><MinimumBenefit>107</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK023</BillingCode><PriorBillingCodes><PriorBillingCode>UQ022</PriorBillingCode></PriorBillingCodes><Name>Plates</Name><Description>Micro, Midface, Mini &amp; Maxi</Description><Size>Chin Plate 2, 3, 4, 6, 8, 10 &amp; 12mm, Plates 4 to 7 holes.</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112918</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>341</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ085</BillingCode><PriorBillingCodes><PriorBillingCode>WH013</PriorBillingCode></PriorBillingCodes><Name>Materialise Standard+ Solutions - Plates</Name><Description>Titanium plate, S-shape</Description><Size>1.0-1.99mm thick, 4-7 holes</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112918</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>377044</ARTG></ARTGs><MinimumBenefit>341</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO097</BillingCode><Name>MODUS Orthognathics</Name><Description>Indication-specific solutions for maxillary and mandibular orthognathic surgeries</Description><Size>1.0-1.99mm, 4-7 Holes </Size><SupplierCode>40165</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112918</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>350270</ARTG><ARTG>350271</ARTG></ARTGs><MinimumBenefit>341</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK131</BillingCode><Name>Leibinger Titanium Implant System - Universal Mandible Fracture Plate</Name><Description>Items used for reconstruction and fixation of mandibular fractures and tumour resection.</Description><Size>Universal Mandible Fracture Plate, C-shaped, 4 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112918</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>295882</ARTG><ARTG>200615</ARTG></ARTGs><MinimumBenefit>341</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY587</BillingCode><Name>AO/ASIF Plate</Name><Description>Titanium mandible locking plate, complex shape</Description><Size>4-7 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112918</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>345</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK132</BillingCode><Name>Leibinger Titanium Implant System - Universal Mandible Fracture Plate</Name><Description>Items used for reconstruction and fixation of mandibular fractures and tumour resection.</Description><Size>Universal Mandible Fracture Plate, Angled Shaped, 6 holes, 115-140 deg</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112918</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>200615</ARTG></ARTGs><MinimumBenefit>341</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WU006</BillingCode><PriorBillingCodes><PriorBillingCode>VK025</PriorBillingCode></PriorBillingCodes><Name>CPS Bioabsorbable Fixation System</Name><Description>CPS Systems and Baby System Plates.  Polylactic Acid Trimethylene Carbonate Copolymer</Description><Size>1.5mm plates:- 20 holes, c-plate &amp; x-plate 7 hole, L-plate 7 hole L &amp; R. burrhole</Size><SupplierCode>40389</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112918</SubGroupID><Suffix>Resorbable</Suffix><ARTGs><ARTG>154544</ARTG></ARTGs><MinimumBenefit>245</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT012</BillingCode><Name>Martin Level One Fixation Resorb x &amp; SonicWeld Rx</Name><Description>Mesh, PDLLA (resorbable)</Description><Size>1.0 to 1.99mm thick, 4 to 7 holes</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112918</SubGroupID><Suffix>Resorbable</Suffix><ARTGs><ARTG>143326</ARTG></ARTGs><MinimumBenefit>245</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK024</BillingCode><PriorBillingCodes><PriorBillingCode>UQ023</PriorBillingCode></PriorBillingCodes><Name>OsteoMed Plating &amp; Fixation System</Name><Description>Plates - Fracture</Description><Size>1.0-1.99mm thick, 4-7 holes</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112918</SubGroupID><Suffix>Compression</Suffix><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>135</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ086</BillingCode><PriorBillingCodes><PriorBillingCode>WH012</PriorBillingCode></PriorBillingCodes><Name>Materialise Standard+ Solutions - Plates</Name><Description>Titanium plate</Description><Size>1.0-1.99mm thick, 4-7 holes</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112918</SubGroupID><Suffix>Compression</Suffix><ARTGs><ARTG>377044</ARTG></ARTGs><MinimumBenefit>135</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA009</BillingCode><Name>Mandibular Fracture System</Name><Description>plates, various shapes</Description><Size>4-7 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112918</SubGroupID><ARTGs><ARTG>128458</ARTG><ARTG>211079</ARTG></ARTGs><MinimumBenefit>135</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY498</BillingCode><Name>AO/ASIF Plate</Name><Description>Mandible plate</Description><Size>4-7 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112918</SubGroupID><ARTGs><ARTG>298355</ARTG></ARTGs><MinimumBenefit>135</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC517</BillingCode><Name>TiMesh</Name><Description>Mandibular "J" Plate</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112918</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>135</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT059</BillingCode><Name>Martin Level  One Fixation Plate</Name><Description>Martin Level One Fixation</Description><Size>1.0-1.99mm thick, 4-7 holes</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112918</SubGroupID><ARTGs><ARTG>96619</ARTG></ARTGs><MinimumBenefit>135</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH513</BillingCode><Name>Martin Osteosynthesis 1.5mm System Mesh 1mm 4-7 hole plate</Name><Description>Plate, Titanium</Description><Size>1.0-1.99mm thick, 4-7 holes</Size><SupplierCode>40192</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112918</SubGroupID><ARTGs><ARTG>202851</ARTG></ARTGs><MinimumBenefit>135</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW493</BillingCode><Name>Stryker Leibinger Plating System</Name><Description>Mandible Locking Fixation Plates</Description><Size>1.0 -1.9mm thick, 4 - 7 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112918</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>295882</ARTG><ARTG>200615</ARTG></ARTGs><MinimumBenefit>345</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT043</BillingCode><Name>Martin Level One Fixation</Name><Description>Plate Titanium locking</Description><Size>1.0 to 1.99 mm thick, 4 - 7 holes</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112918</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>96619</ARTG></ARTGs><MinimumBenefit>345</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ087</BillingCode><PriorBillingCodes><PriorBillingCode>WH014</PriorBillingCode></PriorBillingCodes><Name>Materialise Standard+ Solutions - Plates</Name><Description>Titanium plate, Locking</Description><Size>1.0-1.99mm thick, 4-7 holes</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112918</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>377044</ARTG></ARTGs><MinimumBenefit>345</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK025</BillingCode><PriorBillingCodes><PriorBillingCode>UQ024</PriorBillingCode></PriorBillingCodes><Name>OsteoMed Plating &amp; Fixation System</Name><Description>Plates - Fracture</Description><Size>8 Hole Fracture Plate, 4 &amp; 6 hole locking fracture plate, 4 to 7 hole locking plate.</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112918</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>345</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ089</BillingCode><PriorBillingCodes><PriorBillingCode>WH015</PriorBillingCode></PriorBillingCodes><Name>Materialise Standard+ Solutions - Plates</Name><Description>Titanium plate</Description><Size>1.0-1.99mm thick, 8-15 holes</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112919</SubGroupID><ARTGs><ARTG>377044</ARTG></ARTGs><MinimumBenefit>336</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI970</BillingCode><Name>Mandibular Fracture System</Name><Description>Mandibular fracture plates</Description><Size>8-15 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112919</SubGroupID><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>336</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC522</BillingCode><Name>TiMesh</Name><Description>Curved Plate:  Standard, Rigid, Left, Right</Description><Size>1mm x 12 holes</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112919</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>336</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO099</BillingCode><Name>MODUS Orthognathics</Name><Description>Indication-specific solutions for maxillary and mandibular orthognathic surgeries</Description><Size>2.0mm</Size><SupplierCode>40165</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112919</SubGroupID><ARTGs><ARTG>350270</ARTG><ARTG>350271</ARTG></ARTGs><MinimumBenefit>336</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WU007</BillingCode><PriorBillingCodes><PriorBillingCode>VK022</PriorBillingCode></PriorBillingCodes><Name>CPS Bioabsorbable Fixation System</Name><Description>OTPS fixation system: PLGA/TMC copolymer</Description><Size>Plates 6 &amp; 8 hole</Size><SupplierCode>40389</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112919</SubGroupID><Suffix>Resorbable</Suffix><ARTGs><ARTG>154544</ARTG></ARTGs><MinimumBenefit>336</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY508</BillingCode><Name>AO/ASIF Plate</Name><Description>Rapid resorbable reconstruction plate</Description><Size>8-15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112919</SubGroupID><Suffix>Resorbable</Suffix><ARTGs><ARTG>167547</ARTG></ARTGs><MinimumBenefit>336</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT036</BillingCode><Name>Martin Level One Fixation Resorb x &amp; Sonic Weld</Name><Description>Plate PDLLA (resorbable)</Description><Size>1.0 to 1.99mm thick, 8 to 15 holes</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112919</SubGroupID><Suffix>Resorbable</Suffix><ARTGs><ARTG>143326</ARTG></ARTGs><MinimumBenefit>336</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO098</BillingCode><Name>MODUS Orthognathics</Name><Description>Indication-specific solutions for maxillary and mandibular orthognathic surgeries</Description><Size>1.3-1.99 Thickness, 8-15 Holes </Size><SupplierCode>40165</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112919</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>350270</ARTG><ARTG>350271</ARTG></ARTGs><MinimumBenefit>629</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK026</BillingCode><PriorBillingCodes><PriorBillingCode>UQ026</PriorBillingCode></PriorBillingCodes><Name>OsteoMed Plating &amp; Fixation System</Name><Description>Mandible Locking plates</Description><Size>8-15 Hole Plates, 1.0-1.99 mm thick</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112919</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>629</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH514</BillingCode><Name>Martin Osteosynthesis 1.5mm System 1mm 8-15 hole plate</Name><Description>Plate, Titanium</Description><Size>1.0-1.99mm thick, 8-15 holes</Size><SupplierCode>40192</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112919</SubGroupID><ARTGs><ARTG>202851</ARTG></ARTGs><MinimumBenefit>336</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT056</BillingCode><Name>Martin Level One Fixation</Name><Description>Plate ,Titanium</Description><Size>1.0 to 1.99mm thick, 8 -15 holes</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112919</SubGroupID><ARTGs><ARTG>99619</ARTG></ARTGs><MinimumBenefit>336</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ088</BillingCode><PriorBillingCodes><PriorBillingCode>WH008</PriorBillingCode></PriorBillingCodes><Name>Materialise Standard+ Solutions - Plates</Name><Description>Titanium plate, Locking</Description><Size>1.0-1.99mm thick, 8-15 holes</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112919</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>377044</ARTG></ARTGs><MinimumBenefit>629</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY588</BillingCode><Name>AO/ASIF Plate</Name><Description>Titanium mandible locking plate, complex shape</Description><Size>8-15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112919</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>629</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW494</BillingCode><Name>Stryker Leibinger Plating System</Name><Description>Mandible Fixation Plates</Description><Size>1.0 - 1.99mm thick, 8 -15 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112919</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>200615</ARTG></ARTGs><MinimumBenefit>629</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW508</BillingCode><Name>Stryker Leibinger Plating System</Name><Description>Mandible Locking Fixation Plates</Description><Size>1.0 - 1.99mm thick, 8 - 15 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112919</SubGroupID><ARTGs><ARTG>11565</ARTG><ARTG>124319</ARTG></ARTGs><MinimumBenefit>336</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK027</BillingCode><PriorBillingCodes><PriorBillingCode>UQ025</PriorBillingCode></PriorBillingCodes><Name>Plates</Name><Description>Mini &amp; Maxi</Description><Size>12 Hole Straight Plate 1.0 mm thick, 8 Hole Straight Plate 1.0 mm thick, Plates 8 to 15 holes</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112919</SubGroupID><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>336</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK028</BillingCode><PriorBillingCodes><PriorBillingCode>UQ028</PriorBillingCode></PriorBillingCodes><Name>OsteoMed Plating &amp; Fixation System</Name><Description>Mandible Locking Plates</Description><Size>16-32 Hole Plates, 1.0-1.99 mm thick</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112920</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>798</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO119</BillingCode><Name>MODUS Mandible </Name><Description>Mandible Locking Plates </Description><Size>16-21 Hole, 1.0-1.99 thickness</Size><SupplierCode>40165</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112920</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>350271</ARTG><ARTG>350270</ARTG></ARTGs><MinimumBenefit>798</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ102</BillingCode><Name>Materialise Standard+ Solutions - Plates</Name><Description>Titanium Plate, Locking</Description><Size>1.0mm-1.99mm thick, 16-32 holes</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112920</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>377044</ARTG></ARTGs><MinimumBenefit>798</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW496</BillingCode><Name>Stryker Leibinger Plating System</Name><Description>Mandible Fixation Plates</Description><Size>1.0 -1.9mm thick, 16 - 32 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112920</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>200615</ARTG><ARTG>295882</ARTG></ARTGs><MinimumBenefit>798</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO121</BillingCode><Name>MODUS Mandible </Name><Description>Titanium Mandibular locking plates, complex shape</Description><Size>16-20 holes, 1.3-1.5mm thickness. </Size><SupplierCode>40165</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112920</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>350270</ARTG><ARTG>350271</ARTG></ARTGs><MinimumBenefit>854</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY493</BillingCode><Name>AO/ASIF Plate</Name><Description>Titanium Mandibular locking plate, complex shape</Description><Size>16-32 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112920</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>854</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT029</BillingCode><Name>Martin Level One Fixation</Name><Description>Plate, titanium</Description><Size>1.0 to 1.99mm thick, 16 to 32 holes</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112920</SubGroupID><Suffix>3D</Suffix><ARTGs><ARTG>96619</ARTG></ARTGs><MinimumBenefit>798</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT030</BillingCode><Name>Martin Level One Fixation</Name><Description>Plate Titanium</Description><Size>1.0 to 1.99mm thick, 16 to 32 holes</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112920</SubGroupID><ARTGs><ARTG>96619</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO118</BillingCode><Name>MODUS Mandible </Name><Description>Indication-specific solutions for mandibular orthognatic surgeries   </Description><Size>1.0-1.99 thickness, 16-32 Holes </Size><SupplierCode>40165</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112920</SubGroupID><ARTGs><ARTG>350271</ARTG><ARTG>350270</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH515</BillingCode><Name>Martin Osteosynthesis 1.5mm System 1mm 16-32 hole plate</Name><Description>Plate, Titanium</Description><Size>1.0-1.99mm thick, 16-32 holes</Size><SupplierCode>40192</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112920</SubGroupID><ARTGs><ARTG>202851</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK029</BillingCode><PriorBillingCodes><PriorBillingCode>UQ027</PriorBillingCode></PriorBillingCodes><Name>Plates</Name><Description>Micro, Mini, Maxi</Description><Size>16 Hole Straight Plate, 1.0mm thick, Plate 15 to 32 holes</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112920</SubGroupID><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW495</BillingCode><Name>Stryker Leibinger Plating System</Name><Description>Mandible Fixation Plates</Description><Size>1.0 - 1.9mm thick, 16- 32 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112920</SubGroupID><ARTGs><ARTG>295882</ARTG><ARTG>200615</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI762</BillingCode><Name>Mandibular Fracture System</Name><Description>Plates, 2.4 Mandibular Fracture System, Titanium</Description><Size>16 - 24 Hole</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112920</SubGroupID><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY589</BillingCode><Name>AO/ASIF Plate</Name><Description>Rapid resorbable reconstruction plate</Description><Size>16-32 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112920</SubGroupID><Suffix>Resorbable</Suffix><ARTGs><ARTG>167547</ARTG></ARTGs><MinimumBenefit>394</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WU008</BillingCode><PriorBillingCodes><PriorBillingCode>VK024</PriorBillingCode></PriorBillingCodes><Name>CPS Bioabsorbable Fixation System</Name><Description>CPS Systems and Baby System Plates.  Polylactic Acid Trimethylene Carbonate Copolymer</Description><Size>1.5mm baby plates:- 20 hole, c-plate &amp; x-plate 7 hole, 2 hole</Size><SupplierCode>40389</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112920</SubGroupID><Suffix>Resorbable</Suffix><ARTGs><ARTG>154544</ARTG></ARTGs><MinimumBenefit>394</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT028</BillingCode><Name>Martin Level One Fixation Resorb x &amp; SonicWeld Rx</Name><Description>Plate, PDLLA (resorbable)</Description><Size>1.0 to 1.99mm thick, 16 to 32 holes</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112920</SubGroupID><Suffix>Resorbable</Suffix><ARTGs><ARTG>143326</ARTG></ARTGs><MinimumBenefit>394</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY700</BillingCode><Name>AO/ASIF Plate</Name><Description>Titanium Mandibular locking plate, complex shape</Description><Size>&gt;32 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112921</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>756</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY511</BillingCode><Name>AO/ASIF Plate</Name><Description>Rapid resorbable reconstruction plate</Description><Size>&gt;32 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112921</SubGroupID><Suffix>Resorbable</Suffix><ARTGs><ARTG>167547</ARTG></ARTGs><MinimumBenefit>378</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ090</BillingCode><PriorBillingCodes><PriorBillingCode>WH017</PriorBillingCode></PriorBillingCodes><Name>Materialise Standard+ Solutions - Plates</Name><Description>Titanium plate</Description><Size>2.0-2.99mm thick, 4-7 holes</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112922</SubGroupID><ARTGs><ARTG>377044</ARTG></ARTGs><MinimumBenefit>604</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK030</BillingCode><PriorBillingCodes><PriorBillingCode>UQ029</PriorBillingCode></PriorBillingCodes><Name>OsteoMed  Plating &amp; Fixation System</Name><Description>Mandible locking plates</Description><Size>4-7 Holes, 2.0-2.99 mm thick</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112922</SubGroupID><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>604</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT066</BillingCode><Name>Martin Level One Fixation</Name><Description>Plate, Titanium</Description><Size>2.0-2.99m thick, 4-7 holes</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112922</SubGroupID><ARTGs><ARTG>96619</ARTG></ARTGs><MinimumBenefit>604</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY499</BillingCode><Name>AO/ASIF Plate</Name><Description>Titanium mandible plate</Description><Size>4-7 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112922</SubGroupID><Suffix>Compression</Suffix><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW674</BillingCode><Name>Stryker Mini Plating System</Name><Description>Craniomaxillofacial reconstruction fixation plates. </Description><Size>2.0-2.99mm thick, 4-7 holes</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112922</SubGroupID><Suffix>Compression</Suffix><ARTGs><ARTG>295882</ARTG></ARTGs><MinimumBenefit>702</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT067</BillingCode><Name>Martin Level One Fixation</Name><Description>Plate, Titanium</Description><Size>2.0-2.99m thick, 8-15 holes</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112923</SubGroupID><ARTGs><ARTG>96619</ARTG></ARTGs><MinimumBenefit>459</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY497</BillingCode><Name>AO/ASIF Plate</Name><Description>Titanium mandible plate</Description><Size>8-15 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112923</SubGroupID><Suffix>Compression</Suffix><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>761</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ091</BillingCode><PriorBillingCodes><PriorBillingCode>WH018</PriorBillingCode></PriorBillingCodes><Name>Materialise Standard+ Solutions - Plates</Name><Description>Titanium plate, Locking</Description><Size>2.0-2.99mm thick, 8-15 holes</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112923</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>377044</ARTG></ARTGs><MinimumBenefit>926</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK140</BillingCode><Name>Leibinger Titanium Implant System - Universal Mandible Reconstruction Plate</Name><Description>Items used for reconstruction and fixation of mandibular fractures and tumour resection.</Description><Size>Universal Mandible Reconstruction Plate, 8 - 15 holes, straight with template</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112923</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>200615</ARTG><ARTG>295882</ARTG></ARTGs><MinimumBenefit>926</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK141</BillingCode><Name>Leibinger Titanium Implant System - Universal Mandible Reconstruction Plate</Name><Description>Items used for reconstruction and fixation of mandibular fractures and tumour resection</Description><Size>Universal Mandible Reconstruction Plate, (Hemi), Right and Left, 6 + 17 holes with template</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112924</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>200615</ARTG><ARTG>295882</ARTG></ARTGs><MinimumBenefit>1073</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK138</BillingCode><Name>Leibinger Titanium Implant System - Universal Mandible Reconstruction Plate</Name><Description>Items used for reconstruction and fixation of mandibular fractures and tumour resection.</Description><Size>Universal Mandible Reconstruction Plate, (Full), 16 - 32 holes, with template</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112924</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>200615</ARTG><ARTG>295882</ARTG></ARTGs><MinimumBenefit>1073</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK142</BillingCode><Name>Leibinger Titanium Implant System - Universal Mandible Reconstruction Plate</Name><Description>Items used for reconstruction and fixation of mandibular fractures and tumour resection</Description><Size>Universal Mandible Reconstruction Plate, (Full), 6 + 17 + 6 holes, with template</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112924</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>200615</ARTG></ARTGs><MinimumBenefit>1073</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI938</BillingCode><Name>Lorenz Locking Reconstruction System</Name><Description>Locking plates</Description><Size>2.0 and 2.4 mm, 16-32 holes</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112924</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>1073</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT068</BillingCode><PriorBillingCodes><PriorBillingCode>KT055</PriorBillingCode></PriorBillingCodes><Name>KLS Martin Plating System</Name><Description>Locking, Preshaped reconstruction plates, in left and right options</Description><Size>2.0mm to 2.5mm thickness with 26 holes</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112924</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>96619</ARTG></ARTGs><MinimumBenefit>1073</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK031</BillingCode><PriorBillingCodes><PriorBillingCode>UQ030</PriorBillingCode></PriorBillingCodes><Name>OsteoMed Plating &amp; Fixation System</Name><Description>Plates - Fracture</Description><Size>Rigid Comminuted Fracture Plate</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112924</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>1073</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ092</BillingCode><PriorBillingCodes><PriorBillingCode>WH019</PriorBillingCode></PriorBillingCodes><Name>Materialise Standard+ Solutions - Plates</Name><Description>Titanium plate, Locking</Description><Size>2.0-2.99mm thick, 16-32 holes</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112924</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>377044</ARTG></ARTGs><MinimumBenefit>1073</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY600</BillingCode><Name>AO/ASIF Plate</Name><Description>Titanium mandible locking plate</Description><Size>16-32 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112924</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>1073</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT069</BillingCode><PriorBillingCodes><PriorBillingCode>KT055</PriorBillingCode></PriorBillingCodes><Name>KLS Martin Plating System</Name><Description>Preshaped reconstruction plates, in left and right options, Complex, locking</Description><Size>2.0mm to 2.5mm thickness with 26 holes</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112924</SubGroupID><Suffix>Complex, Locking</Suffix><ARTGs><ARTG>96619</ARTG></ARTGs><MinimumBenefit>1287</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO132</BillingCode><Name>MODUS Mandible </Name><Description>Anatomical contoured Complex, pre-formed locking plates intended for orthognathic reconstruction, inclusive of C-shaped adaption plates.</Description><Size>16-32 holes, 2.0 thickness</Size><SupplierCode>40165</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112924</SubGroupID><Suffix>Complex, Locking</Suffix><ARTGs><ARTG>350271</ARTG><ARTG>350270</ARTG></ARTGs><MinimumBenefit>1287</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RV013</BillingCode><Name>Complex Locking plate</Name><Description>Preshaped reconstruction plates, in left and right options, Complex, locking</Description><Size>Small  Medium  Large</Size><SupplierCode>39940</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112924</SubGroupID><Suffix>Complex, Locking</Suffix><ARTGs><ARTG>366767</ARTG></ARTGs><MinimumBenefit>1287</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY780</BillingCode><Name>AO/ASIF Plate</Name><Description>Anatomical Preformed Complex Locking Reconstruction Plates</Description><Size>Small, Medium, Large</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112924</SubGroupID><Suffix>Complex, Locking</Suffix><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>1287</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ093</BillingCode><PriorBillingCodes><PriorBillingCode>WH020</PriorBillingCode></PriorBillingCodes><Name>Materialise Standard+ Solutions - Plates</Name><Description>Titanium plate, Locking, Complex Shape</Description><Size>2.0-2.99mm thick, &gt;32 holes</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112925</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>377044</ARTG></ARTGs><MinimumBenefit>1414</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY472</BillingCode><Name>AO/ASIF Plate</Name><Description>Titanium mandible locking plate, complex shape</Description><Size>&gt;32 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112925</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>1414</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY550</BillingCode><Name>Titanium Sternal Fixation System</Name><Description>Locking Plate - Star</Description><Size>Star: 6 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112926</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>1306</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PF027</BillingCode><Name>ClawLink</Name><Description>A patented complex sternal fixation system for thoracotomy</Description><Size>18-50mm</Size><SupplierCode>40106</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112926</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>308885</ARTG></ARTGs><MinimumBenefit>1306</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT007</BillingCode><Name>Martin Level One Fixation</Name><Description>Plate, titanium</Description><Size>=&gt;3mm thick, 8 to 15 holes</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112927</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>96620</ARTG></ARTGs><MinimumBenefit>562</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY551</BillingCode><Name>Titanium Sternal Fixation System</Name><Description>Locking Plate - Straight , H or Star</Description><Size>Straight: 12holes, H: small &amp; large, Star: 12 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112927</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>1443</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT061</BillingCode><Name>Martin Level One Fixation</Name><Description>Plate, Titanium</Description><Size>≥3mm thick, 16 to 32 Holes</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112928</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>96619</ARTG></ARTGs><MinimumBenefit>554</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY347</BillingCode><Name>Titanium Sternal Fixation System</Name><Description>Locking Plate - straight</Description><Size>20 or 30 holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109353</GroupID><SubGroupID>112928</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>1630</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK033</BillingCode><PriorBillingCodes><PriorBillingCode>UQ031</PriorBillingCode></PriorBillingCodes><Name>Screws</Name><Description>Micro, Maxi &amp; Self Drilling</Description><Size>"Size 1.2mm self-drilling screws, 1.2mm x (2 - 14)mm, Screws diameter &lt; 1.24mm"</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112929</SubGroupID><ARTGs><ARTG>130509</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO124</BillingCode><Name>MODUS Orthognathics Screw</Name><Description>Cortical Screw and Sliders </Description><Size>2-14mm</Size><SupplierCode>40165</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112929</SubGroupID><ARTGs><ARTG>350272</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC574</BillingCode><Name>Timesh</Name><Description>X-Drive Screws</Description><Size>2 - 15mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112929</SubGroupID><ARTGs><ARTG>128524</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW511</BillingCode><Name>Stryker Leibinger Plating System</Name><Description>Micro Screws</Description><Size>1.0 - 1.2mm diameter, 3 - 15mm length</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112929</SubGroupID><ARTGs><ARTG>251654</ARTG><ARTG>200615</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY559</BillingCode><Name>AO/ASIF Screw</Name><Description>CMF screw; cortex, cortical, emergency, self-tapping,self-drilling</Description><Size>1.0mm-1.20mm various lengths</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112929</SubGroupID><ARTGs><ARTG>157706</ARTG><ARTG>297881</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC879</BillingCode><Name>TiMesh Rigid Fixation Bone Grafting and Plating System</Name><Description>Titanium, Screw - Cruciate Head, 12 point Flat Head</Description><Size>Diameter &lt;1.24mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112929</SubGroupID><ARTGs><ARTG>128524</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK032</BillingCode><PriorBillingCodes><PriorBillingCode>UQ032</PriorBillingCode></PriorBillingCodes><Name>OsteoMed Plating &amp; Fixation System</Name><Description>Lag Screws - Micro, Mini</Description><Size>1.2mm x (6 - 16)mm; 1.6mm x (10-12)mm; 2.0mm x (8 - 22)mm;</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112929</SubGroupID><Suffix>Compression</Suffix><ARTGs><ARTG>130509</ARTG></ARTGs><MinimumBenefit>78</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT025</BillingCode><Name>Martin Level One Fixation</Name><Description>Screw Titanium</Description><Size>diameter &lt;1.24mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112929</SubGroupID><ARTGs><ARTG>96619</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI092</BillingCode><Name>TiMesh</Name><Description>Internal Drive Screws</Description><Size>Diameter: 1.5 - 1.8mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>128524</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY590</BillingCode><Name>AO/ASIF Screw</Name><Description>Cortex, Cortical, Emergency, Self-tapping, Self-drilling; Low Profile, Pure Titanium; Matrix Plating System Titanium Alloy, </Description><Size>1.25-3.24mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>297881</ARTG><ARTG>295238</ARTG><ARTG>298355</ARTG><ARTG>309862</ARTG><ARTG>157706</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI093</BillingCode><Name>TiMesh</Name><Description>Rescue Screws</Description><Size>Diameter: 1.8 - 2.4mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>128524</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RV020</BillingCode><Name>CMF Screw</Name><Description>Self tapping and self drilling screws</Description><Size>Diameter 1.5 - 2.4mm</Size><SupplierCode>39940</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>330190</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ002</BillingCode><PriorBillingCodes><PriorBillingCode>AT077</PriorBillingCode><PriorBillingCode>AT077</PriorBillingCode></PriorBillingCodes><Name>Anatomics Bone Screws</Name><Description>Titanium bone screws for patient specific implants</Description><Size>Diameter - 1.6-2.0 mm
Length - 5mm</Size><SupplierCode>40481</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>288564</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WT003</BillingCode><Name>EvoFix Micro Screws </Name><Description>Titanium screws for craniofacial fixation </Description><Size>1. Diameter 1.5mm, Length 3.5mm to 6mm    2. Diameter 1.8mm, Length 4mm to 5mm</Size><SupplierCode>40396</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>314801</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ095</BillingCode><PriorBillingCodes><PriorBillingCode>WH009</PriorBillingCode></PriorBillingCodes><Name>Materialise Standard+ Solutions - Screws</Name><Description>Titanium Screw</Description><Size>Diameter 1.25-3.24mm</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>377044</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB415</BillingCode><Name>Aesculap Neuro Plating System</Name><Description>Cranial fixation system</Description><Size>Screws Neuro, Emergency, self tapping, magazine of 100, 1.5mm x  4mm lengths and magazine of 6, 1.5mm x 3mm &amp; 5mm, 1.8mm x 4mm &amp; 6mm lengths</Size><SupplierCode>40020</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>388669</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI744</BillingCode><Name>Mandibular Fracture System</Name><Description>Screw, High Torque 2.0/2.4 Mandibular Fracture, Titanium</Description><Size>2.0 x (9-17)mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>128459</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW491</BillingCode><Name>Stryker Leibinger Plating System</Name><Description>Craniofacial Fixation Screws</Description><Size>1.5 - 2.7mm diameter, 3 - 20mm length</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>251654</ARTG><ARTG>200615</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI726</BillingCode><Name>Mandibular Fracture System</Name><Description>Screw, High Torque (HT), Emergency, 2.0/2.4 Mandibular Fracture System, Titanium</Description><Size>Dia 2.3mm x 4.0, 5.0, 7.0, 9.0, 11.0, 13.0, 15.0mm  Lengths</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>128459</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RV014</BillingCode><Name>CMF Screw</Name><Description>Self tapping and self drilling screws</Description><Size>Diameter 1.5 - 2.4mm</Size><SupplierCode>39940</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><Suffix>Compression</Suffix><ARTGs><ARTG>366767</ARTG></ARTGs><MinimumBenefit>116</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI733</BillingCode><Name>W.Lorenz Osteosynthesis System</Name><Description>Bone Screw, Self Drilling, Cross Drive, Titanium</Description><Size>1.5 mm (dia) x 6.0, 7.0mm [lengths]</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>128459</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZA080</BillingCode><PriorBillingCodes><PriorBillingCode>BH016</PriorBillingCode><PriorBillingCode>BH017</PriorBillingCode><PriorBillingCode>BI742</PriorBillingCode></PriorBillingCodes><Name>TMJ System</Name><Description>Screw, Cross Drive, Titanium  </Description><Size>2.0-3.2mm diameter</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>128459</ARTG><ARTG>145265</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT038</BillingCode><Name>Martin Level One Fixation</Name><Description>Screw Titanium</Description><Size>Diameter 1.25 to 3.24mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>96620</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH021</BillingCode><Name>W Lorenz Osteosynthesis System</Name><Description>Bone Screw, Cross Drive or Centre Drive. Titanium</Description><Size>1.8mm dia x (3.5 - 17)mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>128459</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI734</BillingCode><Name>W.Lorenz Osteosynthesis System</Name><Description>Bone Screw, Self Drilling, Cross Drive, Titanium</Description><Size>1.5 mm (dia) x 3.5, 4.0, 5.0mm, [lengths]</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>128459</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WU009</BillingCode><PriorBillingCodes><PriorBillingCode>VK018</PriorBillingCode></PriorBillingCodes><Name>CPS Bioabsorbable Fixation System</Name><Description>OTPS fixation system: PLGA/TMC copolymer</Description><Size>Screws 1.5 - 2.5mm dia x 5-8mm long</Size><SupplierCode>40389</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><Suffix>Resorbable</Suffix><ARTGs><ARTG>154541</ARTG></ARTGs><MinimumBenefit>100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI924</BillingCode><Name>OmniMax Screws</Name><Description>IMF screws</Description><Size>2.0 diameter, 7-11mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>128459</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF127</BillingCode><Name>Melbourne TMJ Prosthesis</Name><Description>TMJ Mandibular Component - Screws</Description><Size>(2.7-3.2mm Diameter) x (8-12mm Length)</Size><SupplierCode>40413</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>246581</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC880</BillingCode><Name>TiMesh Rigid Fixation Bone Grafting and Plating System</Name><Description>Titanium, Screw - Cruciate Head, 12 point Flat Head</Description><Size>Diameter 1.25 - 1.74mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>128524</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW510</BillingCode><Name>Delta Resorbable Fixation System</Name><Description>Resorbable Screws</Description><Size>1.7mm diameter, 3 -6mm length</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><Suffix>Resorbable</Suffix><ARTGs><ARTG>151008</ARTG><ARTG>72659</ARTG></ARTGs><MinimumBenefit>100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT040</BillingCode><Name>Martin Level One Fixation Resorb x &amp; Sonic Weld</Name><Description>Sonic Pin PDDLA (resorbable)</Description><Size>Diameter 1.25 - 3.24mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><Suffix>Resorbable</Suffix><ARTGs><ARTG>143327</ARTG></ARTGs><MinimumBenefit>100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT025</BillingCode><Name>SCS Interlink Screw</Name><Description>Titanum screw, self-drilling</Description><Size>Diameter 1.5mm, 2.0mm  </Size><SupplierCode>40227</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>339424</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ058</BillingCode><Name>Lyka Smith Jeil LeForte System Screws</Name><Description>Self tapping and self drilling screws</Description><Size>Diameter- 1.3 - 2.7mm  Length 2-20mm</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>310093</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO125</BillingCode><Name>MODUS Orthognathic Screw</Name><Description>Cortical screw, TriLock locking Screw, TriLock Speed-Tip screw, Self-Tapping screw Screw </Description><Size>1.5-2.5 Diameter,  5-23mm lengths</Size><SupplierCode>40165</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>350272</ARTG><ARTG>350350</ARTG></ARTGs><MinimumBenefit>88</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK034</BillingCode><PriorBillingCodes><PriorBillingCode>UQ034</PriorBillingCode></PriorBillingCodes><Name>OsteoMed Plating &amp; Fixation System</Name><Description>Locking Screws</Description><Size>Diameter 1.25-3.24mm</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>130509</ARTG></ARTGs><MinimumBenefit>88</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZI925</BillingCode><Name>OmniMax Screws</Name><Description>MMF Screws</Description><Size>2.0 diameter, 7mm-11mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>128459</ARTG></ARTGs><MinimumBenefit>88</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI457</BillingCode><Name>Lorenz 2 - 2.4mm Locking Reconstruction System</Name><Description>Screw, Locking Reconstruction Modular. Titanium</Description><Size>2 - 2.4 x (6-18)mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>128459</ARTG></ARTGs><MinimumBenefit>88</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HQ001</BillingCode><Name>Bionnovation Fixation Screws</Name><Description>Craniofacial Bone Screw, non-biodegradable    These are bone screws that are intended to be used to be surgically inserted for the use in bone graft surgery, fixation of grafts and membranes in the maxilla and mandible. </Description><Size>Diameter 1.2mm, Length 4,6,8,10,12,14mm   Diameter 1.4mm, Length 4,6,8,10,12,14mm  Diameter 1.6mm, Length 4,6,8,10,12, 14mm  Diameter 1.8mm, Length 4,6,8,10,12,14mm  </Size><SupplierCode>40238</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>247012</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI723</BillingCode><Name>Mandibular Fracture System</Name><Description>Screw, High Torque 2.0/2.4 Mandibular Fracture, Titanium</Description><Size>2.7 x (6-20)mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>128459</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI360</BillingCode><Name>W Lorenz Osteosynthesis System</Name><Description>Bone Screw, Cross or Centre Drive, Std or Self Drilling; Titanium</Description><Size>2.0mm x (4 - 7) mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>128459</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC571</BillingCode><Name>Timesh</Name><Description>12 Point Screws</Description><Size>3 - 20mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>128524</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH516</BillingCode><Name>Martin Osteosynthesis 1.5mm System Screw</Name><Description>Self retaining, Titanium</Description><Size>3-7mm length, 1.5-1.8mm diam</Size><SupplierCode>40192</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>212844</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH020</BillingCode><Name>W Lorenz Osteosynthesis System</Name><Description>Bone Screw, Cross Drive or Centre Drive. Titanium</Description><Size>1.5mm dia x (3.5 - 17)mm</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>143957</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI748</BillingCode><Name>Mandibular Fracture System</Name><Description>Screw, High Torque (HT), 2.0/2.4 Mandibular Fracture System, Titanium</Description><Size>Dia 2.4 x 6.0mm, 8.0, 10.0, 12.0, 14.0, 16.0, 18.0mm Lengths</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>128459</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY591</BillingCode><Name>External Midface Distractor System</Name><Description>Fixation; Set - Screws</Description><Size>1.25-3.24mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><Suffix>Distractor</Suffix><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>83</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ059</BillingCode><Name>Lyka Smith Jeil Le Fort Locking Screws</Name><Description>Titanium Locking Screws</Description><Size>Diameter 2-2.4mm  Length 4-20mm</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>310093</ARTG></ARTGs><MinimumBenefit>88</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ094</BillingCode><PriorBillingCodes><PriorBillingCode>WH021</PriorBillingCode></PriorBillingCodes><Name>Materialise Standard+ Solutions - Screws</Name><Description>Titanium Screw, Locking</Description><Size>Diameter 1.25-3.24mm</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>377044</ARTG></ARTGs><MinimumBenefit>88</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK035</BillingCode><PriorBillingCodes><PriorBillingCode>UQ033</PriorBillingCode></PriorBillingCodes><Name>Screws</Name><Description>Micro, Maxi &amp; Self Drilling</Description><Size>Diameter 1.25-3.24mm</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><ARTGs><ARTG>130509</ARTG></ARTGs><MinimumBenefit>42</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RV015</BillingCode><Name>CMF Locking Screw</Name><Description>Locking Screw, Self tapping</Description><Size>Diameter 1.5-2.4 mm</Size><SupplierCode>39940</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>366767</ARTG></ARTGs><MinimumBenefit>88</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY592</BillingCode><Name>AO/ASIF Screw</Name><Description>Cortex, Cortical, Emergency, Self-tapping, Self-drilling; Locking Screws</Description><Size>1.25-3.24mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>88</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW487</BillingCode><Name>Stryker Leibinger Hybrid MMF Screws</Name><Description>SMARTLock Hybrid MMF Screws, Locking  System - Universal SMARTLock Hybrid MMF  Component - MMF Screws</Description><Size>Two Sizes -   2.0mm Diameter, 6mm Length  2.0mm Diameter, 8mm Length</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>200615</ARTG><ARTG>251654</ARTG></ARTGs><MinimumBenefit>88</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT035</BillingCode><Name>Martin Level One Fixation</Name><Description>Screw, titanium</Description><Size>Diameter 2.25 - 2.74mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109354</GroupID><SubGroupID>112930</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>96619</ARTG></ARTGs><MinimumBenefit>88</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY345</BillingCode><Name>Titanium Sternal Fixation System</Name><Description>Titanium Emergency Release Pin</Description><Size>One Size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109355</GroupID><SubGroupID>112932</SubGroupID><ARTGs><ARTG>157069</ARTG></ARTGs><MinimumBenefit>93</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK146</BillingCode><Name>Leibinger Titanium Implant System - Universal Mandible Biconcave Washer</Name><Description>Items used for reconstruction and fixation of mandibular fractures and tumour resection</Description><Size>Universal Mandible Bi-concave Washer</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109355</GroupID><SubGroupID>112934</SubGroupID><ARTGs><ARTG>142141</ARTG></ARTGs><MinimumBenefit>29</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW435</BillingCode><Name>E-POR Biomaterial/ Craniotomy Gap Wedge Porous Polyethylene</Name><Description>Craniotomy Gap Wedge Porous Polyethylene</Description><Size>One Size - V and T shape</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109355</GroupID><SubGroupID>112935</SubGroupID><ARTGs><ARTG>144944</ARTG></ARTGs><MinimumBenefit>375</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK036</BillingCode><PriorBillingCodes><PriorBillingCode>UQ035</PriorBillingCode></PriorBillingCodes><Name>OsteoMed Plating &amp; Fixation System</Name><Description>Screws</Description><Size>MMF / Anchorage Screws 1.2/1.6/2.0mm Anchor, Bone</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109355</GroupID><SubGroupID>112936</SubGroupID><ARTGs><ARTG>130509</ARTG></ARTGs><MinimumBenefit>137</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB289</BillingCode><Name>CranioFix Absorbable</Name><Description>Double sided Cranial clamp, absorbable polyester</Description><Size>11mm, 16mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109355</GroupID><SubGroupID>112937</SubGroupID><ARTGs><ARTG>125104</ARTG></ARTGs><MinimumBenefit>93</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB384</BillingCode><PriorBillingCodes><PriorBillingCode>BB072</PriorBillingCode><PriorBillingCode>BB073</PriorBillingCode><PriorBillingCode>BB168</PriorBillingCode></PriorBillingCodes><Name>CranioFix</Name><Description>Titanium Skull Fixation Clamp</Description><Size>11mm - 20mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109355</GroupID><SubGroupID>112937</SubGroupID><ARTGs><ARTG>138311</ARTG></ARTGs><MinimumBenefit>93</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY252</BillingCode><Name>AO/ASIF Facio-Maxillary Plates</Name><Description>Flapfix - Plates for fixation of cranial bone flaps</Description><Size>10 - 20mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109355</GroupID><SubGroupID>112937</SubGroupID><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>93</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK037</BillingCode><PriorBillingCodes><PriorBillingCode>UQ036</PriorBillingCode></PriorBillingCodes><Name>OsteoMed Plating &amp; Fixation System</Name><Description>Screws</Description><Size>Locking Screw Inserts, Other ancillary</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109355</GroupID><SubGroupID>112938</SubGroupID><ARTGs><ARTG>130509</ARTG></ARTGs><MinimumBenefit>137</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC264</BillingCode><Name>SYSTEM-  Doppler Blood Flow Monitoring System. COMPONENT - Cook-Swartz Implantable Doppler Flow Probe</Name><Description>The Cook-Swartz Implantable Doppler Flow Probe is an implantable 20MHz Probe with epoxy-coated Crystal and patented Silicone Cuff which provides continuous direct vessel monitoring of microvascular anastomoses. A 30cm wire with external Retention Tabs is attached to the 1mm diameter Crystal.</Description><Size>Cuff Lengths: 17.4 and 32mm</Size><SupplierCode>40434</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109355</GroupID><SubGroupID>112940</SubGroupID><ARTGs><ARTG>187643</ARTG></ARTGs><MinimumBenefit>380</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NJ010</BillingCode><Name>Neoss Ti Reinforced Membrane - S I, Neoss Ti Reinforced Membrane - M I, Neoss Non- Reinforced Membra</Name><Description>Neoss Ti Reinforced membrane NeoGen is an implantable temporary non-resorbable device (membrane) for use as a spacer creation barrier in the treatment of local defects in the oral cavity in conjunction with tissue regeneration or augmentation. Neoss membranes are intended to be submerged and clinically implanted more than 30 days with an expected duration of implantation up of 6 months.</Description><Size>28.7mm x 18mm, 0.3mm thick (Reinforced S I)
30.4mm x 19.4mm, 0.3 thick (Reinforced M I)
29mm x 14mm, 0.3mm thick (Non-reinforced)</Size><SupplierCode>40137</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109359</GroupID><SubGroupID>112944</SubGroupID><ARTGs><ARTG>235233</ARTG></ARTGs><MinimumBenefit>159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HQ002</BillingCode><Name>SURGITIME PTFE</Name><Description>Surgitime PTFE is a synthetic non-absorbable membrane that is 100% biocompatible and not derived from animal source. This Membrane is considered to be a barrier for tissue regeneration. polytetraflouroethylene membranes or mechanical barriers for guided bone regeneration are used to prevent migration of cells from epithelial and connective tissues, thus providing a proper space for the formation of a natural fibrin structure which is the bone tissue precursor. Surgitime PTFE  are a high-density sheet with a surface structure and porosity suitable to prevent intergration and passage of bacteria within the interstices of the material, and simultaneously facilitate adhesion of the host cells and the material.</Description><Size>30x20mm- Thickness 0,10mm  30x20mm- Thickness 0,25mm</Size><SupplierCode>40238</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109359</GroupID><SubGroupID>112944</SubGroupID><ARTGs><ARTG>247014</ARTG></ARTGs><MinimumBenefit>159</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NJ011</BillingCode><Name>Neoss Ti Reinforced Membrane - L I, Neoss Ti Reinforced Membrane - M</Name><Description>Neoss Ti Reinforced membrane NeoGen is an implantable temporary non-resorbable device (membrane) for use as a spacer creation barrier in the treatment of local defects in the oral cavity in conjunction with tissue regeneration or augmentation. Neoss membranes are intended to be submerged and clinically implanted more than 30 days with an expected duration of implantation up of 6 months.</Description><Size>35.9mm x 21.2mm, 0.3mm thick (L I) 
32.2mm x 22mm, 0.3mm thick (M)</Size><SupplierCode>40137</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109359</GroupID><SubGroupID>112945</SubGroupID><ARTGs><ARTG>235233</ARTG></ARTGs><MinimumBenefit>215</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NJ012</BillingCode><Name>Neoss Non-Reinforced Membrane, Neoss Ti Reinforced Membrane - L, XL</Name><Description>Neoss Ti Reinforced membrane NeoGen is an implantable temporary non-resorbable device (membrane) for use as a spacer creation barrier in the treatment of local defects in the oral cavity in conjunction with tissue regeneration or augmentation. Neoss membranes are intended to be submerged and clinically implanted more than 30 days with an expected duration of implantation up of 6 months.</Description><Size>34mm x 25mm, 0.3mm thick and 46mm  x 32mm, 0.3mm thick</Size><SupplierCode>40137</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107804</SubCategoryID><GroupID>109359</GroupID><SubGroupID>112946</SubGroupID><ARTGs><ARTG>235233</ARTG></ARTGs><MinimumBenefit>285</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ005</BillingCode><PriorBillingCodes><PriorBillingCode>AT075</PriorBillingCode><PriorBillingCode>AT075</PriorBillingCode></PriorBillingCodes><Name>Anatomics Cranial Patient Specific Implant - Two Piece</Name><Description>Patient Specific Cranial Implant constructed of Titanium, Acrylic or Porous Polyethylene</Description><Size>Custom</Size><SupplierCode>40481</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109362</GroupID><SubGroupID>112947</SubGroupID><Suffix>Biomodelled Two Piece</Suffix><ARTGs><ARTG>288564</ARTG></ARTGs><MinimumBenefit>10169</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC528</BillingCode><Name>TiMesh</Name><Description>Cranial Custom Mesh</Description><Size>121mm x 72mm - 152  x 152mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109362</GroupID><SubGroupID>112947</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>9682</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT034</BillingCode><Name>SCS Biomodelled Mesh, 2-piece</Name><Description>Titanium mesh, 2-piece: 2D, 3D</Description><Size>Custom</Size><SupplierCode>40227</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109362</GroupID><SubGroupID>112947</SubGroupID><Suffix>Biomodelled Two Piece</Suffix><ARTGs><ARTG>339425</ARTG></ARTGs><MinimumBenefit>10169</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC625</BillingCode><Name>Modified Dual TiMesh</Name><Description>TiMesh Surgical Mesh Modified, includes two cranial plates. Composition: Titanium</Description><Size>121mm x 77mm - 152mm x 152mm.</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109362</GroupID><SubGroupID>112947</SubGroupID><Suffix>Biomodelled, Dual Mesh</Suffix><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>10237</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ140</BillingCode><Name>Stryker MEDPOR Patient Specific Implant</Name><Description>Biomodelled Patient Specific Craniofacial Implant</Description><Size>Custom - Patient Specific</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109362</GroupID><SubGroupID>112947</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>434590</ARTG></ARTGs><MinimumBenefit>9682</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ004</BillingCode><PriorBillingCodes><PriorBillingCode>AT074</PriorBillingCode><PriorBillingCode>AT074</PriorBillingCode></PriorBillingCodes><Name>Anatomics Cranial Patient Specific Implant - One Piece</Name><Description>Cranial patient specific implant constructed of Titanium, Acrylic or Porous Polyethylene</Description><Size>Custom</Size><SupplierCode>40481</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109362</GroupID><SubGroupID>112947</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>288564</ARTG></ARTGs><MinimumBenefit>9682</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY834</BillingCode><Name>OBL PorousiTi® Patient Specific Implant - Cranium</Name><Description>Patient specific implant for the cranium constructed of PourousTi®</Description><Size>The implant is custom made so the size is variable</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109362</GroupID><SubGroupID>112947</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>276733</ARTG></ARTGs><MinimumBenefit>9682</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-09-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT035</BillingCode><Name>SCS Biomodelled Mesh, 3-piece</Name><Description>Titanium mesh, 3-piece: 2D, 3D</Description><Size>Custom</Size><SupplierCode>40227</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109362</GroupID><SubGroupID>112947</SubGroupID><Suffix>Biomodelled Three Piece</Suffix><ARTGs><ARTG>339425</ARTG></ARTGs><MinimumBenefit>10657</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT003</BillingCode><Name>IPS Implants® Cranium</Name><Description>IPS Implants® Cranium</Description><Size>Custom - Patient Specific</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109362</GroupID><SubGroupID>112947</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>96619</ARTG><ARTG>96620</ARTG></ARTGs><MinimumBenefit>9682</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW547</BillingCode><Name>Stryker Biomodelled Patient Specific Implant</Name><Description>Biomodelled Patient Specific Craniofacial Implant</Description><Size>Custom</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109362</GroupID><SubGroupID>112947</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>225792</ARTG></ARTGs><MinimumBenefit>9682</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UT033</BillingCode><Name>SCS Biomodelled Mesh, 1-piece</Name><Description>Titanium mesh, 1-piece: 2D, 3D</Description><Size>Custom </Size><SupplierCode>40227</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109362</GroupID><SubGroupID>112947</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>339425</ARTG></ARTGs><MinimumBenefit>9682</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ096</BillingCode><PriorBillingCodes><PriorBillingCode>WH001</PriorBillingCode></PriorBillingCodes><Name>Materialise PorousiTi - Cranium</Name><Description>Patient specific Titanium 3D printed implant for cranial reconstruction</Description><Size>Personalized so the size is variable</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109362</GroupID><SubGroupID>112947</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>377044</ARTG></ARTGs><MinimumBenefit>9682</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE815</BillingCode><PriorBillingCodes><PriorBillingCode>VL012</PriorBillingCode></PriorBillingCodes><Name>Su-Por Pterional, Mastoid, Temporal</Name><Description>Mastoid, Pterional, Contourable Porous Polyethylene.</Description><Size>Various sizes, left, right</Size><SupplierCode>39975</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109362</GroupID><SubGroupID>112948</SubGroupID><ARTGs><ARTG>335454</ARTG></ARTGs><MinimumBenefit>1267</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW437</BillingCode><Name>E-POR Biomaterial/ Mastoid, Pterional, Contourable Porous Polyethylene</Name><Description>Mastoid, Pterional, Contourable Porous Polyethylene</Description><Size>Left, Right, 43mm - 57mm x 0.6mm, 1.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109362</GroupID><SubGroupID>112948</SubGroupID><ARTGs><ARTG>257032</ARTG></ARTGs><MinimumBenefit>1267</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE809</BillingCode><PriorBillingCodes><PriorBillingCode>VL006</PriorBillingCode></PriorBillingCodes><Name>Su-Por Custom Made Implant</Name><Description>An implantable device made of high-density polyethylene material with an interconnecting pore structure that supports tissue ingrowth. The device is custom made/biomodelled from individual patient's CT scan, on doctors prescription, used for correction and reconstruction of any facial, head or any non-weight bearing bone structure.</Description><Size>Custom designed and biomodelled from patient's CT scan image.</Size><SupplierCode>39975</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109362</GroupID><SubGroupID>112948</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>335454</ARTG></ARTGs><MinimumBenefit>9682</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK038</BillingCode><PriorBillingCodes><PriorBillingCode>UQ037</PriorBillingCode></PriorBillingCodes><Name>OsteoMed Plating &amp; Fixation System</Name><Description>Plates</Description><Size>90 x 90mm, 95 x 165mm, &amp; Large Pre-formed Osteoform Mesh, Cranium.</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109362</GroupID><SubGroupID>112949</SubGroupID><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>2535</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ014</BillingCode><PriorBillingCodes><PriorBillingCode>AT081</PriorBillingCode><PriorBillingCode>AT081</PriorBillingCode></PriorBillingCodes><Name>Anatomics Surgical Guide</Name><Description>Biomodelled surgical guides to support surgical decision making both pre and intra-operatively</Description><Size>The device is custom made so the size will vary</Size><SupplierCode>40481</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109362</GroupID><SubGroupID>112950</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>288564</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1315</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY777</BillingCode><Name>ProPlan</Name><Description>Patient Specific Cranical Surgical Guides, Implants</Description><Size>Custom</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109362</GroupID><SubGroupID>112950</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>276733</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1315</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW420</BillingCode><Name>Ear Reconstruction</Name><Description>Porus Polyethylene. Helical rim, models 8328 and 8329</Description><Size>Helical rim: 37 x 62mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109363</GroupID><SubGroupID>112952</SubGroupID><ARTGs><ARTG>152165</ARTG></ARTGs><MinimumBenefit>277</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW432</BillingCode><Name>Ear Reconstruction</Name><Description>Porus Polyethylene. Ear base left and right, models 7542 and 7525  - 7527. Ear base extended left and right, models 8330 and 8331.</Description><Size>Ear base: 29 x 55 x 13mm, 32 x 65 x 16mm. Ear base extended: 30 x 60mm.</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109363</GroupID><SubGroupID>112953</SubGroupID><ARTGs><ARTG>187187</ARTG><ARTG>257034</ARTG></ARTGs><MinimumBenefit>395</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY783</BillingCode><Name>SynPOR</Name><Description>Porous Polyethylene Malar Implant</Description><Size>3-5 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109364</GroupID><SubGroupID>112954</SubGroupID><ARTGs><ARTG>190454</ARTG></ARTGs><MinimumBenefit>1121</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE807</BillingCode><PriorBillingCodes><PriorBillingCode>VL004</PriorBillingCode></PriorBillingCodes><Name>Su-Por Malar, Paranasal, Midface Implant</Name><Description>An implantable device intended to support, contour and provide structure for the face including the cheeks and eye sockets. Made of high-density polyethylene material with an interconnecting pore structure that supports tissue ingrowth. The device is available in various shapes and can be cut by the surgeon to meet the patient's specific needs.</Description><Size>Left and Right (47mm x 24mm x 4mm)</Size><SupplierCode>39975</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109364</GroupID><SubGroupID>112954</SubGroupID><ARTGs><ARTG>335454</ARTG></ARTGs><MinimumBenefit>1121</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW438</BillingCode><Name>E-POR Biomaterial/ Temporal Fossa Implant Porous Polyethylene</Name><Description>Temporal Fossa Implant Porous Polyethylene</Description><Size>61mm - 105mm x 18mm - 20mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109364</GroupID><SubGroupID>112954</SubGroupID><ARTGs><ARTG>257032</ARTG><ARTG>187178</ARTG></ARTGs><MinimumBenefit>1121</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW434</BillingCode><Name>E-POR Biomaterial/ Midface Contour Porous Polyethylene</Name><Description>Midface Contour Porous Polyethylene</Description><Size>One size</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109364</GroupID><SubGroupID>112954</SubGroupID><ARTGs><ARTG>257037</ARTG></ARTGs><MinimumBenefit>1121</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW436</BillingCode><Name>E-POR Biomaterial/ Transsphenoidal Sellar Contourable Porous Polyethylene</Name><Description>Transphenoidal Sellar Contourable Porous Polyethylene</Description><Size>2.5mm x 20mm - 40mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109364</GroupID><SubGroupID>112955</SubGroupID><ARTGs><ARTG>257032</ARTG></ARTGs><MinimumBenefit>487</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ009</BillingCode><PriorBillingCodes><PriorBillingCode>AT083</PriorBillingCode><PriorBillingCode>AT083</PriorBillingCode></PriorBillingCodes><Name>Anatomics Patient Specific Malar Implant</Name><Description>A customised patient specific implant constucted of porous polyethelene</Description><Size>The device is customised so sizes will vary</Size><SupplierCode>40481</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109364</GroupID><SubGroupID>112955</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>288564</ARTG></ARTGs><MinimumBenefit>4095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO120</BillingCode><Name>MODUS Mandible </Name><Description>Locking Plates - Mandibular Reconstruction </Description><Size>6+19+6 Hole, Full Mandible Plate </Size><SupplierCode>40165</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112956</SubGroupID><ARTGs><ARTG>350270</ARTG><ARTG>350271</ARTG></ARTGs><MinimumBenefit>915</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK039</BillingCode><PriorBillingCodes><PriorBillingCode>UQ038</PriorBillingCode></PriorBillingCodes><Name>Osteo Plating &amp; Fixation System</Name><Description>Plates - Reconstruction</Description><Size>5 x 20 x 5 Hole Full Mandible Plate; 5 x 16 x 5 Hole Full Mandible Plate; Mandible, Full</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112956</SubGroupID><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>915</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC513</BillingCode><Name>TiMesh</Name><Description>Full Mandible</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112956</SubGroupID><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>915</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ196</BillingCode><Name>Stryker Patient-Matched TMJ – Full, Mandibular Component</Name><Description>The mandibular component consists of a cobalt-chromium-molybdenum alloy condylar head and a titanium alloy mandibular body.</Description><Size>Patient Specific</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112956</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>427023</ARTG></ARTGs><MinimumBenefit>5119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ097</BillingCode><PriorBillingCodes><PriorBillingCode>WH002</PriorBillingCode></PriorBillingCodes><Name>Materialise PorousiTi - Mandible</Name><Description>Patient specific Titanium 3D printed implant for mandible</Description><Size>Personalized so the size is variable</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112956</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>377044</ARTG></ARTGs><MinimumBenefit>5119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY824</BillingCode><Name>OBL PorousiTi Patient Specific Implant - Mandible</Name><Description>Patient specific implant for mandible constructed of PourousiTi</Description><Size>The model is custom made so size will vary</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112956</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>276733</ARTG></ARTGs><MinimumBenefit>5119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-09-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI569</BillingCode><Name>TMJ System</Name><Description>Fossa Component, Left or Right; Titanium, UHMWPE</Description><Size>Small, Medium Large</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112957</SubGroupID><ARTGs><ARTG>145265</ARTG></ARTGs><MinimumBenefit>4114</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ195</BillingCode><Name>Stryker Patient-Matched TMJ - Fossa Component</Name><Description>The fossa component consists of an ultra-high-molecular-weight polyethylene (UHMWPE)
fossa bearing and an unalloyed titanium mesh backing.</Description><Size>Patient Specific</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112957</SubGroupID><ARTGs><ARTG>427023</ARTG></ARTGs><MinimumBenefit>4114</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OG003</BillingCode><Name>OMX Solutions Melbourne TMJ Glenoid Fossa Component</Name><Description>Universal glenoid fossa component constructed of UHMWP</Description><Size>The device is custom made so the size will vary.</Size><SupplierCode>40126</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112957</SubGroupID><ARTGs><ARTG>276176</ARTG></ARTGs><MinimumBenefit>4114</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ044</BillingCode><Name>OrthoTin TMJ Fossa Component</Name><Description>Titanium fossa component with UHMWPE bearing surface</Description><Size>The device is custom made so the size will vary</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112957</SubGroupID><ARTGs><ARTG>293845</ARTG></ARTGs><MinimumBenefit>4114</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF131</BillingCode><Name>Melbourne TMJ Prosthesis</Name><Description>TMJ Fossa component</Description><Size>One Size</Size><SupplierCode>40413</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112957</SubGroupID><ARTGs><ARTG>268455</ARTG></ARTGs><MinimumBenefit>4114</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE810</BillingCode><PriorBillingCodes><PriorBillingCode>VL007</PriorBillingCode></PriorBillingCodes><Name>Su-Por Mandible (Left / Right)</Name><Description>An implantable device intended to support, contour, and provide structure for the mandible. Made of high-density polyethylene material with an interconnecting pore structure that supports tissue ingrowth. The device can be cut by the surgeon to meet the patient's specific needs.</Description><Size>74 x 33 x5mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112958</SubGroupID><Suffix>Polymer</Suffix><ARTGs><ARTG>335454</ARTG></ARTGs><MinimumBenefit>1448</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK040</BillingCode><PriorBillingCodes><PriorBillingCode>UQ039</PriorBillingCode></PriorBillingCodes><Name>Plates</Name><Description>Micro, Mini, Maxi</Description><Size>Angled EDC Plate, Angled Long EDC Plate, 40mm 6 Hole Fracture Plate, 6 Hole Curved EDC Plate, 33mm &amp; 38mm 4 Hole EDC Plate, 48mm 6 Hole EDC Plate, Mandible, Mandible/Reduction, Mandible Angle</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112958</SubGroupID><Suffix>Compression</Suffix><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>148</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW422</BillingCode><Name>Mandibular angle</Name><Description>Porus Polyethylene. RZ mandibular angles left and right (Models 9955 - 9960); Porus Polyethylene. Contoured mandibular angles left and right (Models 88037 - 88038)</Description><Size>RZ mandibular angles: 65 x 35 x 3 x 6.5 x 3 x 3mm, 65 x 35 x 7 x 6.5 x 3 x 3mm, 65 x 35 x 11 x 6.5 x 3 x 3mm. Contoured mandibular angles left and right:59 x 29 x 7 x 11mm.</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112958</SubGroupID><Suffix>Polymer</Suffix><ARTGs><ARTG>257036</ARTG><ARTG>187186</ARTG></ARTGs><MinimumBenefit>1448</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK218</BillingCode><Name>Leibinger Titanium Implant System - Universal Mandible Condylar Device</Name><Description>Items used for reconstruction following trauma or tumor resection of the mandible. Included are 2x cross pin fixation screw.</Description><Size>Universal Mandible Condylar Device Left and Right</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112959</SubGroupID><ARTGs><ARTG>295882</ARTG></ARTGs><MinimumBenefit>1506</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY694</BillingCode><Name>Condylar Head Add-On System</Name><Description>Condylar Head - Left, Right</Description><Size>One Size</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112959</SubGroupID><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>1506</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT008</BillingCode><Name>Martin Level One Fixation</Name><Description>Temporary condylar impant, titanium</Description><Size>5cm</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112959</SubGroupID><ARTGs><ARTG>304394</ARTG></ARTGs><MinimumBenefit>1506</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO123</BillingCode><Name>MODUS Mandible </Name><Description>MODUS Mandible - Complete Condylar Device system (Left and Right), inclusive of carrier element and connecting screws for Condylar Head Prosthesis. </Description><Size>Mandible Condylar Device, Left and Right   </Size><SupplierCode>40165</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112959</SubGroupID><ARTGs><ARTG>350311</ARTG></ARTGs><MinimumBenefit>1506</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY695</BillingCode><Name>Condylar Head Add-On System</Name><Description>Fixation Plate 0-6mm positions</Description><Size>2 Holes</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112959</SubGroupID><Suffix>Fixation Plate</Suffix><ARTGs><ARTG>157706</ARTG></ARTGs><MinimumBenefit>629</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK041</BillingCode><PriorBillingCodes><PriorBillingCode>UQ045</PriorBillingCode></PriorBillingCodes><Name>OsteoMed Plating &amp; Fixation System</Name><Description>Plates - Reconstruction</Description><Size>5 x 16 Hole plate Right &amp; Left</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112960</SubGroupID><Suffix>Hemimandible</Suffix><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>453</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC516</BillingCode><Name>TiMesh</Name><Description>Mandibular Symphysis</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112960</SubGroupID><Suffix>Symphsis</Suffix><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>909</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OG002</BillingCode><Name>OMX Solutions Melbourne TMJ Mandibular Ramus</Name><Description>Custom 3D printed mandible component constructed of titanium alloy</Description><Size>The device is custom made so the size will vary.</Size><SupplierCode>40126</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112960</SubGroupID><ARTGs><ARTG>276176</ARTG></ARTGs><MinimumBenefit>4738</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RV016</BillingCode><Name>Patient Specific Implant</Name><Description>Patient Specific Implant</Description><Size>The device is custom made so the size will vary.</Size><SupplierCode>39940</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112960</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>366767</ARTG></ARTGs><MinimumBenefit>2952</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW545</BillingCode><Name>Stryker Biomodelled Patient Specific Mandible Reconstruction Plate</Name><Description>Biomodelled Patient Specific Mandible Complex Locking Reconstruction Plate</Description><Size>Custom</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112960</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>218563</ARTG></ARTGs><MinimumBenefit>2952</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC515</BillingCode><Name>TiMesh</Name><Description>Hemimandible, Left/Right</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112960</SubGroupID><Suffix>Hemimandible</Suffix><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>453</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT095</BillingCode><Name>IPS Implants® – Patient-Specific Implants</Name><Description>IPS patient specific maxilla complex locking reconstruction plate</Description><Size>Custom made - patient specific</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112960</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>96619</ARTG></ARTGs><MinimumBenefit>2952</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC512</BillingCode><Name>TiMesh</Name><Description>Maxillary Prosthesis</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112960</SubGroupID><Suffix>Maxilla</Suffix><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>1491</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW668</BillingCode><Name>Facial iD</Name><Description>Patient specific implants</Description><Size>These plates are patient specific - size will vary</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112960</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>331521</ARTG></ARTGs><MinimumBenefit>2952</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ197</BillingCode><Name>Stryker Patient-Matched TMJ – Plate, Mandibular Component</Name><Description>The mandibular component consists of a cobalt-chromium-molybdenum alloy condylar
head and a titanium alloy mandibular body.</Description><Size>Patient Specific</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112960</SubGroupID><ARTGs><ARTG>427023</ARTG></ARTGs><MinimumBenefit>4738</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BI559</BillingCode><Name>TMJ System</Name><Description>Mandibular Component, Left or Right, Titanium</Description><Size>(40 - 60mm), 5-13 hole</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112960</SubGroupID><ARTGs><ARTG>145265</ARTG></ARTGs><MinimumBenefit>4738</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ045</BillingCode><Name>OrthoTin TMJ Ramus Component</Name><Description>TiN coated titanium mandibular ramus</Description><Size>The device is custom made so the size will vary</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112960</SubGroupID><ARTGs><ARTG>293845</ARTG></ARTGs><MinimumBenefit>4738</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SF128</BillingCode><Name>Melbourne TMJ Prosthesis</Name><Description>TMJ Mandibular Component</Description><Size>S, M, L (Left &amp; Right)</Size><SupplierCode>40413</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112960</SubGroupID><ARTGs><ARTG>268455</ARTG></ARTGs><MinimumBenefit>4738</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT002</BillingCode><Name>UNIQOS custom Threadlock TS Mandible Reconstruction Plates</Name><Description>UNIQOS Custom Threadlock TS Mandible Reconstruction Plates</Description><Size>Custom-Patient Specific</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112960</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>96619</ARTG></ARTGs><MinimumBenefit>2952</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GI030</BillingCode><Name>Yxoss CBR</Name><Description>Yxoss CBR is a customized 3-D printed pure titanium or titanium alloys (certified medical grade 4) scaffold for use in craniofacial surgery, to regenerate complex alveolar bone in craniofacial bone rejuvenation and augmentation (Attachments 1 &amp; 2).</Description><Size>Patient specific - size matches individual patient.</Size><SupplierCode>40366</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112960</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>280805</ARTG></ARTGs><MinimumBenefit>2952</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY832</BillingCode><Name>SynpliciTi System - Plates</Name><Description>Patient specific plates for the mandible, maxilla and TMJ</Description><Size>The model is custom made so size will vary</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112960</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>276733</ARTG></ARTGs><MinimumBenefit>2952</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-09-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ048</BillingCode><Name>Lyka Smith Patient Specific Plate</Name><Description>3D printed custom plate</Description><Size>The device is custom so the size will vary</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112960</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>293845</ARTG></ARTGs><MinimumBenefit>2952</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DZ097</BillingCode><Name>Patient Specific Biomodelled Plate</Name><Description>Patient Specific Biomodelled Plate</Description><Size>Patient Specific</Size><SupplierCode>40057</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112960</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>366767</ARTG></ARTGs><MinimumBenefit>2952</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OG005</BillingCode><Name>Custom Plate</Name><Description>A titanium plate designed to be attached to bone fragments with screws to bridge the fracture gap and shield the fracture site from stress as the bone heals. The device is used for fixation of maxillofacial, mandibular fractures and reconstructions.</Description><Size>Customised to patients</Size><SupplierCode>40126</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112960</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>330150</ARTG></ARTGs><MinimumBenefit>2952</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ098</BillingCode><PriorBillingCodes><PriorBillingCode>WH003</PriorBillingCode></PriorBillingCodes><Name>Materialise Titanium 3D Printed Plates</Name><Description>Patient specific Titanium 3D printed plates for maxillofacial applications</Description><Size>Personalized so the size is variable</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112960</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>377044</ARTG></ARTGs><MinimumBenefit>2952</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ010</BillingCode><PriorBillingCodes><PriorBillingCode>AT084</PriorBillingCode><PriorBillingCode>AT084</PriorBillingCode></PriorBillingCodes><Name>Anatomics Patient Specific Mandible</Name><Description>Custom mandible implant constructed of porous polyethylene</Description><Size>The device is custom made so the size will vary.</Size><SupplierCode>40481</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112961</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>288564</ARTG></ARTGs><MinimumBenefit>3493</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ047</BillingCode><Name>OrthoTin Surgical Guide</Name><Description>Patient specific surgical guide</Description><Size>The device is custom so the size may vary</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112969</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>293845</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW653</BillingCode><Name>VSP Reconstruction Mandibular/Maxillary Case Bundle</Name><Description>VSP Reconstruction Mandibular/Maxillary Case Bundle (With Metal Inserts) Customized Bundle</Description><Size>Custom</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112969</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>200615</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OG001</BillingCode><Name>OMX Solutions patient Optimized Guide system</Name><Description>CT Based Patient Specific Surgical Guide</Description><Size>The device is patient specific so size will vary</Size><SupplierCode>40126</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112969</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>276176</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ008</BillingCode><PriorBillingCodes><PriorBillingCode>AT085</PriorBillingCode><PriorBillingCode>AT085</PriorBillingCode></PriorBillingCodes><Name>Anatomics Patient Specifc Surgical Guide</Name><Description>Patient specific surgical guide created from patient CT scan data, used to assist surgeons to implant the device by assisting in clinical decision making both pre- and intraoperatively</Description><Size>The device is custom made so the size will vary.</Size><SupplierCode>40481</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112969</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>288564</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ049</BillingCode><Name>Lyka Smith Patient Specific Guides</Name><Description>Patient specific surgical guide</Description><Size>The device is custom made so the size will vary.</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112969</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>293845</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY829</BillingCode><Name>Custom made plates (including Megaplates) – Surgical Guides</Name><Description>Surgical Guides for patient specific plates for the mandible and maxilla</Description><Size>The model is custom made so size will vary</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112969</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>276733</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-09-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY778</BillingCode><Name>ProPlan</Name><Description>Pateint specific Maxillofacial Surgical Guides, Implants</Description><Size>Custom</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112969</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>276733</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT005</BillingCode><Name>UNIQOS Patient Specific Surgical guides</Name><Description>UNIQOS Patient Specific Surgical guides</Description><Size>Custom - Patient specific</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112969</SubGroupID><Suffix>Biomodelled</Suffix><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MV007</BillingCode><Name>MGuide</Name><Description>3D printed surgical template</Description><Size>Custom-made, patient specific so size will vary</Size><SupplierCode>40146</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112969</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>348196</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UI003</BillingCode><Name>DGUIDE</Name><Description>A custom made patient-specific and single-use aid, intended to be used in dental and craniomaxillofacial surgical procedures.</Description><Size>Patient specific</Size><SupplierCode>40421</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112969</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>322576</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HI001</BillingCode><Name>DDN Guide</Name><Description>Custom made patient specific guide for use with the Neoss Implant System (NJ001)</Description><Size>The device is custom made so the size will vary</Size><SupplierCode>40245</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112969</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>336209</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1495</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UI001</BillingCode><Name>OsGuide</Name><Description>A non-sterile, custom-made surgical guide manufactured by 3-D printing  and CAD/CAM techniques</Description><Size>Custom-made. Patient specific</Size><SupplierCode>40421</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112969</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>292759</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW650</BillingCode><Name>VSP Orthognathics Bundle (Surgical Guide and Implants)</Name><Description>VSP Orthognathic Bundle (Surgical Guide and Implants - Plates and Screws)</Description><Size>Custom</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112969</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>200615</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ312</BillingCode><Name>AI Guide</Name><Description>Custom made patient specific guide for use with the ARDS Dental System (JN001)</Description><Size>size will vary as patent specific</Size><SupplierCode>40405</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112969</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>443915</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.

</Note><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HI006</BillingCode><Name>DDN Guide</Name><Description>Custom made patient specific guide for use with the STRAUMANN Implant System (SB024), (SB009), (SB015), (SB023), (SB008), (SB012), (SB018)</Description><Size>The device is custom made so the size will vary.</Size><SupplierCode>40245</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112969</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>336209</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>1450</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ099</BillingCode><PriorBillingCodes><PriorBillingCode>WH004</PriorBillingCode></PriorBillingCodes><Name>Materialise PorousiTi - Maxilla</Name><Description>Patient specific Titanium 3D printed implant for maxilla</Description><Size>Personalized so the size is variable</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112970</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>377044</ARTG></ARTGs><MinimumBenefit>6337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY828</BillingCode><Name>OBL PorousiTi Patient Specific Implant - Maxilla</Name><Description>Patient specific implant for maxilla constructed of PorousiTi</Description><Size>The model is custom made so size will vary</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109365</GroupID><SubGroupID>112970</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>276733</ARTG></ARTGs><MinimumBenefit>6337</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-09-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ100</BillingCode><PriorBillingCodes><PriorBillingCode>WH005</PriorBillingCode></PriorBillingCodes><Name>Materialise Titanium 3D Printed Plates - Zygoma</Name><Description>Patient specific Titanium 3D printed plates for zygoma reconstruction</Description><Size>Personalized so the size is variable</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109366</GroupID><SubGroupID>112972</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>377044</ARTG></ARTGs><MinimumBenefit>4095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE811</BillingCode><PriorBillingCodes><PriorBillingCode>VL008</PriorBillingCode></PriorBillingCodes><Name>Biopore Nasal Dorsum Shape</Name><Description>An implantable device intended to support, contour, and provide structure for the nose and zygoma. Made of high-density polyethylene material with an interconnecting pore structure that supports tissue ingrowth. The device is available in various shapes and can be cut by the surgeon to meet the patient's specific needs.</Description><Size>53 x 5mm, 66 x 6 mm, 76 x 15mm, 40 x 9mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109366</GroupID><SubGroupID>112974</SubGroupID><ARTGs><ARTG>335454</ARTG></ARTGs><MinimumBenefit>272</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW423</BillingCode><Name>Nasal Shape. Petite Nasal Dorsum.</Name><Description>Porus Polyethylene. Petite Nasal Dorsum ( Models 84000 - 84004).</Description><Size>Petite Nasal Dorsum: 4 x 4 x 45mm, 4 x 4 x 55mm, 5 x 5 x 45mm, 5 x 5 x 55mm, 6 x 9 x 55mm.</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109366</GroupID><SubGroupID>112974</SubGroupID><ARTGs><ARTG>257016</ARTG></ARTGs><MinimumBenefit>272</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW415</BillingCode><Name>Nasal Shape or Rhinoplasty Shape</Name><Description>Porus Polyethylene. Nasal Arch shapes, nasal arch and nasal sheet (Models 9533 - 9536). Nasal dorsum shapes, design A and design B (Models 7516 - 7518). Nasal valve support, lateral nasal valve support and ext.</Description><Size>Nasal arch shapes: small 70 x 13 x 2mm, medium 70 x 15 x 2mm, large 70 x 15 x 2mm, sheet 40 x 9 x 1.1mm. Nasal dorsum shapes: design A small 53 x 5mm, design A large 66 x 8mm, design B 67 x 6.5mm. Nasal valve support: lateral nasal valve 13 x 0.85 x 3.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109366</GroupID><SubGroupID>112975</SubGroupID><ARTGs><ARTG>152165</ARTG></ARTGs><MinimumBenefit>341</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW425</BillingCode><Name>Nasal Shell Shapes.</Name><Description>Nasal Shell Shapes, Regular and Large with Inserts Small and Large (included). Models 9553 - 9554. Thin Nasal Shell 84006</Description><Size>Regular: 38 x 21 x 17mm, Insert Small 30 x 4 x 9mm, Insert Large 38 x 2.5 x 9mm. Large: 40 x 20 x 18mm, Insert Small 32 x 4 x 9mm, Insert Large 41 x 3 x 9mm. Thin Nasal Dorsal Shell 42.7mm x 16.4mm x 21.8mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109366</GroupID><SubGroupID>112976</SubGroupID><ARTGs><ARTG>257016</ARTG></ARTGs><MinimumBenefit>478</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW424</BillingCode><Name>Nasal Valve Support.</Name><Description>Lateral Nasal Valve, Model 7545. External Nasal Valve Batten, Model 7546. External Nasal Valve Batten - Thin, Model 7167</Description><Size>Lateral Nasal Valve:13 x 3.5 x 0.85mm, External Nasal Valve Batten: 25 x 11 x 0.85mm, External Nasal Valve Batten - Thin: 24 x 11.5 x 0.6mm.</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109366</GroupID><SubGroupID>112977</SubGroupID><ARTGs><ARTG>257016</ARTG></ARTGs><MinimumBenefit>221</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC521</BillingCode><Name>TiMesh</Name><Description>Naso-Orbital-Ethmoid </Description><Size>1mm - 2.2mm;  Complex 1, Complex 2, Complex 3</Size><SupplierCode>40151</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109366</GroupID><SubGroupID>112978</SubGroupID><Suffix>Complex</Suffix><ARTGs><ARTG>128523</ARTG></ARTGs><MinimumBenefit>527</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE814</BillingCode><PriorBillingCodes><PriorBillingCode>VL011</PriorBillingCode></PriorBillingCodes><Name>Su-Por Inferior 2/3 Orbit, Complete Orbit, 3D Orbital Floor</Name><Description>An implantable device intended to support, contour, and provide structure for the face including the cheeks and eye socket. Made of high-density polyethylene material with an interconnecting pore structure that supports tissue ingrowth. Includes Inferior 2/3 Orbit (left, right); left complete orbit (left, right)</Description><Size>various sizes, left, right</Size><SupplierCode>39975</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109367</GroupID><SubGroupID>112979</SubGroupID><ARTGs><ARTG>335454</ARTG></ARTGs><MinimumBenefit>1892</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW411</BillingCode><Name>Complete Orbital Shape</Name><Description>Porus Polyethylene. Complete and 2 / 3 orbit shapes. Inferior 2 / 3 left and right. Models 9567, 9568</Description><Size>Inferior: 83 x 78mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109367</GroupID><SubGroupID>112979</SubGroupID><ARTGs><ARTG>257032</ARTG></ARTGs><MinimumBenefit>1892</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN355</BillingCode><Name>TRUMATCH® CMF Orbital</Name><Description>Patient matched, orbital floor reconstruction implants, Titanium  </Description><Size>Custom sized</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109367</GroupID><SubGroupID>112980</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>276733</ARTG></ARTGs><MinimumBenefit>4095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZZ101</BillingCode><PriorBillingCodes><PriorBillingCode>WH006</PriorBillingCode></PriorBillingCodes><Name>Materialise PorousiTi - Orbital</Name><Description>Patient specific Titanium 3D printed implant for orbital reconstruction</Description><Size>Personalized so the size is variable</Size><SupplierCode>40063</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109367</GroupID><SubGroupID>112980</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>377044</ARTG></ARTGs><MinimumBenefit>4095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ011</BillingCode><PriorBillingCodes><PriorBillingCode>AT087</PriorBillingCode><PriorBillingCode>AT087</PriorBillingCode></PriorBillingCodes><Name>Anatomics Patient Specific Orbital Floor Implant</Name><Description>A custom, patient specific implant intended for the reconstruction of the patient's orbital floor manufactured with titanium or porous polyethylene.</Description><Size>The device is custom made so the size will vary.</Size><SupplierCode>40481</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109367</GroupID><SubGroupID>112980</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>288564</ARTG></ARTGs><MinimumBenefit>4095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT001</BillingCode><Name>UNIQOS Biomodelled Customised Orbital Floor Mesh</Name><Description>UNIQOS Biomodelled Customised Orbital Floor Mesh</Description><Size>Customised - patient specific</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109367</GroupID><SubGroupID>112980</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>109878</ARTG></ARTGs><MinimumBenefit>4095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW433</BillingCode><Name>E-POR Biomaterial/ Orbital Wall and Floor Porous Polyethylene Titanium Mesh Composite (large)</Name><Description>Orbital Wall and Floor Porous Polyethylene Titanium Mesh Composite</Description><Size>41 x 42 x 0.6-1.0mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109367</GroupID><SubGroupID>112980</SubGroupID><Suffix>Coated</Suffix><ARTGs><ARTG>257032</ARTG></ARTGs><MinimumBenefit>960</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW522</BillingCode><Name>Stryker Leibinger 3D Orbital Floor Plate</Name><Description>Stryker Leibinger 3D Orbital Floor Plate</Description><Size>Small, Right  Small, Left  Large, Right  Large, Left</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109367</GroupID><SubGroupID>112980</SubGroupID><ARTGs><ARTG>257032</ARTG><ARTG>200615</ARTG><ARTG>295882</ARTG></ARTGs><MinimumBenefit>868</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK042</BillingCode><PriorBillingCodes><PriorBillingCode>UQ040</PriorBillingCode></PriorBillingCodes><Name>Plates</Name><Description>Micro, Mini</Description><Size>Orbital Plate, Orbital Plate Large</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109367</GroupID><SubGroupID>112980</SubGroupID><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>868</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EO122</BillingCode><Name>MODUS Orbital Plating System</Name><Description>Orbital Floor Plate </Description><Size>Small - Large </Size><SupplierCode>40165</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109367</GroupID><SubGroupID>112980</SubGroupID><ARTGs><ARTG>350270</ARTG><ARTG>350271</ARTG></ARTGs><MinimumBenefit>868</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK043</BillingCode><PriorBillingCodes><PriorBillingCode>UQ049</PriorBillingCode></PriorBillingCodes><Name>OsteoMed Orbital Floor Plates</Name><Description>Preformed titanium mesh orbital floor plates</Description><Size>Small Left,  Small Right,  Large Left,  Large Right</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109367</GroupID><SubGroupID>112980</SubGroupID><ARTGs><ARTG>130508</ARTG></ARTGs><MinimumBenefit>868</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE813</BillingCode><PriorBillingCodes><PriorBillingCode>VL010</PriorBillingCode></PriorBillingCodes><Name>Su-Por Orbital Floor</Name><Description>An implantable device intended to support, contour, and provide structure for the face including the cheeks and eye socket. Made of high-density polyethylene material with an interconnecting pore structure that supports tissue ingrowth. The device is available in various size and can be cut by the surgeon to meet the patient's specific needs.</Description><Size>24mm, 30mm, 34mm, 35mm, 40mm</Size><SupplierCode>39975</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109367</GroupID><SubGroupID>112980</SubGroupID><ARTGs><ARTG>335454</ARTG></ARTGs><MinimumBenefit>868</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY391</BillingCode><Name>Orbital Fixation System</Name><Description>Orbital Floor Plate</Description><Size>S, M, L</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109367</GroupID><SubGroupID>112980</SubGroupID><ARTGs><ARTG>167547</ARTG></ARTGs><MinimumBenefit>868</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BH363</BillingCode><Name>Lorenz Plating System</Name><Description>Orbital Floor Plate, Titanium</Description><Size>Small to Large</Size><SupplierCode>40315</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109367</GroupID><SubGroupID>112980</SubGroupID><ARTGs><ARTG>128458</ARTG></ARTGs><MinimumBenefit>868</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY698</BillingCode><Name>SynPOR</Name><Description>Anatomical Porous Polyethylene</Description><Size>0.8mm - 1.5mm thick</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109367</GroupID><SubGroupID>112980</SubGroupID><ARTGs><ARTG>190454</ARTG></ARTGs><MinimumBenefit>868</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK511</BillingCode><Name>Orbital Rim</Name><Description>Orbital rims, left and right extended. Models 9539, 9540 Orbital Rim Onlay Implants 81001, 81002</Description><Size>Left &amp; right extended models 47 x 40mm Oribtal Rim Onlay Implants left &amp; right 40 x 40mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109367</GroupID><SubGroupID>112981</SubGroupID><ARTGs><ARTG>257035</ARTG><ARTG>257037</ARTG></ARTGs><MinimumBenefit>385</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE808</BillingCode><PriorBillingCodes><PriorBillingCode>VL005</PriorBillingCode></PriorBillingCodes><Name>Su-Por Orbital Rim, Extended</Name><Description>An implantable device intended to support, contour, and provide structure for the face including the cheeks and eye socket. Made of high-density polyethylene material with an interconnecting pore structure that supports tissue ingrowth. The device is available in various shapes and can be cut by the surgeon to meet the patient's specific needs.</Description><Size>Left and Right (44mm x 38mm)</Size><SupplierCode>39975</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109367</GroupID><SubGroupID>112981</SubGroupID><ARTGs><ARTG>335454</ARTG></ARTGs><MinimumBenefit>385</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ012</BillingCode><PriorBillingCodes><PriorBillingCode>AT082</PriorBillingCode><PriorBillingCode>AT082</PriorBillingCode></PriorBillingCodes><Name>Anatomics Patient Specific Orbital Rim</Name><Description>Custom, 3D-printed orbital rim constructed of porous polyethylene.</Description><Size>The device is custom made so the size will vary.</Size><SupplierCode>40481</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109367</GroupID><SubGroupID>112981</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>288564</ARTG></ARTGs><MinimumBenefit>4095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE816</BillingCode><PriorBillingCodes><PriorBillingCode>VL013</PriorBillingCode></PriorBillingCodes><Name>Su-Por Enophthalmos Wedge</Name><Description>The Su-Por Enophthalmos Wedge is contoured in the shape of the orbital floor and provides volume to restore the orbit to its normal shape and size. </Description><Size>24mm x 33.5mm x 7mm (left,right)  28mm x 40mm x 7.5mm (left, right)    </Size><SupplierCode>39975</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109367</GroupID><SubGroupID>112982</SubGroupID><ARTGs><ARTG>335454</ARTG></ARTGs><MinimumBenefit>325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW410</BillingCode><Name>Enophthalmos Wedge</Name><Description>Regular left and right. Large left and right. (Models 9541 - 9544)</Description><Size>Regular: 22 x 31 x 7mm. Large: 28 x 40 x 7.5mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109367</GroupID><SubGroupID>112982</SubGroupID><ARTGs><ARTG>257032</ARTG></ARTGs><MinimumBenefit>325</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ013</BillingCode><PriorBillingCodes><PriorBillingCode>AT088</PriorBillingCode><PriorBillingCode>AT088</PriorBillingCode></PriorBillingCodes><Name>Anatomics Patient Specific Surgical Guide</Name><Description>The Surgical Guide component of the system is created from the patient's CT scan data to assist the surgeon with pre- and intraoperative planning.</Description><Size>The device is custom made so the size will vary.</Size><SupplierCode>40481</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109367</GroupID><SubGroupID>112983</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>288564</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>2584</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY830</BillingCode><Name>Surgical Guide for OBL PorousiTi® PSI System – Orbital Floor</Name><Description>Patient specific surgical guide for orbital floor implant</Description><Size>The model is custom made so size will vary</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109367</GroupID><SubGroupID>112983</SubGroupID><Suffix>Biomodelled</Suffix><ARTGs><ARTG>276733</ARTG></ARTGs><Note>Prescribed List reimbursement is restricted to the use of the device in craniomaxillofacial surgery procedures involving insertion of an implantable medical device, where that implantable device is listed in either sub-category 07.01 - Craniomaxillofacial Reconstruction &amp; Fixation, or 07.02 – Craniomaxillofacial Implants, or 07.04 – Distractor Systems of Schedule 1, or sub-category 07.03 - Dental Implants, but only if the implantable medical device is explicitly identified in the product name or description of the billing code for the surgical guide or biomodel and is used in hospital. Not limiting the above, for a claim for any implantation procedure (defined by the respective MBS items stated in the claim) for a patient, the Prescribed List reimbursement is limited to 3 or less PL benefits for any billing codes for surgical guides or biomodels, or no more than 6 benefits if both surgical guides and biomodels (maximum 3 for each) have been used in an implantation procedure for a patient. This restriction is not impacted by a number of devices implanted during a procedure. The condition is taking effect on 1 February 2024.</Note><MinimumBenefit>2584</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-09-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IC008</BillingCode><Name>Southern Implant IE Osseointegrated Implant</Name><Description>Titanium implant for the treatment of patients with craniofacial defects</Description><Size>Width 3.75mm - 4.0mm  Length 3.0mm - 6.0mm</Size><SupplierCode>40338</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107805</SubCategoryID><GroupID>109368</GroupID><SubGroupID>112984</SubGroupID><Suffix>Concave</Suffix><ARTGs><ARTG>225923</ARTG></ARTGs><MinimumBenefit>1055</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB027</BillingCode><Name>BL/BLT Screw-retained Abutment</Name><Description>Screw-retained abutment, straight or angled</Description><Size>Diameter: 3.5mm, 4.6mm  Gingiva height: 1.5mm, 2.5mm, 3.5mm, 4.5mm, 5.5mm</Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112988</SubGroupID><ARTGs><ARTG>212172</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB033</BillingCode><Name>TLX Screw-Retained Abutment</Name><Description>Titanium abutment</Description><Size>AH 3.5 mm   Narrow base  </Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112988</SubGroupID><ARTGs><ARTG>212172</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB025</BillingCode><Name>Straumann Zygomatic Screw-retained Abutment</Name><Description>Titanium screw-retained abutments, straight</Description><Size>4.6mm diameter, 1.5mm - 4.5mm height</Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112988</SubGroupID><ARTGs><ARTG>330841</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MV005</BillingCode><Name>MIS Abutments</Name><Description>Abutments</Description><Size>Height: 1mm - 5mm, Crown height: 4 - 11mm, Platform: Narrow, Standard or Wide</Size><SupplierCode>40146</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112988</SubGroupID><ARTGs><ARTG>115006</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB019</BillingCode><Name>BLX Screw-Retained Abutment</Name><Description>Screw-retained abutment, straight or angled</Description><Size>Diameter: 4.6mm  Gingiva height: 1.5mm, 2.5mm, 3.5mm, 4.5mm, 5.5mm</Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112988</SubGroupID><ARTGs><ARTG>212172</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NJ003</BillingCode><Name>Neoss Titanium Abutment</Name><Description>Neoss Abutment Titanium</Description><Size>Universal</Size><SupplierCode>40137</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112988</SubGroupID><ARTGs><ARTG>120228</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NJ004</BillingCode><Name>Neoss Gold Abutment</Name><Description>Neoss Abutment Gold </Description><Size>Universal</Size><SupplierCode>40137</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112988</SubGroupID><ARTGs><ARTG>120228</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MV017</BillingCode><Name>MIS Abutments</Name><Description>Abutments</Description><Size>Height: 1mm - 5mm, Crown height: 4 - 11mm, Platform: Narrow, Standard or Wide</Size><SupplierCode>40146</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112988</SubGroupID><ARTGs><ARTG>115006</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FV007</BillingCode><Name>Ankylos / DS EV Permanent Abutments</Name><Description>Permanent Abutments</Description><Size>Diameter range: 3.3mm - 5.7mm, height range: 7.5mm - 11.1mm</Size><SupplierCode>40265</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112988</SubGroupID><ARTGs><ARTG>153161</ARTG><ARTG>224096</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HD026</BillingCode><Name>BioHorizons Multi-unit Abutments</Name><Description>Titanium abutments used for multiple-unit restorations. Includes straight, 17 and 30 degree abutments. Laser-lok technology optional. Comes with a cover cap. </Description><Size>Collar height: 1.0 - 5.0mm  Platforms: 3.0, 3.5, 4.5, 5.7mm  Angles: Straight,  17 and 30 degrees  </Size><SupplierCode>40347</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112988</SubGroupID><ARTGs><ARTG>133898</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JN003</BillingCode><Name>ARDS Abutments</Name><Description>Permanent - ball,  conical,  straight, angled, anatomic</Description><Size>(4.2 - 6)mm width x (2.5 - 1)mm height</Size><SupplierCode>40405</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112988</SubGroupID><ARTGs><ARTG>375050</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER415</BillingCode><Name>Bicon Dental Implant System-Abutment, Permanent</Name><Description>Bicon Dental Implant System permanent abutment, universal, Ti, various profiles</Description><Size>diameter (4-7.5mm) (post (2-3mm), angle 0˚ and 15˚, height (1-12mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112988</SubGroupID><ARTGs><ARTG>160010</ARTG><ARTG>158187</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HD031</BillingCode><Name>CAMLOG Conelog Progressive Line - Multi Unit Abutment </Name><Description>Titanium abutments used for multiple-unit restorations. Includes straight, 17 and 30 degree abutments. Comes with a cover cap</Description><Size>Collar height: 1.0 - 5.0mm.  Angles: Straight,17 and 30 degrees </Size><SupplierCode>40347</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112988</SubGroupID><ARTGs><ARTG>343993</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NR001</BillingCode><Name>Nobel Biocare Abutments</Name><Description>Final Abutments (Multi-Units)</Description><Size>NP, RP, WP</Size><SupplierCode>40132</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112988</SubGroupID><ARTGs><ARTG>127964</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HQ005</BillingCode><Name>Rex PiezoImplants Permanent Abutments (No Screw included) </Name><Description>The PiezoImplant System permanent restorations may consist of single crowns or bridges as well as complete or partial dentures. The prosthetic components are connected to the implants by corresponding abutments. The PiezoImplant System is intended for delayed loading. </Description><Size>1.8mm &amp; 2.9mm     </Size><SupplierCode>40238</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112988</SubGroupID><ARTGs><ARTG>389981</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MV014</BillingCode><Name>MIS Abutments</Name><Description>Abutments</Description><Size>Height: 1mm - 5mm, Crown height: 4 - 11mm, Platform: Narrow or Standard</Size><SupplierCode>40146</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112988</SubGroupID><ARTGs><ARTG>115006</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IC003</BillingCode><Name>Southern Implants Abutments</Name><Description>Final Abutments (multiple units)</Description><Size>3.0 - 6mm Diameter
1.0 - 5.5mm Height</Size><SupplierCode>40338</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112988</SubGroupID><ARTGs><ARTG>146306</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW001</BillingCode><Name>3i Abutment Complete</Name><Description>Titanium</Description><Size>3.25 - 6mm diameter</Size><SupplierCode>39969</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112988</SubGroupID><ARTGs><ARTG>120288</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB010</BillingCode><Name>Neodent GM Abutment</Name><Description>Neodent GM Abutment Titanium (Mini Conical, Exact Mini Conical)</Description><Size>Height: 0.8mm to 5.5mm. Angle: 0, 17, 30, 45 and 60 degrees</Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112988</SubGroupID><ARTGs><ARTG>295056</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GZ003</BillingCode><Name>JD Permanent Abutments</Name><Description>Titanium Abutments</Description><Size>1.5mm to 6.0mm (height)</Size><SupplierCode>40479</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112988</SubGroupID><ARTGs><ARTG>334161</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW010</BillingCode><Name>Zimmer Tapered Screw-Vent Healing Abutment </Name><Description>Temporary or healing abutment </Description><Size>2.9mm  3.5mm  4.5mm  5.7mm</Size><SupplierCode>39969</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112989</SubGroupID><ARTGs><ARTG>338406</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW012</BillingCode><Name>T3 Healing abutment</Name><Description>Abutment, temporary or healing, complete</Description><Size>3.25 - 6mm diameter    </Size><SupplierCode>39969</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112989</SubGroupID><ARTGs><ARTG>120289</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FV006</BillingCode><PriorBillingCodes><PriorBillingCode>DH006</PriorBillingCode></PriorBillingCodes><Name>Ankylos Temporary Abutments</Name><Description>Temporary and healing abutments</Description><Size>Diameter 3.3mm - 7mm</Size><SupplierCode>40265</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112989</SubGroupID><ARTGs><ARTG>212101</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HD032</BillingCode><Name>CAMLOG Conelog Progressive Line - Healing Abutment </Name><Description>Temporary healing abutment for Camlog Conelog implant. Sterile. </Description><Size>Shape: Cylindrical, Wide body, Bottle neck  Height: 2-6mm</Size><SupplierCode>40347</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112989</SubGroupID><ARTGs><ARTG>378911</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HD025</BillingCode><Name>BioHorizons Healing Abutment</Name><Description>Titanium healing abutment with or without laser-lok technology</Description><Size>Emergence profiles: Narrow - Wide     Diameter - 4.0-8.0mm     Height: 1.0 - 5.0mm   </Size><SupplierCode>40347</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112989</SubGroupID><ARTGs><ARTG>133898</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NJ009</BillingCode><Name>Neoss Implant System</Name><Description>Healing / Provisional Abutment with Screw</Description><Size>Universal</Size><SupplierCode>40137</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112989</SubGroupID><ARTGs><ARTG>120227</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FV004</BillingCode><Name>Astra Tech Implant System / DS EV Abutments</Name><Description>Temporary Abutment</Description><Size>Diameter range: 3.3 - 7.0 mm</Size><SupplierCode>40265</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112989</SubGroupID><ARTGs><ARTG>212101</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB032</BillingCode><Name>Straumann Tissue Level Healing Caps</Name><Description>Straumann Tissue Level Healing Caps (TL and TLX)</Description><Size>Diameter: 4mm to 7.2mm   Height: 2mm to 4.5mm  </Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112989</SubGroupID><ARTGs><ARTG>200750</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FV003</BillingCode><Name>Astra Tech Implant System/ DS EV Healing Abutments</Name><Description>Healing Abutments</Description><Size>Healing Abutment  Diameter: Range 3.5 - 7.5 mm,  Height Range from 2.0 - 10mm</Size><SupplierCode>40265</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112989</SubGroupID><ARTGs><ARTG>212101</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB013</BillingCode><Name>Neodent GM Healing Abutment</Name><Description>Titanium healing abutment</Description><Size>Diameter: 3.3mm, 4.5mm  Profile: 0.8mm - 5.5mm</Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112989</SubGroupID><ARTGs><ARTG>429210</ARTG><ARTG>303678</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB004</BillingCode><Name>Straumann Bone Level Implant Healing Abutment</Name><Description>Straumann Healing Abutment NC/RC/SC</Description><Size>Heights 2mm – 7mm    Diameters from 3.3mm to 7mm  Shape: Conical, Bottle shaped, Customizable, Oval </Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112989</SubGroupID><ARTGs><ARTG>200750</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB017</BillingCode><Name>BLX/BLC Healing Abutment</Name><Description>Titanium healing abutment</Description><Size>Diameter: 4mm, 5mm, 6mm, 6.5mm, 7.5mm  Abutment height: 2mm, 4mm</Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112989</SubGroupID><ARTGs><ARTG>200750</ARTG></ARTGs><ChangeExplanation>Change to Product name, ARTG</ChangeExplanation><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GZ004</BillingCode><Name>JD Temporary Abutments</Name><Description>Titanium Abutments</Description><Size>3.2mm to 7.5mm (diameter), 3.0mm to 9.0mm (height)</Size><SupplierCode>40479</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112989</SubGroupID><ARTGs><ARTG>334161</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NR004</BillingCode><Name>Nobel Biocare Abutments</Name><Description>Abutment, temporary or healing, complete</Description><Size>NP, RP, WP, 6.0mm</Size><SupplierCode>40132</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112989</SubGroupID><ARTGs><ARTG>127913</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IC006</BillingCode><Name>Southern Implants Healing Abutments</Name><Description>Titanium healing abutment that sculpts and prepares soft tissue</Description><Size>Emergence profiles:  Narrow - Wide  Diameter 3.0 - 8.0mm  Height 1.0 - 12mm</Size><SupplierCode>40338</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112989</SubGroupID><ARTGs><ARTG>197727</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER414</BillingCode><Name>Bicon Dental Implant System-Abutment (temporary)</Name><Description>Bicon Dental Implant System temporary abutments</Description><Size>dia (4-7.5mm) x length (2.5-6.5mm) x post (2-3mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112989</SubGroupID><ARTGs><ARTG>160010</ARTG><ARTG>158187</ARTG></ARTGs><MinimumBenefit>68</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FV001</BillingCode><Name>Astra Tech Implant System/ DS EV Cover Screws &amp; healing cap</Name><Description>Cover Screw and healing cap</Description><Size>Diameter range 3.0 - 5.4</Size><SupplierCode>40265</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112990</SubGroupID><ARTGs><ARTG>212100</ARTG><ARTG>153161</ARTG></ARTGs><MinimumBenefit>47</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB026</BillingCode><Name>Straumann Zygomatic Cover-Screw/Protective Cap</Name><Description>Cover screw for implant; protective cap for screw-retained abutment</Description><Size>Cover screw: 4mm diameter.  Protective cap: 4.6mm diameter, 4.5 - 8.1mm height</Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112990</SubGroupID><ARTGs><ARTG>200750</ARTG></ARTGs><MinimumBenefit>47</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MV019</BillingCode><Name>MIS Cover Screws and Healing Caps</Name><Description>Cover screws and healing caps (C1)</Description><Size>1.5mm - 8mm height, 3.3mm - 6.3mm diameter</Size><SupplierCode>40146</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112990</SubGroupID><ARTGs><ARTG>115006</ARTG></ARTGs><MinimumBenefit>47</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB028</BillingCode><Name>BL/BLT Protective Cap</Name><Description>Protective cap for screw-retained abutment</Description><Size>Height: 5mm, 6.5mm, 8mm  Diameter: 3.5mm, 4.6mm</Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112990</SubGroupID><ARTGs><ARTG>196612</ARTG></ARTGs><MinimumBenefit>47</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB002</BillingCode><Name>Straumann Closure Caps</Name><Description>Straumann Closure Caps</Description><Size>Height 0.0 - 1.5 mm</Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112990</SubGroupID><ARTGs><ARTG>200750</ARTG></ARTGs><MinimumBenefit>47</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB011</BillingCode><Name>Neodent GM Cover Screw</Name><Description>Cover screw</Description><Size>Height: 0mm, 2mm</Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112990</SubGroupID><ARTGs><ARTG>303678</ARTG></ARTGs><MinimumBenefit>47</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MV006</BillingCode><Name>MIS Cover Screws and Healing Caps</Name><Description>Cover screws and healing caps (Biocom, Seven, Mistral)</Description><Size>1.5mm - 6mm height, 4mm - 6.3mm diameter</Size><SupplierCode>40146</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112990</SubGroupID><ARTGs><ARTG>115006</ARTG></ARTGs><MinimumBenefit>47</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NR002</BillingCode><Name>Nobel Biocare Cover Screws</Name><Description>Cover screw</Description><Size>NP, RP, WP, 6.0mm</Size><SupplierCode>40132</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112990</SubGroupID><ARTGs><ARTG>97382</ARTG></ARTGs><MinimumBenefit>47</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JN002</BillingCode><Name>ARDS Cover Screws and Healing Caps</Name><Description>Cover Screws and Healing Caps </Description><Size>(4-6.3)mm diameter  x (2 - 5)mm height,</Size><SupplierCode>40405</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112990</SubGroupID><ARTGs><ARTG>375050</ARTG></ARTGs><MinimumBenefit>47</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IC007</BillingCode><Name>Southern Implants Cover Screw</Name><Description>Titanium covering cap/screw</Description><Size>Platforms from 3 - 9mm   Length &lt;1mm</Size><SupplierCode>40338</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112990</SubGroupID><ARTGs><ARTG>197727</ARTG></ARTGs><MinimumBenefit>47</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MV016</BillingCode><Name>MIS Cover Screws and Healing Caps</Name><Description>Cover screws and healing caps (V3)</Description><Size>1.5mm - 8mm height, 3.3mm - 5.8mm diameter</Size><SupplierCode>40146</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109369</GroupID><SubGroupID>112990</SubGroupID><ARTGs><ARTG>115006</ARTG></ARTGs><MinimumBenefit>47</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GI018</BillingCode><Name>Master Pin</Name><Description>Pins used in dental surgery for the fixation of membranes (absorbable, non-absorbable and titanium membranes) in order to avoid micro-mobility of the graft. With sharp tips and the stable construction, the pins can be precisely inserted into cortical bones. The pins have an additional minithread and are a hybrid composed of a screw and pin. The thread makes easy and safe removal possible after a healing period has taken place. This thread enlarges the surface of the shaft at the same time and therefore offers more stability.</Description><Size>3.5mm</Size><SupplierCode>40366</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112991</SubGroupID><ARTGs><ARTG>280879</ARTG></ARTGs><MinimumBenefit>76</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT064</BillingCode><Name>Martin Level 1 Fixation</Name><Description>Orthodontic Screw</Description><Size>1.5 - 2.0mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112991</SubGroupID><ARTGs><ARTG>96619</ARTG></ARTGs><MinimumBenefit>76</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK422</BillingCode><Name>Orthodontic Skeletal Anchor Screw</Name><Description>Anchor Screw for Mandibular Maxillary Fixation Screw, Self-Drilling</Description><Size>1.7mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112991</SubGroupID><ARTGs><ARTG>251654</ARTG></ARTGs><MinimumBenefit>76</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK423</BillingCode><Name>Orthodontic Skeletal Anchor Screw</Name><Description>Anchor Screw for Mandibular Maxillary Fixation Screw, Self-Drilling</Description><Size>2.0mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112991</SubGroupID><ARTGs><ARTG>251654</ARTG><ARTG>200615</ARTG></ARTGs><MinimumBenefit>76</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK420</BillingCode><Name>Orthodontic Skeletal Anchor Plate</Name><Description>Orthodontic Skeletal Anchor Plate, Standard</Description><Size>1.7mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112992</SubGroupID><ARTGs><ARTG>295882</ARTG></ARTGs><MinimumBenefit>220</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT063</BillingCode><Name>Martin Level One Fixation</Name><Description>Orthodontic skeletal anchorage plate</Description><Size>0.5 to 0.99mm thick, 2 to 7 holes</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112992</SubGroupID><ARTGs><ARTG>96619</ARTG></ARTGs><MinimumBenefit>220</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK421</BillingCode><Name>Orthodontic Skeletal Anchor Plate</Name><Description>Orthodontic Skeletal Anchor Plate Locking</Description><Size>1.7mm</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112992</SubGroupID><Suffix>Locking</Suffix><ARTGs><ARTG>295882</ARTG></ARTGs><MinimumBenefit>312</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HQ004</BillingCode><Name>Rex PiezoImplant (Piezoimplant, Retention Screw, Fixture Mount/Temp &amp; cover screw)</Name><Description>The PiezoImplant System is intended for use in Dental Implant applications for oral rehabilitation of edentoulous and partially dentate Patients in the Maxilla and Mandible.The Rex PiezoImplant was designed to manage reduced Crestal Width. Its rectangular section mimics the anatomy of the reduced Crestal bone. This level of bone preservation is not possible with traditional, screw-form implants because their circular section poses a geometrical discrepancy with the anatomy.</Description><Size>1.8mm x 5.0mm (rectangle)in lengths of 9,11,13 &amp; 15mm   2.9mm x 5.0mm (rectangle)in lengths of 9,11,13 &amp; 15mm</Size><SupplierCode>40238</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><ARTGs><ARTG>389951</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW011</BillingCode><Name>Zimmer Tapered Screw-Vent Implant </Name><Description>Dental Implant Endosseous</Description><Size>3.1mm  3.7mm  4.1mm  4.7mm  6.0mm  </Size><SupplierCode>39969</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><ARTGs><ARTG>282252</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW002</BillingCode><Name>T3 Implant System</Name><Description>Dental Implant</Description><Size>3.25 - 6mm diameter</Size><SupplierCode>39969</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><ARTGs><ARTG>100482</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB008</BillingCode><Name>Straumann Dental Implant</Name><Description>Straumann Dental Implant</Description><Size>Diameter 3.3mm - 6.5mm  Length 6 - 18mm</Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><ARTGs><ARTG>119306</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB012</BillingCode><Name>Neodent Helix GM Implant</Name><Description>Neodent Helix GM Titanium Implant (NeoPoros)</Description><Size>Diameter: 3.5mm - 7mm    Length: 8.0mm - 18.0mm</Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><ARTGs><ARTG>329014</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB030</BillingCode><Name>TLX Roxolid SLA Implant</Name><Description>Tissue Level Implant </Description><Size>Diameter: 3.75 mm, 4.5 mm, 5.5 mm, 6.5 mm      narrow, regular or wide base  Length: 6 mm, 8 mm, 10 mm, 12 mm, 14 mm, 16 mm, 18 mm  </Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><ARTGs><ARTG>119306</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MV018</BillingCode><Name>MIS Implants</Name><Description>Titanium implants (C1)</Description><Size>3.30mm, 3.75mm, 4.2mm, 5mm Diameter. 8mm, 10mm, 11.5mm, 13mm, 16mm Length.</Size><SupplierCode>40146</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><ARTGs><ARTG>104449</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NR014</BillingCode><Name>NobelParallel Conical Connection</Name><Description>Dental implants</Description><Size>Diameter: 3.75mm - 5.5mm
Length : 7.0mm - 18mm</Size><SupplierCode>40132</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><ARTGs><ARTG>97382</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FV002</BillingCode><Name>Dentsply Sirona Implants (Astra Tech implant EV/Tx, PrimeTaper EV and OmniTaper EV)</Name><Description>Titanium fixture with microthreaded cervical neck</Description><Size>Diameter 3.0 - 5.5mm, Length 6-18mm</Size><SupplierCode>40265</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><ARTGs><ARTG>212688</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MV015</BillingCode><Name>MIS Implants</Name><Description>Titanium implants (V3)</Description><Size>3.30mm, 3.90mm, 4.30mm, 5mm Diameter.   8mm, 10mm, 11.50mm, 13mm, 16mm Length.</Size><SupplierCode>40146</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><ARTGs><ARTG>104449</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FV005</BillingCode><PriorBillingCodes><PriorBillingCode>DH005</PriorBillingCode></PriorBillingCodes><Name>Ankylos C/X Implants</Name><Description>Screw implant with cover screw (included) and pre-mounted placement head</Description><Size>Diameter range 3.5 - 7.0 mm, Length 8-17mm</Size><SupplierCode>40265</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><ARTGs><ARTG>212688</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB018</BillingCode><Name>BLX Roxolid SLA Implant</Name><Description>Bone level implant</Description><Size>Diameter: 3.5mm, 3.75mm, 4.0mm, 4.5mm, 5.0mm, 5.5mm, 6.5mm            Length: 6mm- 18mm</Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><ARTGs><ARTG>119306</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB009</BillingCode><Name>Straumann Implants with SLActive Hydrophillic Surface</Name><Description>Straumann Bone Level and Tissue Level Implants with SLActive Hydrophillic Surface</Description><Size>2.9mm - 4.8mm diameter, 4mm-18mm height</Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><Suffix>Hydrophilic Coating</Suffix><ARTGs><ARTG>119306</ARTG></ARTGs><MinimumBenefit>409</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NJ001</BillingCode><Name>NEOSS IMPLANT SYSTEM</Name><Description>TITANIUM DENTAL IMPLANT</Description><Size>DIAMETERS  3.25; 3.5; 4.0; 4.5; 5.0; 5.5; 6.0 and 6.5 mm in Lengths: 7, 9, 11, 13, 15, and 17mm</Size><SupplierCode>40137</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><Suffix>Hydrophilic Coating</Suffix><ARTGs><ARTG>119452</ARTG></ARTGs><MinimumBenefit>409</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB029</BillingCode><Name>TLX Roxolid SLActive Implant </Name><Description>Tissue Level implant with SLActive hydrophilic surface</Description><Size>Diameter: 3.75 mm, 4.5 mm, 5.5 mm, 6.5 mm  Length: 6 mm, 8 mm, 10 mm, 12 mm, 14 mm, 16 mm, 18 mm  narrow, regular or wide base  </Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><Suffix>Hydrophilic Coating</Suffix><ARTGs><ARTG>119306</ARTG></ARTGs><MinimumBenefit>409</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB035</BillingCode><Name>Straumann SLActive BLC and TLC Implants</Name><Description>Straumann Titanium Dental Implants with SLActive hydrophilic surface</Description><Size>Diameter 3.3mm - 6.5mm    Length 6mm - 18mm</Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><Suffix>Hydrophilic Coating</Suffix><ARTGs><ARTG>119306</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>409</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB015</BillingCode><Name>BLX Roxolid SLActive Implant</Name><Description>Bone level implant with SLActive hydrophilic surface</Description><Size>Diameter: 3.5mm, 3.75mm, 4.0mm, 4.5mm, 5.0mm, 5.5mm, 6.5mm            Length: 6mm - 18mm</Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><Suffix>Hydrophilic Coating</Suffix><ARTGs><ARTG>119306</ARTG></ARTGs><MinimumBenefit>409</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB023</BillingCode><Name>Neodent Helix GM Acqua Implant</Name><Description>Titanium dental implant, Acqua hydrophilic surface</Description><Size>Diameter: 3.5mm - 7.0mm    Length: 8.0mm - 18.0mm</Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><Suffix>Hydrophilic Coating</Suffix><ARTGs><ARTG>329014</ARTG></ARTGs><MinimumBenefit>409</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IC001</BillingCode><Name>Southern Dental Implants</Name><Description>Titanium dental implants in External-Hex, Tri-Nex or Internal Octagon (IT) connection</Description><Size>3.25 to 6.0mm diameter, 6.0 to 52.5mm length</Size><SupplierCode>40338</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><ARTGs><ARTG>146307</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NR012</BillingCode><Name>Groovy Implants (NobelReplace Tapered Groovy, Branemark System Mk III Groovy, NobelSpeedy Groovy)</Name><Description>Dental Implants, endosseous</Description><Size>Diameter 3.3 - 6.0mm; Length 7.0 - 25.0mm</Size><SupplierCode>40132</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><ARTGs><ARTG>97382</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JN001</BillingCode><Name>ARDS Implants</Name><Description>Titanium implants (SMART, CIT)  </Description><Size>(3 - 6)mm diameter x (8-13)mm length</Size><SupplierCode>40405</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><ARTGs><ARTG>375050</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NR010</BillingCode><Name>Replace Implant (NobelReplace Conical Connection, NobelReplace Conical Connection PMC)</Name><Description>Dental Implant Endosseous, Titanium</Description><Size>Diameter: 3.5mm- 5.0mm
Length : 8.0mm - 16.00mm</Size><SupplierCode>40132</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><ARTGs><ARTG>97382</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER413</BillingCode><Name>Bicon Dental Implant System-Implant</Name><Description>Bicon Dental Implants for mandible or maxilla, endosseous, hydroxyapatite coated, with well</Description><Size>Dia (3-6mm) x length (5-11mm); well (2-3mm)</Size><SupplierCode>40067</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><ARTGs><ARTG>160010</ARTG><ARTG>158187</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NR003</BillingCode><Name>Branemark System</Name><Description>Dental Implants, endosseous</Description><Size>Diameter: 3.3mm - 5.0mm
Length: 10mm - 15mm</Size><SupplierCode>40132</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><ARTGs><ARTG>97382</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GZ002</BillingCode><Name>JD Evolution Dental Implants</Name><Description>Titanium Dental Implants</Description><Size>2.75mm to 6.0mm (diameter), 6mm to 26mm (height)</Size><SupplierCode>40479</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><ARTGs><ARTG>334160</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NR013</BillingCode><Name>NobelActive implants</Name><Description>Dental implants, endosseous</Description><Size>Diameter 3.5 - 5.5mm; Length 7.0 - 18.0mm</Size><SupplierCode>40132</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><ARTGs><ARTG>97382</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IF001</BillingCode><Name>Implant Direct Oceania Implant Systems (InterActive, Legacy, Swish)</Name><Description>Dental implants, endosseous</Description><Size>Diameter 3.2 - 7.0mm; Length 6.0 - 16.0mm</Size><SupplierCode>40248</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><ARTGs><ARTG>238870</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HD024</BillingCode><Name>BioHorizons Tapered Pro</Name><Description>Bone level tapered implant with Laser-Lok collar for immediate placement. Colour-coded internal hex conical connection. Cover screw included.</Description><Size>Body diameter: 3.8-5.2mm   Platform diameter: 3-4.5mm   Body length: 9-18mm  </Size><SupplierCode>40347</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><ARTGs><ARTG>126233</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HD030</BillingCode><Name>Camlog Conelog Progressive Line Implant</Name><Description>Bone-level CONELOG PROGRESSIVE conically tapered implant designed for high primary stability in all bone types. Other features include sand-blasted and acid etched surface and proven deep conical connection with integrated platform switching. </Description><Size>Diameters: 3.3, 3.8, 4.3, 5.0. Length: 7, 9, 11, 13, 16mm </Size><SupplierCode>40347</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><ARTGs><ARTG>378610</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HD033</BillingCode><Name>BioHorizons PTG Implant</Name><Description>BioHorizons Tapered PTG implants support full-arch treatment in severely resorbed maxillae and provide an alternative to grafting, potentially expediting treatment. Tapered PTG Implant is narrow, dual tapered shape which is designed for precise placement. This approach maximizes AP spread for full arch restorations, while maintaining high implant stability. Cover screw included.  </Description><Size>Body diameter: 4.2mm.  Apex diameter: 2.2mm.  Platform diameter: 3.5mm.  Body length: 15-18mm.  </Size><SupplierCode>40347</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><ARTGs><ARTG>126233</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MV004</BillingCode><Name>MIS Implants</Name><Description>Titanium implants (Biocom, Seven, Mistral)</Description><Size>3mm - 6mm Diameter, 6mm - 16mm length</Size><SupplierCode>40146</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112993</SubGroupID><ARTGs><ARTG>104449</ARTG></ARTGs><MinimumBenefit>351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB005</BillingCode><Name>Straumann Bone Ceramic</Name><Description>070.198 Straumann Bone Ceramic 400 -700</Description><Size>Straumann Bone Ceramic 400 -700, Granule size 400 - 700 microns, Unit size 0.25 g, Volume: approx 0.3 ml</Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112994</SubGroupID><ARTGs><ARTG>194429</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER377</BillingCode><Name>Bicon SynthoGraft Pure Phase Beta-Tricalcium Phosphate, 0.25 g</Name><Description>Bicon SynthoGraft Pure Phase Beta-Tricalcium Phosphate, 0.25 g, synthetic</Description><Size>0.25 g, granule size 50-500μm or 500-1000μm</Size><SupplierCode>40067</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112994</SubGroupID><ARTGs><ARTG>230860</ARTG></ARTGs><MinimumBenefit>96</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW006</BillingCode><Name>Endobon Xenograft Granules</Name><Description>Hydroxyapatite granules, 0.5-1mm diameter</Description><Size>0.5ml</Size><SupplierCode>39969</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112995</SubGroupID><ARTGs><ARTG>171507</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FV013</BillingCode><Name>OSSIX Bone</Name><Description>OSSIX Bone is an osteoconductive bone grafting material aimed to fill, augment, or reconstruct periodontal and bony defects of the maxillo-facial complex.</Description><Size>5 x 10 x 10mm (0.5 cc)</Size><SupplierCode>40265</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112995</SubGroupID><ARTGs><ARTG>380303</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB006</BillingCode><Name>Straumann Bone Ceramic</Name><Description>070.199 Straumann Bone Ceramic 500 -1000</Description><Size>Straumann Bone Ceramic 500 -1000, Granule size: 500 -1000 microns, Unit size: 0.5 g, Volume: approx 0.95 ml</Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112995</SubGroupID><ARTGs><ARTG>194429</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MV021</BillingCode><Name>BVital GENOSS Granules </Name><Description>Anorganic Bone Mineral Granules , vial or preloaded applicator </Description><Size>&lt;1.0 cc</Size><SupplierCode>40146</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112995</SubGroupID><ARTGs><ARTG>376529</ARTG><ARTG>376530</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GI007</BillingCode><Name>Bio-Oss Pen</Name><Description>Pen applicator with natural bone mineral derived from bovine bone</Description><Size>0.25 to 1mm; 0.25g (0.5125cc)</Size><SupplierCode>40366</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112995</SubGroupID><ARTGs><ARTG>229990</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HD023</BillingCode><Name>BioHorizons MinerOss XP</Name><Description>MinerOss XP is a highly porous anorganic porcine bone mineral matrix designed for hard tissue grafting applications. Xenograft for filling of bone defects in maxillofacial surgery, implantology, and periodontology.</Description><Size>Particle size ranges from 250-1000μm   Volume: 0.5cc,  Jar or Syringe applicator</Size><SupplierCode>40347</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112995</SubGroupID><ARTGs><ARTG>299220</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IF002</BillingCode><Name>Bioresorb Macro Pore</Name><Description>ß-Tricalcium Phosphate Bone Regeneration Material with Advanced Porosity</Description><Size>200 – 500 μm at 0.5 ml, 500 – 1000 μm at 0.5 ml, 500 – 1000 μm at 1.0 ml </Size><SupplierCode>40248</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112995</SubGroupID><ARTGs><ARTG>136546</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GI032</BillingCode><Name>Bio-Oss</Name><Description>Natural bone mineral derived from bovine bone</Description><Size>0.25 to 1mm; 0.25g (0.5125cc)</Size><SupplierCode>40366</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112995</SubGroupID><ARTGs><ARTG>229987</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER378</BillingCode><Name>Bicon SynthoGraft Pure Phase Beta-Tricalcium Phosphate, 0.5 g</Name><Description>Bicon SynthoGraft Pure Phase Beta-Tricalcium Phosphate, 0.5 gram, synthetic</Description><Size>0.5 gram; granule size 50-500μm or 500-1000μm</Size><SupplierCode>40067</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112995</SubGroupID><ARTGs><ARTG>230860</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB021</BillingCode><Name>cerabone</Name><Description>Bone grafting material derived from bovine bone</Description><Size>Granule size 0.5 - 1.0mm; 0.5ml.  Granule size 1.0 - 2.0mm; 0.5ml. </Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112995</SubGroupID><ARTGs><ARTG>329433</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GI006</BillingCode><Name>Bio-Oss</Name><Description>Natural bone mineral derived from bovine bone</Description><Size>1 to 2mm: 0.5g (1.5cc)</Size><SupplierCode>40366</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112996</SubGroupID><ARTGs><ARTG>229987</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HD028</BillingCode><Name>BioHorizons MinerOss XP</Name><Description>MinerOss XP is a highly porous anorganic porcine bone mineral matrix designed for hard tissue grafting applications. Xenograft for filling of bone defects in maxillofacial surgery,implantology, and periodontology.</Description><Size>Particle size ranges from 250-1000μm or 1000-2000μm Volume: 1.0cc, 2.0cc, and 4.0cc Jar or Syringe applicator</Size><SupplierCode>40347</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112996</SubGroupID><ARTGs><ARTG>299220</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WB001</BillingCode><Name>Ethoss</Name><Description>EthOss TCP is intended to fill, augment, or reconstruct periodontal or bony defects of the oral and maxillofacial region. </Description><Size>65% beta tri-calcium phosphate (ß-TCP) and 35% medical grade calcium sulfate (CaSO4) in 0.5cc syringes or 1.0cc syringes.</Size><SupplierCode>40236</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112996</SubGroupID><ARTGs><ARTG>299917</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>NW007</BillingCode><Name>Endobon Xenograft Granules</Name><Description>Hydroxyapatite granules, 0.5-1mm diameter or 1-2mm diameter</Description><Size>2 - 8ml</Size><SupplierCode>39969</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112996</SubGroupID><ARTGs><ARTG>171507</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER534</BillingCode><PriorBillingCodes><PriorBillingCode>NW008</PriorBillingCode></PriorBillingCodes><Name>NovaBone Dental Putty</Name><Description>NovaBone® Dental Putty is 100% synthetic and fully resorbable.</Description><Size>CARTRIDGES 2 UNITS X 0.5CC  CARTRIDGES 4 UNITS X 0.25CC  CARTRIDGES 4 UNITS X 0.5CC  SYRINGE, 1 UNIT X  0.5CC</Size><SupplierCode>40067</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112996</SubGroupID><ARTGs><ARTG>242772</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GI008</BillingCode><Name>Bio-Oss Pen</Name><Description>Pen applicator with natural bone mineral derived from bovine bone</Description><Size>0.25 to 1mm; 0.5g (1.025cc)</Size><SupplierCode>40366</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112996</SubGroupID><ARTGs><ARTG>229990</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GI009</BillingCode><Name>Bio-Oss Pen</Name><Description>Pen applicator with natural bone mineral derived from bovine bone</Description><Size>1 to 2mm; 0.5g (1.5cc)</Size><SupplierCode>40366</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112996</SubGroupID><ARTGs><ARTG>229990</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IC005</BillingCode><Name>Zen Gro</Name><Description>Dental Bone Matrix Implant, animal derived</Description><Size>Particle size 0.25-1mm 0.5 cc
Particle Sze  0.25-1mm 1.0 cc
Particle Size 0.25-1mm 2.0 cc
Particle Size 0.25-1mm 4.0 cc
Particle size 1.0-2.0mm  1.0cc
Particle size 1.0-2.0mm  2.0cc</Size><SupplierCode>40338</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112996</SubGroupID><ARTGs><ARTG>299165</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB020</BillingCode><Name>cerabone</Name><Description>Bone grafting material derived from bovine bone</Description><Size>Granule size 0.5 - 1.0ml; 2cc(ml), 5cc(ml).   Granule size 1.0 - 2.0mm; 2cc(ml), 5cc(ml).</Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112996</SubGroupID><ARTGs><ARTG>329433</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MV022</BillingCode><Name>BVital GENOSS Granules </Name><Description>Anorganic Bone Mineral Granules , vial </Description><Size> (1 -2) cc</Size><SupplierCode>40146</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112996</SubGroupID><ARTGs><ARTG>376529</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB007</BillingCode><Name>Straumann Bone Ceramic</Name><Description>070.200 Straumann Bone Ceramic 500 -1000</Description><Size>Straumann Bone Ceramic 500 -1000, Granule size: 500 -1000 microns, Unit Size 1g, Volume approx 1.9 ml</Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112996</SubGroupID><ARTGs><ARTG>194429</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SB022</BillingCode><Name>cerabone</Name><Description>Bone grafting material derived from bovine bone</Description><Size>Granule size: 0.5 - 1.0mm; 1ml.  Granule size: 1.0 - 2.0mm; 1ml.</Size><SupplierCode>40330</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112996</SubGroupID><ARTGs><ARTG>329433</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER379</BillingCode><Name>Bicon SynthoGraft Pure Phase Beta-Tricalcium Phosphate, 1-2 g</Name><Description>Bicon SynthoGraft Pure Phase Beta-Tricalcium Phosphate, 1-2 gram, synthetic</Description><Size>1 and 2 grams, granule size 50-500μm and  500-1000μm</Size><SupplierCode>40067</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107806</SubCategoryID><GroupID>109371</GroupID><SubGroupID>112996</SubGroupID><ARTGs><ARTG>230860</ARTG></ARTGs><MinimumBenefit>293</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT016</BillingCode><Name>Martin Distraction Osteogenesis</Name><Description>Distractor System, Complete, other, titanium</Description><Size>1.5mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107807</SubCategoryID><GroupID>109373</GroupID><SubGroupID>112997</SubGroupID><Suffix>Single Vector</Suffix><ARTGs><ARTG>113786</ARTG></ARTGs><MinimumBenefit>4114</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY401</BillingCode><Name>External Midface Distractor System</Name><Description>Head Frame Assembly, Carbon Fibre Rods</Description><Size>One size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107807</SubCategoryID><GroupID>109373</GroupID><SubGroupID>112997</SubGroupID><Suffix>Multivector</Suffix><ARTGs><ARTG>155806</ARTG></ARTGs><MinimumBenefit>7897</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT018</BillingCode><Name>Martin Distraction Osteogenesis Rigid External Distraction (Polley RED II)</Name><Description>Distractor System, Complete, External, Midface, Aluminium, Carbon Fibre</Description><Size>one size only</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107807</SubCategoryID><GroupID>109373</GroupID><SubGroupID>112997</SubGroupID><Suffix>Multivector</Suffix><ARTGs><ARTG>113786</ARTG></ARTGs><MinimumBenefit>7897</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT019</BillingCode><Name>Martin Distraction Osteogenesis</Name><Description>Distractor System, Complete, other, titanium</Description><Size>15-60 mm distraction length</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107807</SubCategoryID><GroupID>109373</GroupID><SubGroupID>112999</SubGroupID><Suffix>Multivector</Suffix><ARTGs><ARTG>113786</ARTG></ARTGs><MinimumBenefit>2608</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SK183</BillingCode><Name>Leibinger Intraoral Distractor (Multiguide II)</Name><Description>Manufactured from stainless steel, allows gradual, independent, and simultaneous distraction of the mandible in 3 planes.</Description><Size>Frame 20mm - 35mm, 2.0mm diameter, 50 - 90 mm length Auto - Pilot Pins</Size><SupplierCode>40329</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107807</SubCategoryID><GroupID>109373</GroupID><SubGroupID>112999</SubGroupID><Suffix>Multivector</Suffix><ARTGs><ARTG>200615</ARTG></ARTGs><MinimumBenefit>2608</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT011</BillingCode><Name>Martin Distraction Osteogenesis</Name><Description>Distractor System, Complete, internal/intraoral, titanium</Description><Size>10 to 20 mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107807</SubCategoryID><GroupID>109373</GroupID><SubGroupID>112999</SubGroupID><Suffix>Single Vector</Suffix><ARTGs><ARTG>113786</ARTG></ARTGs><MinimumBenefit>1906</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY399</BillingCode><Name>Alveolar Distractor</Name><Description>Vertical mandibular, maxilla alveolar ridge distractor</Description><Size>8-16mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107807</SubCategoryID><GroupID>109373</GroupID><SubGroupID>112999</SubGroupID><Suffix>Single Vector</Suffix><ARTGs><ARTG>155806</ARTG></ARTGs><MinimumBenefit>1906</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT065</BillingCode><Name>IPS Custom Distractor</Name><Description>Internal distractor with patient specific 3D Printed plates and/or standard implant parts that have been adjusted to patients anatomical structures and needs.</Description><Size>1mm – 2mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107807</SubCategoryID><GroupID>109373</GroupID><SubGroupID>112999</SubGroupID><Suffix>Multivector</Suffix><ARTGs><ARTG>113786</ARTG></ARTGs><MinimumBenefit>2608</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY753</BillingCode><Name>Curvilinear Distraction System</Name><Description>Curvilinear Distraction, Right Left</Description><Size>30mm - 100mm radius</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107807</SubCategoryID><GroupID>109373</GroupID><SubGroupID>112999</SubGroupID><Suffix>Multivector</Suffix><ARTGs><ARTG>183673</ARTG></ARTGs><MinimumBenefit>2608</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK044</BillingCode><PriorBillingCodes><PriorBillingCode>UQ041</PriorBillingCode></PriorBillingCodes><Name>Logic Distraction System</Name><Description>Distractor, spacers &amp; activation set</Description><Size>Straight, Curved 18-52mm</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107807</SubCategoryID><GroupID>109373</GroupID><SubGroupID>112999</SubGroupID><Suffix>Multivector</Suffix><ARTGs><ARTG>130510</ARTG></ARTGs><MinimumBenefit>2608</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY515</BillingCode><Name>CMF Distraction System</Name><Description>Distractor System, Distractor Body</Description><Size>10-40mm distraction length</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107807</SubCategoryID><GroupID>109374</GroupID><SubGroupID>113000</SubGroupID><ARTGs><ARTG>183673</ARTG><ARTG>155806</ARTG></ARTGs><MinimumBenefit>2145</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT053</BillingCode><Name>KLS Martin Distractor</Name><Description>Zurich II distractor bodies</Description><Size>15mm - 30mm distraction length</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107807</SubCategoryID><GroupID>109374</GroupID><SubGroupID>113000</SubGroupID><ARTGs><ARTG>113786</ARTG></ARTGs><MinimumBenefit>2145</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT006</BillingCode><Name>Zurich II Modular Distractors</Name><Description>Distractor System, Component, Dual fixation plates, pair</Description><Size>Mesh-large and small design; Cloverleaf design</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107807</SubCategoryID><GroupID>109374</GroupID><SubGroupID>113001</SubGroupID><Suffix>Dual Plate</Suffix><ARTGs><ARTG>113786</ARTG></ARTGs><MinimumBenefit>1279</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY595</BillingCode><Name>Midface, CMF Distractor System</Name><Description>Distractor Footplate</Description><Size>Various</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107807</SubCategoryID><GroupID>109374</GroupID><SubGroupID>113001</SubGroupID><Suffix>Dual Plate</Suffix><ARTGs><ARTG>183673</ARTG><ARTG>155806</ARTG></ARTGs><MinimumBenefit>1279</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY406</BillingCode><Name>External Midface Distractor System</Name><Description>Titanium Zygomatic, Maxxilary Footplate</Description><Size>3 holes, 40mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107807</SubCategoryID><GroupID>109374</GroupID><SubGroupID>113001</SubGroupID><ARTGs><ARTG>155806</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT021</BillingCode><Name>Martin Distraction Osteogenesis Rigid External Distraction (Polley RED II)</Name><Description>Distractor System, Component, Footplate, titanium</Description><Size>1.5mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107807</SubCategoryID><GroupID>109374</GroupID><SubGroupID>113001</SubGroupID><ARTGs><ARTG>113786</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT022</BillingCode><Name>Martin Distraction Osteogenesis Rigid External Distraction (Polley RED II)</Name><Description>Distractor System, Component, Cross Bar, aluminium.carbon fibre</Description><Size>one size only</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107807</SubCategoryID><GroupID>109374</GroupID><SubGroupID>113002</SubGroupID><ARTGs><ARTG>113786</ARTG></ARTGs><MinimumBenefit>965</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY402</BillingCode><Name>External Midface Distractor System</Name><Description>Horizontal Rod Assembly</Description><Size>One size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107807</SubCategoryID><GroupID>109374</GroupID><SubGroupID>113002</SubGroupID><ARTGs><ARTG>155806</ARTG></ARTGs><MinimumBenefit>965</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT017</BillingCode><Name>Martin Distraction Osteogenesis Rigid External Distraction (Polley RED II)</Name><Description>Distractor System, Component, Screws/Pins (other than bone screws), titanium</Description><Size>45-55mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107807</SubCategoryID><GroupID>109374</GroupID><SubGroupID>113004</SubGroupID><ARTGs><ARTG>96619</ARTG><ARTG>113786</ARTG></ARTGs><MinimumBenefit>144</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY517</BillingCode><Name>Midface Distractor System</Name><Description>Distractor System, Screw</Description><Size>4-10mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107807</SubCategoryID><GroupID>109374</GroupID><SubGroupID>113005</SubGroupID><ARTGs><ARTG>155806</ARTG></ARTGs><MinimumBenefit>73</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT020</BillingCode><Name>Martin Distraction Osteogenesis Rigid External Distraction (Polley RED II)</Name><Description>Distractor System, Component, Other, titanium, aluminium</Description><Size>1.5-1.58mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107807</SubCategoryID><GroupID>109374</GroupID><SubGroupID>113006</SubGroupID><ARTGs><ARTG>113786</ARTG></ARTGs><MinimumBenefit>1424</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY518</BillingCode><Name>Midface, CMF Distractor System</Name><Description>Distractor System , Body extensions</Description><Size>20-60 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107807</SubCategoryID><GroupID>109374</GroupID><SubGroupID>113007</SubGroupID><ARTGs><ARTG>155806</ARTG><ARTG>213820</ARTG></ARTGs><MinimumBenefit>487</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KT054</BillingCode><Name>KLS Martin Distractors</Name><Description>Zurich II remote release activators</Description><Size>20mm - 50mm</Size><SupplierCode>40203</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107807</SubCategoryID><GroupID>109374</GroupID><SubGroupID>113007</SubGroupID><ARTGs><ARTG>113786</ARTG></ARTGs><MinimumBenefit>487</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN176</BillingCode><Name>Mentor Siltex Contour Profile Breast Tissue Expander</Name><Description>Siltex Contour Profile Breast Tissue Expander (CPX4)</Description><Size>250-850cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107808</SubCategoryID><GroupID>109376</GroupID><SubGroupID>113011</SubGroupID><ARTGs><ARTG>226977</ARTG></ARTGs><MinimumBenefit>653</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN001</BillingCode><Name>Mentor Radovan Tissue Expander</Name><Description>Tissue Expander</Description><Size>Volume 25cc - 1000cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107808</SubCategoryID><GroupID>109376</GroupID><SubGroupID>113011</SubGroupID><ARTGs><ARTG>125097</ARTG></ARTGs><MinimumBenefit>653</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JT006</BillingCode><Name>Polytech Textured Mammary or  Tissue Expander with integrated or remote magnetic valve</Name><Description>Textured with integrated or remote valve.</Description><Size>The tissue expanders vary in maximum volume from 100 - 960mls</Size><SupplierCode>40216</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107808</SubCategoryID><GroupID>109376</GroupID><SubGroupID>113011</SubGroupID><ARTGs><ARTG>168188</ARTG></ARTGs><MinimumBenefit>653</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK045</BillingCode><PriorBillingCodes><PriorBillingCode>UQ048</PriorBillingCode></PriorBillingCodes><Name>PMT Tissue Expander (Integra/Accuspan)</Name><Description>Smooth tissue expander with remote or internal port</Description><Size>Volume 5cc to 1600cc</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107808</SubCategoryID><GroupID>109376</GroupID><SubGroupID>113011</SubGroupID><ARTGs><ARTG>337350</ARTG></ARTGs><MinimumBenefit>653</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN177</BillingCode><Name>Mentor Siltex Contour Profile Breast Tissue Expander</Name><Description>Siltex Contour Profile Breast Tissue Expander (CPX4) with suture tabs</Description><Size>250-850cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107808</SubCategoryID><GroupID>109376</GroupID><SubGroupID>113011</SubGroupID><ARTGs><ARTG>226982</ARTG></ARTGs><MinimumBenefit>653</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JT005</BillingCode><Name>Polytech Smooth Tissue Expander with integrated or remote magnetic valve</Name><Description>Smooth with integrated or remote valve</Description><Size>The  tissue expanders vary in maximum volume from 100 - 960mls</Size><SupplierCode>40216</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107808</SubCategoryID><GroupID>109376</GroupID><SubGroupID>113011</SubGroupID><ARTGs><ARTG>168188</ARTG></ARTGs><MinimumBenefit>653</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JT007</BillingCode><Name>Polytech Textured Mammary Expander with integrated or remote magnetic valve</Name><Description>Textured  with integrated or remote magnetic valve. Anatomically shaped with reinforced inner base</Description><Size>The mammary expanders vary in maximum volume from 200 - 960mls</Size><SupplierCode>40216</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107808</SubCategoryID><GroupID>109376</GroupID><SubGroupID>113011</SubGroupID><ARTGs><ARTG>168188</ARTG></ARTGs><MinimumBenefit>653</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN013</BillingCode><Name>Mentor Siltex Becker Expander/Mammary Implant</Name><Description>Textured Becker Expander/Mammary Implant</Description><Size>145 to 800cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107808</SubCategoryID><GroupID>109376</GroupID><SubGroupID>113011</SubGroupID><Suffix>Expander Implant</Suffix><ARTGs><ARTG>119809</ARTG></ARTGs><MinimumBenefit>1989</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PW003</BillingCode><Name>NovoSorb® BTM 5cm x 5cm</Name><Description>NovoSorb® BTM is a synthetic biocompatible and biodegradable temporary skin substitute and scaffold, intended to temporise dermal injuries and facilitate dermal repair.</Description><Size>5cm x 5cm</Size><SupplierCode>40273</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107808</SubCategoryID><GroupID>109377</GroupID><SubGroupID>113014</SubGroupID><ARTGs><ARTG>308217</ARTG></ARTGs><MinimumBenefit>877</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE802</BillingCode><PriorBillingCodes><PriorBillingCode>FC018</PriorBillingCode></PriorBillingCodes><Name>MatriDerm Dermal Matrix</Name><Description>Dermal Matrix Scaffold for tissue regeneration and modulation of scar tissue formation.</Description><Size>Width (mm) 37-52 (mm) Length (mm) 52-74 (mm) Thickness 1(mm)</Size><SupplierCode>39975</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107808</SubCategoryID><GroupID>109377</GroupID><SubGroupID>113014</SubGroupID><ARTGs><ARTG>370020</ARTG></ARTGs><MinimumBenefit>877</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG034</BillingCode><Name>Integra Artificial Skin (IDRT) Terminally Sterile</Name><Description>INTEGRA  Dermal Regeneration Template is a bilayer membrane system for skin replacement made of a porous matrix of fibers of cross-linked bovine tendon collagen and glycosaminoglycan and polysiloxane layer.</Description><Size>5cm x 5cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107808</SubCategoryID><GroupID>109377</GroupID><SubGroupID>113014</SubGroupID><ARTGs><ARTG>158795</ARTG></ARTGs><MinimumBenefit>877</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG035</BillingCode><Name>Integra Artificial Skin (IDRT) Terminally Sterile</Name><Description>INTEGRA  Dermal Regeneration Template is a bilayer membrane system for skin replacement made of a porous matrix of fibers of cross-linked bovine tendon collagen and glycosaminoglycan and polysiloxane layer.</Description><Size>10cm x 12.5cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107808</SubCategoryID><GroupID>109377</GroupID><SubGroupID>113015</SubGroupID><ARTGs><ARTG>158795</ARTG></ARTGs><MinimumBenefit>1112</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PW002</BillingCode><Name>NovoSorb® BTM 10cm x 10cm</Name><Description>NovoSorb® BTM is a synthetic biocompatible and biodegradable temporary skin substitute and scaffold, intended to temporise dermal injuries and facilitate dermal repair.</Description><Size>10cm x 10cm</Size><SupplierCode>40273</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107808</SubCategoryID><GroupID>109377</GroupID><SubGroupID>113015</SubGroupID><ARTGs><ARTG>308217</ARTG></ARTGs><MinimumBenefit>1112</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PW001</BillingCode><Name>NovoSorb® BTM 10cm x 20cm</Name><Description>NovoSorb® BTM is a synthetic biocompatible and biodegradable temporary skin substitute and scaffold, intended to temporise dermal injuries and facilitate dermal repair.</Description><Size>10cm x 20cm</Size><SupplierCode>40273</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107808</SubCategoryID><GroupID>109377</GroupID><SubGroupID>113016</SubGroupID><ARTGs><ARTG>308217</ARTG></ARTGs><MinimumBenefit>1697</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG036</BillingCode><Name>Integra Artificial Skin (IDRT) Terminally Sterile</Name><Description>INTEGRA  Dermal Regeneration Template is a bilayer membrane system for skin replacement made of a porous matrix of fibers of cross-linked bovine tendon collagen and glycosaminoglycan and polysiloxane layer.</Description><Size>10cm x 25cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107808</SubCategoryID><GroupID>109377</GroupID><SubGroupID>113016</SubGroupID><ARTGs><ARTG>158795</ARTG></ARTGs><MinimumBenefit>1697</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE803</BillingCode><PriorBillingCodes><PriorBillingCode>FC017</PriorBillingCode></PriorBillingCodes><Name>MatriDerm Dermal Matrix</Name><Description>Dermal Matrix Scaffold for tissue regeneration and modulation of scar tissue formation. </Description><Size>Width (mm) 148 (mm)  Length (mm) 105 (mm)  Thickness 1 -2(mm)</Size><SupplierCode>39975</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107808</SubCategoryID><GroupID>109377</GroupID><SubGroupID>113016</SubGroupID><ARTGs><ARTG>370020</ARTG></ARTGs><MinimumBenefit>1697</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG037</BillingCode><Name>Integra Artificial Skin (IDRT) Terminally Sterile</Name><Description>INTEGRA  Dermal Regeneration Template is a bilayer membrane system for skin replacement made of a porous matrix of fibers of cross-linked bovine tendon collagen and glycosaminoglycan and polysiloxane layer.</Description><Size>20cm x 25cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107808</SubCategoryID><GroupID>109377</GroupID><SubGroupID>113017</SubGroupID><ARTGs><ARTG>158795</ARTG></ARTGs><MinimumBenefit>3296</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PW004</BillingCode><Name>NovoSorb® BTM 20cm x 25cm</Name><Description>NovoSorb® BTM is a synthetic biocompatible and biodegradable temporary skin substitute and scaffold, intended to temporise dermal injuries and facilitate dermal repair.</Description><Size>20cm x 25cm</Size><SupplierCode>40273</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107808</SubCategoryID><GroupID>109377</GroupID><SubGroupID>113017</SubGroupID><ARTGs><ARTG>308217</ARTG></ARTGs><MinimumBenefit>3296</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DE804</BillingCode><PriorBillingCodes><PriorBillingCode>FC019</PriorBillingCode></PriorBillingCodes><Name>MatriDerm Dermal Matrix</Name><Description>Dermal Matrix Scaffold for tissue regeneration and modulation of scar tissue formation</Description><Size>Width (mm) 210 (mm) Length (mm) 297 (mm) Thickness 1-2 (mm)</Size><SupplierCode>39975</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107808</SubCategoryID><GroupID>109377</GroupID><SubGroupID>113017</SubGroupID><ARTGs><ARTG>370020</ARTG></ARTGs><MinimumBenefit>3296</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN118</BillingCode><Name>Mentor Smooth Round Saline Implant</Name><Description>Smooth Round implant with Anterior Diaphragm Valve</Description><Size>&lt;500cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109379</GroupID><SubGroupID>113019</SubGroupID><Suffix>Valved</Suffix><ARTGs><ARTG>119646</ARTG></ARTGs><MinimumBenefit>697</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN119</BillingCode><Name>Mentor Smooth Round Saline Implant</Name><Description>Smooth Round implant with Anterior Diaphragm Valve</Description><Size>≥500cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109379</GroupID><SubGroupID>113020</SubGroupID><Suffix>Valved</Suffix><ARTGs><ARTG>119646</ARTG></ARTGs><MinimumBenefit>624</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JT003</BillingCode><Name>Sublime Line Mammary Implant</Name><Description>Smooth, Microthane or textured surface. Round or oval based with anatomical or central projection.</Description><Size>Low Profile, Moderate Profile, High Profile and Extra High Profile. Sizes 45-495cc.</Size><SupplierCode>40216</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109380</GroupID><SubGroupID>113021</SubGroupID><Suffix>Pre-shaped</Suffix><ARTGs><ARTG>171783</ARTG></ARTGs><MinimumBenefit>975</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH729</BillingCode><PriorBillingCodes><PriorBillingCode>BY017</PriorBillingCode></PriorBillingCodes><Name>MOTIVA IMPLANTS ANATOMICAL TRUEFIXATION</Name><Description>Sterile Silicone Breast Implants. Gel filled, pre-shaped. </Description><Size>250- 495 cc</Size><SupplierCode>40192</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109380</GroupID><SubGroupID>113021</SubGroupID><Suffix>Pre-shaped</Suffix><ARTGs><ARTG>373251</ARTG></ARTGs><MinimumBenefit>975</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN124</BillingCode><Name>Mentor Siltex Round Gel Implant</Name><Description>Textured, Round Cohesive l Gel implant</Description><Size>less than 500cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109380</GroupID><SubGroupID>113021</SubGroupID><ARTGs><ARTG>110588</ARTG><ARTG>326144</ARTG></ARTGs><MinimumBenefit>595</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN130</BillingCode><Name>Mentor Siltex Round Gel Implant</Name><Description>Textured, Round Cohesive Gel ll Implant</Description><Size>&lt;500cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109380</GroupID><SubGroupID>113021</SubGroupID><ARTGs><ARTG>110589</ARTG></ARTGs><MinimumBenefit>595</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH725</BillingCode><PriorBillingCodes><PriorBillingCode>BY012</PriorBillingCode></PriorBillingCodes><Name>Motiva Ergonomix Implant Matrix, SilkSurface with Qid</Name><Description>Sterile Silicone Breast Implants Motiva Implant  Matrix Ergonomix, SilkSurface with Qid - Prosthesis, internal,  mammary, gel filled</Description><Size>105cc to 500cc</Size><SupplierCode>40192</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109380</GroupID><SubGroupID>113021</SubGroupID><Suffix>Pre-shaped</Suffix><ARTGs><ARTG>282777</ARTG></ARTGs><MinimumBenefit>975</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN126</BillingCode><Name>Mentor Contour Profile Gel Implant</Name><Description>Textured, Contour Profile, Cohesive lll, Gel implant</Description><Size>&lt;500cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109380</GroupID><SubGroupID>113021</SubGroupID><Suffix>Pre-shaped</Suffix><ARTGs><ARTG>130678</ARTG></ARTGs><MinimumBenefit>975</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EG027</BillingCode><Name>Sebbin Mammary Implants</Name><Description>Sterile Silicone Breast Implants less than 500cc</Description><Size>Volume less than 500cc</Size><SupplierCode>40068</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109380</GroupID><SubGroupID>113021</SubGroupID><ARTGs><ARTG>309616</ARTG></ARTGs><MinimumBenefit>595</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KK002</BillingCode><PriorBillingCodes><PriorBillingCode>AW019</PriorBillingCode></PriorBillingCodes><Name>BRST Round MICROCELL™ Micotextured cohesive gel filled mammary implant</Name><Description>Round-shaped implants with MICROCELL™ microtextured surface, silicone elastomer barrier layer and cohesive silicone gel.   Available in three profiles:  moderate, high and extra high.</Description><Size>175 - 700 g</Size><SupplierCode>40388</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109380</GroupID><SubGroupID>113021</SubGroupID><ARTGs><ARTG>220900</ARTG></ARTGs><MinimumBenefit>595</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ZW002</BillingCode><Name>Eurosilicone Breast Implants</Name><Description>Round Cohesive Gel Breast Implants for Plastic and Reconstructive Surgery</Description><Size>100cc to 900cc</Size><SupplierCode>40324</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109380</GroupID><SubGroupID>113021</SubGroupID><ARTGs><ARTG>132036</ARTG></ARTGs><MinimumBenefit>595</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>KK001</BillingCode><PriorBillingCodes><PriorBillingCode>AW008</PriorBillingCode></PriorBillingCodes><Name>Natrelle® INSPIRA® TruForm™ Smooth Mammary Implant</Name><Description>Round implants with smooth surface. Available in four projections: low, moderate, full and extra-full; and two cohesive gel types: TruForm™ 1 Responsive Gel and TruForm™ 2 Soft-Touch™ Gel.</Description><Size>110 - 800 grams</Size><SupplierCode>40388</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109380</GroupID><SubGroupID>113021</SubGroupID><ARTGs><ARTG>175421</ARTG><ARTG>175426</ARTG></ARTGs><MinimumBenefit>595</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN122</BillingCode><Name>Mentor Smooth MemoryGel™, MemoryGel™ XTRA Breast Implant</Name><Description>Round, smooth surface cohesive I silicone gel-filled breast implant. Available in two projections: MemoryGel™ and MemoryGel™ XTRA. MemoryGel™ has two options: Moderate Plus and High Profile. MemoryGel™ XTRA has two options: Moderate Plus XTRA and High Profile XTRA</Description><Size>less than 500cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109380</GroupID><SubGroupID>113021</SubGroupID><ARTGs><ARTG>393728</ARTG><ARTG>393729</ARTG></ARTGs><MinimumBenefit>595</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH728</BillingCode><PriorBillingCodes><PriorBillingCode>BY016</PriorBillingCode></PriorBillingCodes><Name>Motiva, Matrix Silk Surface PLUS with QID</Name><Description>Sterile Silicone Breast Implants Motiva Implant Matrix SilkSurface PLUS with Qid - Prosthesis, internal, mammary,gel filled</Description><Size>105cc to 500cc</Size><SupplierCode>40192</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109380</GroupID><SubGroupID>113021</SubGroupID><ARTGs><ARTG>282776</ARTG></ARTGs><MinimumBenefit>595</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH724</BillingCode><PriorBillingCodes><PriorBillingCode>BY011</PriorBillingCode></PriorBillingCodes><Name>Motiva, Matrix Silk Surface PLUS</Name><Description>Sterile Silicone Breast Implants, Motiva Matrix SilkSurface PLUS - Prosthesis, internal, mammary, gel filled</Description><Size>105cc to 500cc</Size><SupplierCode>40192</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109380</GroupID><SubGroupID>113021</SubGroupID><ARTGs><ARTG>282778</ARTG></ARTGs><MinimumBenefit>595</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK048</BillingCode><PriorBillingCodes><PriorBillingCode>JK046</PriorBillingCode></PriorBillingCodes><Name>Impleo gel-filled Nagor mammary implant range - smooth - IMP-SMR, IMP-SHR and IMP-SEHR</Name><Description>Smooth Round</Description><Size>150 to 460ml</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109380</GroupID><SubGroupID>113021</SubGroupID><ARTGs><ARTG>277759</ARTG></ARTGs><MinimumBenefit>595</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JT004</BillingCode><Name>Sublime Line Mammary Implant</Name><Description>Smooth, Microthane or textured surface. Round or oval based with anatomical or central projection</Description><Size>Low Profile, Moderate Profile, High Profile and Extra High Profile. Sizes 500-1035cc.</Size><SupplierCode>40216</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109380</GroupID><SubGroupID>113022</SubGroupID><Suffix>Pre-shaped</Suffix><ARTGs><ARTG>171783</ARTG></ARTGs><MinimumBenefit>1170</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH727</BillingCode><PriorBillingCodes><PriorBillingCode>BY015</PriorBillingCode></PriorBillingCodes><Name>Motiva Ergonomix Implant Matrix, SilkSurface with QID</Name><Description>Sterile Silicone Breast Implants, Motiva Ergonomix Matrix, SilkSurface PLUS with QID  - prostheses, Internal, Mammary, gel filled</Description><Size>500cc TO 775cc</Size><SupplierCode>40192</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109380</GroupID><SubGroupID>113022</SubGroupID><Suffix>Pre-shaped</Suffix><ARTGs><ARTG>282777</ARTG></ARTGs><MinimumBenefit>1170</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH730</BillingCode><PriorBillingCodes><PriorBillingCode>BY018</PriorBillingCode></PriorBillingCodes><Name>MOTIVA IMPLANTS ANATOMICAL TRUEFIXATION</Name><Description>Sterile Silicone Breast Implants. Gel filled, pre-shaped. </Description><Size>500-600 cc</Size><SupplierCode>40192</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109380</GroupID><SubGroupID>113022</SubGroupID><Suffix>Pre-shaped</Suffix><ARTGs><ARTG>373251</ARTG></ARTGs><MinimumBenefit>1170</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN127</BillingCode><Name>Mentor Contour Profile Gel Implant</Name><Description>Textured, Contour Profile, Cohesive lll, Gel implant</Description><Size>≥500cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109380</GroupID><SubGroupID>113022</SubGroupID><Suffix>Pre-shaped</Suffix><ARTGs><ARTG>130678</ARTG></ARTGs><MinimumBenefit>1170</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JK047</BillingCode><PriorBillingCodes><PriorBillingCode>JK046</PriorBillingCode></PriorBillingCodes><Name>Impleo gel-filled Nagor mammary implant range - smooth - IMP-SMR, IMP-SHR and IMP-SEHR</Name><Description>Smooth Round</Description><Size>520 to 620ml</Size><SupplierCode>40456</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109380</GroupID><SubGroupID>113022</SubGroupID><ARTGs><ARTG>277759</ARTG></ARTGs><MinimumBenefit>668</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN123</BillingCode><Name>Mentor Smooth MemoryGel™, MemoryGel™ XTRA Breast Implant</Name><Description>Round, smooth surface cohesive I silicone gel-filled breast implant. Available in two projections: MemoryGel™ and MemoryGel™ XTRA. MemoryGel™ has two options: Moderate Plus and High Profile. MemoryGel™ XTRA has two options: Moderate Plus XTRA and High Profile XTRA</Description><Size>≥500cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109380</GroupID><SubGroupID>113022</SubGroupID><ARTGs><ARTG>393728</ARTG><ARTG>393729</ARTG></ARTGs><MinimumBenefit>668</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN131</BillingCode><Name>Mentor Siltex Round Gel Implant</Name><Description>Textured, Round Cohesive Gel ll Implant</Description><Size>≥500cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109380</GroupID><SubGroupID>113022</SubGroupID><ARTGs><ARTG>110589</ARTG></ARTGs><MinimumBenefit>668</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EG025</BillingCode><Name>Sebbin Mammary Implants </Name><Description>Sterile Silicone Breast Implants greater than 500cc</Description><Size>Greater Than 500cc</Size><SupplierCode>40068</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109380</GroupID><SubGroupID>113022</SubGroupID><ARTGs><ARTG>309616</ARTG></ARTGs><MinimumBenefit>668</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN125</BillingCode><Name>Mentor Siltex Round Gel Implant</Name><Description>Textured, Round Cohesive l Gel implant</Description><Size>≥500cc</Size><SupplierCode>39932</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109380</GroupID><SubGroupID>113022</SubGroupID><ARTGs><ARTG>326144</ARTG><ARTG>110588</ARTG></ARTGs><MinimumBenefit>668</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH726</BillingCode><PriorBillingCodes><PriorBillingCode>BY013</PriorBillingCode></PriorBillingCodes><Name>Motiva, Matrix Silk Surface PLUS</Name><Description>Sterile Silicone Breast Implants, Motiva Matrix, SilkSurface PLUS - prostheses, Internal, Mammary, gel filled</Description><Size>500cc to 1050cc</Size><SupplierCode>40192</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109380</GroupID><SubGroupID>113022</SubGroupID><ARTGs><ARTG>282778</ARTG></ARTGs><MinimumBenefit>668</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH731</BillingCode><PriorBillingCodes><PriorBillingCode>BY014</PriorBillingCode></PriorBillingCodes><Name>Motiva, Matrix Silk Surface PLUS with QID</Name><Description>Sterile Silicone Breast Implants, Motiva Matrix, SilkSurface PLUS with QID  - prostheses, Internal, Mammary, gel filled</Description><Size>500cc TO 1050cc</Size><SupplierCode>40192</SupplierCode><CategoryID>107575</CategoryID><SubCategoryID>107809</SubCategoryID><GroupID>109380</GroupID><SubGroupID>113022</SubGroupID><ARTGs><ARTG>282776</ARTG></ARTGs><MinimumBenefit>668</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VD004</BillingCode><Name>NEFRO-C Renal Stent with Delivery System</Name><Description>The NEFRO-C Renal Stent with Delivery System is intended to be implanted in the renal artery to maintain its patency and improve its luminal diameter for the treatment of atherosclerotic, radiation-induced, and posttraumatic lesions resulting in arteriostenosis of haemodynamic importance and which are intractable otherwise.   The device consists of a cobalt-chromium alloy L605 stent pre-loaded on a balloon catheter.</Description><Size>Stent diameter: 5-7mm  Stent Length: 8-25</Size><SupplierCode>40269</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113025</SubGroupID><ARTGs><ARTG>316764</ARTG></ARTGs><MinimumBenefit>1053</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT249</BillingCode><Name>Dynetic-35 Peripheral Balloon-Expandable Stent System</Name><Description> Dynetic-35 is a balloon-expandable  cobalt chromium alloy (L-605) stent pre-mounted on an over-the-wire PTA balloon catheter delivery system.</Description><Size>Diameter: 5-10mm; Length: 18-78mm; Catheter length: 90-170 cm</Size><SupplierCode>39967</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113025</SubGroupID><ARTGs><ARTG>209440</ARTG></ARTGs><MinimumBenefit>1053</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JW018</BillingCode><PriorBillingCodes><PriorBillingCode>DO003</PriorBillingCode></PriorBillingCodes><Name>PALMAZ® BLUE™ .018 Peripheral Stent System</Name><Description>L605 Cobalt Chromium Alloy Balloon Expandable Stent</Description><Size>12, 15, 18, 24mm length 4, 5, 6, 7mm diameter</Size><SupplierCode>40402</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113025</SubGroupID><ARTGs><ARTG>187122</ARTG></ARTGs><MinimumBenefit>1053</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JW014</BillingCode><PriorBillingCodes><PriorBillingCode>DO018</PriorBillingCode></PriorBillingCodes><Name>Palmaz Blue .014 Renal Stent System (on Aviator Plus)</Name><Description>CoCr balloon expandable stent</Description><Size>12, 15, 18, 24mm Lengths  40, 50, 60, 70mm diameters  80, 142cm shaft lengths</Size><SupplierCode>40402</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113025</SubGroupID><ARTGs><ARTG>190149</ARTG></ARTGs><MinimumBenefit>1053</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JW012</BillingCode><PriorBillingCodes><PriorBillingCode>DO016</PriorBillingCode></PriorBillingCodes><Name>Palmaz Genesis Peripheral Stent on Opta Pro (Medium)</Name><Description>Stainless steel balloon expandable stent mounted on an Opta Pro Balloon</Description><Size>Diameter 4-8mm, length 12-39mm</Size><SupplierCode>40402</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113025</SubGroupID><ARTGs><ARTG>188675</ARTG></ARTGs><MinimumBenefit>1053</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA218</BillingCode><Name>Lifestent Valeo</Name><Description>Stainless Steel Balloon Expandable Peripheral Stent</Description><Size>6-10mm diameter 17-56mm length</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113025</SubGroupID><ARTGs><ARTG>161500</ARTG></ARTGs><MinimumBenefit>1053</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS059</BillingCode><Name>Express Vascular LD Stent; Express Vascular SD Stent</Name><Description>Stainless Steel, Balloon Expanding Stent</Description><Size>Stent Diameters up to 10mm and lengths up to 60mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113025</SubGroupID><ARTGs><ARTG>153169</ARTG></ARTGs><MinimumBenefit>1053</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JW016</BillingCode><PriorBillingCodes><PriorBillingCode>DO007</PriorBillingCode></PriorBillingCodes><Name>Palmaz Genesis Peripheral Stent on Opta Pro (Large)</Name><Description>Stainless steel balloon expandable stent mounted on an Opta Pro Balloon.</Description><Size>Diameter 4-12mm, length 11-79mm</Size><SupplierCode>40402</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113025</SubGroupID><ARTGs><ARTG>188675</ARTG></ARTGs><MinimumBenefit>1053</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ442</BillingCode><PriorBillingCodes><PriorBillingCode>AY046</PriorBillingCode></PriorBillingCodes><Name>Omnilink Elite Vascular Balloon-Expandable Stent System</Name><Description>Omnilink Elite Vascular Balloon-Expandable Stent System is a balloon- expandable stent system  indicated for the treatment of atherosclerotic iliac artery lesions with reference vessel diameters of ≥ 5.0 mm and ≤ 11.0 mm, and lesion lengths up to 50 mm.</Description><Size>6.0mm x (12,16,19,29,39,59)mm x 80cm                       7.0mm x (12,16,19,29,39,59)mm x 80cm                      8.0mm x (19,29,39,59)mm x 80cm                                 9.0mm x (19,29,39,59)mm x 80cm                                10.0mm x (19,29,39,59)mm x 80cm                              6.0mm x (12, 16,19,29,39,59)mm x 135cm                 7.0mm x (12, 16,19,29,39,59)mm x 135cm                  8.0mm x (19,29,39,59)mm x 135cm                              9.0mm x (19,29,39,59)mm x 135cm                              10.0mm x (19,29,39,59)mm x 135cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113025</SubGroupID><ARTGs><ARTG>269609</ARTG></ARTGs><MinimumBenefit>1053</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ464</BillingCode><PriorBillingCodes><PriorBillingCode>AY022</PriorBillingCode></PriorBillingCodes><Name>Cobalt Chromium Balloon Expandable Peripheral Stent</Name><Description>Cobalt Chromium</Description><Size>Diameter 4-10mm, Length 12-58mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113025</SubGroupID><ARTGs><ARTG>146848</ARTG></ARTGs><MinimumBenefit>1053</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ441</BillingCode><PriorBillingCodes><PriorBillingCode>AY024</PriorBillingCode></PriorBillingCodes><Name>Omnilink Stainless Steel Balloon Deployable Peripheral Stent</Name><Description>Stainless Steel Balloon Expandable Peripheral Stent on 018/035 system</Description><Size>018 &amp; 035 system: 5-10mm diameter by 12, 16, 18, 28, 38, 58mm length</Size><SupplierCode>40062</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113025</SubGroupID><ARTGs><ARTG>146848</ARTG></ARTGs><MinimumBenefit>1053</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT094</BillingCode><Name>Dynamic</Name><Description>PTA Balloon Expandable Stent</Description><Size>Diameters: 5-10mm, Lengths: 15, 25, 38, 56mm</Size><SupplierCode>39967</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113025</SubGroupID><ARTGs><ARTG>209440</ARTG></ARTGs><MinimumBenefit>1053</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VD005</BillingCode><Name>NEPTUN C Peripheral Stent with Delivery System</Name><Description>The NEPTUN C Peripheral Stent with Delivery System is intended for use in percutaneous intravascular implantation in patients with atherosclerotic, radiation-induced and posttraumatic lesions causing peripheral vessel stenosis of hemodynamic significance and intractable in other forms of treatment.The device consists of a cobalt-chromium alloy L605 stent pre-loaded on a balloon  catheter.</Description><Size>Stent Diameter: 2-12mm  Stent Length: 8-100mm  Delivery Catheter Length: 80-135cm  Guidewire Diameter: 0.014"-0.035"</Size><SupplierCode>40269</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113025</SubGroupID><ARTGs><ARTG>316765</ARTG></ARTGs><MinimumBenefit>1053</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC287</BillingCode><Name>Zilver® Flex 35™ Vascular Stent</Name><Description>The Zilver® Flew 35™ Stent (ZFV) is a self-expandable stent made of nitinol.  The special laser-cut pattern of the nitinol tube provides a construction with a strong radial force and high flexibility.  The stent has radiopaque markers at both ends.  The stent is supplied preloaded in a 6.0 French inducer catheter. A radiopaque marker on the distal tip of the sheath is used to visualize deployment of the stent. Stent deployment is controlled by means of a hand held device.</Description><Size>The Zilver®  Flex 35™ Stent is available in the following sizes: stent outer diameters of 5 -10mm and stent lengths of 20 -140mm.</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>183865</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT133</BillingCode><Name>Pulsar 35 Peripheral self-expanding Nitinol stent system</Name><Description>Pulsar 35 Peripheral self-expanding Nitinol stent system</Description><Size>Diameter: 5-7mm; Length: 30-120mm; Catheter length: 90cm</Size><SupplierCode>39967</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>142025</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT103</BillingCode><Name>Astron Pulsar</Name><Description>Astron Pulsar is a 4F compatible, Nitinol self expanding stent (OTW design) used to treat peripheral vessel disease.</Description><Size>4-7mm by 20-80mm</Size><SupplierCode>39967</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>142025</ARTG><ARTG>124625</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC290</BillingCode><Name>Zilver®  Vena ™ Venous Stent</Name><Description>The Zilver® Vena™ Venous Stent is a self-expanding, flexible, slotted-tube nitinol stent. Post-deployment, the stent is designed to impart an outward radial force upon the inner lumen of the vessel, establishing patency in the stented region.</Description><Size>14mm and 16mm diameters, and 60mm/100mm/140mm lengths.</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>183864</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JW007</BillingCode><PriorBillingCodes><PriorBillingCode>DO011</PriorBillingCode></PriorBillingCodes><Name>SMART Control Peripheral Stent System</Name><Description>SMART Control is a laser cut nitinol self expanding stent, used to treat peripheral vessel disease.</Description><Size>Dia 6 – 14mm; Length 20 – 100mm</Size><SupplierCode>40402</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>151010</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VD007</BillingCode><Name>MER Self-Expanding Stent with Delivery System</Name><Description>The MER Self-Expanding Stent with Delivery System consists of a laser-cut Nitinol stent loaded onto the end of a rapid-exchange delivery system.     The device is intended to be implanted in the carotid artery to maintain its patency and improve its luminal diameter for the treatment of atherosclerotic carotid artery disease.</Description><Size>Straight Stent Model:  Stent Diameter: 4-10mm  Stent Length: 20-80mm  Delivery System Length: 80-165cm    Tapered Stent Model:  Distal Diameter: 5-8mm  Proximal Diameter: 7-10mm  Stent Length: 20-80mm  Delivery System Length: 80-165cm</Size><SupplierCode>40269</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>321233</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VD001</BillingCode><Name>JAGUAR Self-Expanding Stent with Delivery System (Regular)</Name><Description>The JAGUAR Self-Expanding Stent with Delivery System consists of a laser-cut self-expanding nitinol stent loaded onto the end of a delivery system. The device is intended for percutaneous intravascular implantation to maintain patency and improve luminal diamater of peripheral arteries in patients with atherosclerotic, radiation induced and post-traumatic lesions causing vessel stenosis</Description><Size>Stent Diameter: 4-14mm  Stent Length: 15-120mm  Guidewire Diameter: 0.018"-0.035"  Guidewire Length: 80-135cm</Size><SupplierCode>40269</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>316740</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JW011</BillingCode><PriorBillingCodes><PriorBillingCode>DO015</PriorBillingCode></PriorBillingCodes><Name>SMART Nitinol Stent System</Name><Description>Long 120mm Stent, 6F compatible</Description><Size>6-8mm diameter, 120mm stent length, 120cm delivery system</Size><SupplierCode>40402</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>151011</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ445</BillingCode><PriorBillingCodes><PriorBillingCode>AY041</PriorBillingCode></PriorBillingCodes><Name>Absolute Self Expanding Peripheral stent</Name><Description>Laser cut nitinol self expanding stent, 20mm - 120mm lengths</Description><Size>Size ranges from:  5.0X20MM, 80CM - 8.0x120MM, 135CM</Size><SupplierCode>40062</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>146848</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PY044</BillingCode><Name>sinus-XL 6F Stents</Name><Description>Self expanding Nitinol Stents</Description><Size>Diameter:  14mm to 24mm
Length:  30mm to &lt;150mm</Size><SupplierCode>40093</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>281020</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PY031</BillingCode><Name>Optimed Sinus Stents</Name><Description>Sinus-wave nitinol stent</Description><Size>Diameter: 3mm to 14mm   Length:  20mm to 130mm</Size><SupplierCode>40093</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>178915</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PY042</BillingCode><Name>sinus-XL Flex Stent</Name><Description>Self expanding Nitinol Stents</Description><Size>Diameter:  14mm to 24mm
Length:  30mm to &lt;150mm</Size><SupplierCode>40093</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>281019</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DL001</BillingCode><Name>iVolution</Name><Description>Self-expanding nitinol stent system</Description><Size>Diameters: 5-10mm 
Lengths: 40-100mm
Catheter Length: 80-140cm</Size><SupplierCode>39987</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>281201</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DL005</BillingCode><Name>CGuard</Name><Description>Carotid Stent System</Description><Size>Diameters: 6-10mm
Lengths: 20mm-60mm</Size><SupplierCode>39987</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>311660</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PY043</BillingCode><Name>sinus-XL Stent</Name><Description>Self expanding Nitinol Stents</Description><Size>Diameter:  14mm to 24mm
Length:  30mm to &lt;150mm</Size><SupplierCode>40093</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>187326</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PY036</BillingCode><Name>Sinus-Venous and Sinus-Obliquus Stents</Name><Description>Sinus-Venous and Sinus-Obliquus Stents used for treating venous insufficiency, occlusion and stenosis</Description><Size>Diameter: 10, 12, 14, 16, 18mm 
Length: 60, 80, 100, 120mm</Size><SupplierCode>40093</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>201852</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA178</BillingCode><Name>Peripheral Vascular Bare Metal Stent</Name><Description>Nitonol self expanding stent</Description><Size>4mm - 14mm diameters,
2cm - 12cm lengths</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>52136</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA271</BillingCode><Name>Bard Venous Stent</Name><Description>Self Expanding Venous Stent</Description><Size>Length: &lt;150mm</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>409902</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA216</BillingCode><Name>Lifestent</Name><Description>Lifestent cut nitinol self expanding stent</Description><Size>6-10mm diameter 20mm-120mm length</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>160453</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS137</BillingCode><Name>EPIC Nitinol Stent</Name><Description>Nitinol self expanding stent</Description><Size>Stent diameters up to 14mm and lengths up to 120mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>104281</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS196</BillingCode><Name>Innova Self-Expanding Stent</Name><Description>Nitinol, self expanding stent</Description><Size>Diameters up to 8mm, lengths less than 150mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>104281</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS056</BillingCode><Name>Carotid WALLSTENT</Name><Description>Elgiloy self expanding stent</Description><Size>Stent diameters up to 10mm and lengths up to 40mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>166856</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JW001</BillingCode><PriorBillingCodes><PriorBillingCode>DO002</PriorBillingCode></PriorBillingCodes><Name>S.M.A.R.T. Flex Vascular Stent System</Name><Description>A fully connected, laser cut nitinol stent </Description><Size>5-8mm diameter, 30-120mm length</Size><SupplierCode>40402</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>223910</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS189</BillingCode><Name>Protege GPS Peripheral and Carotid Stents</Name><Description>Protege RX Peripheral Stent
Protege RX Carotid Stent</Description><Size>Diameter 6-10mm Length 20mm - &lt;150mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>124533</ARTG><ARTG>124534</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ446</BillingCode><PriorBillingCodes><PriorBillingCode>AY043</PriorBillingCode></PriorBillingCodes><Name>Supera Peripheral Stent System</Name><Description>Interwoven Self-Expanding Nitnol Stent</Description><Size>Stent inner diameter: 4.0 mm - 8.0 mm  Stent outer diameter: 4.5 mm - 7.5 mm  Stent length: 20 mm - 120 mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>227976</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS194</BillingCode><Name>EverFlex Peripheral Stent</Name><Description>EverFlex is a self expanding Nitinol stent premounted on an OTW delivery system.</Description><Size>Diameter 5-8, Length 20-120mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>215979</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI414</BillingCode><Name>Abre venous stent system</Name><Description>The Abre stent system consists of a stent and stent delivery system designed specifically for implantation in the peripheral venous system. The system consists of a flexible self expanding stent made of a nickel-titanium alloy (nitinol) provided in multiple lengths and diameters and an over-the wire stent delivery system.</Description><Size>Length: 40mm-120mm.  Diameter: 10mm-20mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>315001</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ462</BillingCode><PriorBillingCodes><PriorBillingCode>AY015</PriorBillingCode></PriorBillingCodes><Name>Xact/ Xact Flex Carotid Stent</Name><Description>Nitinol Self-Expanding stent on rapid exchange delivery system</Description><Size>Diameter 7-10mm Length 20 + 30mm Straight; Diameter 8-6, 9-7, 10-8mm Length 20 + 30mm Tapered</Size><SupplierCode>40062</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>168620</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JW006</BillingCode><PriorBillingCodes><PriorBillingCode>DO010</PriorBillingCode></PriorBillingCodes><Name>Precise Pro Rx Nitinol Stent System</Name><Description>Nitinol self expanding stent</Description><Size>Diameter:  5, 6, 7, 8, 9, 10mm;  Length:  20, 30, 40mm</Size><SupplierCode>40402</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>149399</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT126</BillingCode><Name>Pulsar 18 Peripheral self expanding Nitinol stent system</Name><Description>Pulsar 18  self expanding Nitinol stent system</Description><Size>Stent: Ø 4- 7mm length: 20-120mm Catheter length: 90-135mm</Size><SupplierCode>39967</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><ARTGs><ARTG>169368</ARTG><ARTG>313356</ARTG></ARTGs><MinimumBenefit>1201</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PY029</BillingCode><Name>Sinus-XL Stent ≥25mm Ø</Name><Description>Self-expanding Nitinol stent</Description><Size>Diameter: 25mm to 36mm  Length: 30 to 100mm</Size><SupplierCode>40093</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113026</SubGroupID><Suffix>LD (large diameter, &gt;25mm)</Suffix><ARTGs><ARTG>187326</ARTG></ARTGs><MinimumBenefit>2434</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PY037</BillingCode><Name>Sinus-Venous and Sinus-Obliquus Stents</Name><Description>Sinus-Venous and Sinus-Obliquus Stents used for treating venous insufficiency, occlusion and stenosis</Description><Size>Diameter: 10, 12, 14, 16, 18mm
Length: 150mm</Size><SupplierCode>40093</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113027</SubGroupID><ARTGs><ARTG>201852</ARTG></ARTGs><MinimumBenefit>1394</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PY041</BillingCode><Name>sinus-XL Flex Stent</Name><Description>Flexible Nitinol Stent with diameters up to 24mm</Description><Size>Diameter:  14mm to 24mm
Length:  &gt;150mm</Size><SupplierCode>40093</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113027</SubGroupID><ARTGs><ARTG>281019</ARTG></ARTGs><MinimumBenefit>1394</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PY016</BillingCode><Name>Optimed Iliac Sinus Stent - extra long</Name><Description>Sinus-wave nitinol stent - extra long</Description><Size>Diameter: 3mm to 8 mm
Length:  150mm to 200mm</Size><SupplierCode>40093</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113027</SubGroupID><ARTGs><ARTG>178915</ARTG></ARTGs><MinimumBenefit>1394</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DL002</BillingCode><Name>iVolution  ≥150mm</Name><Description>Self-expanding nitinol stent system</Description><Size>Diameters: 5-8mm   Lengths: 150-200mm  Catheter Length: 80-140cm</Size><SupplierCode>39987</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113027</SubGroupID><ARTGs><ARTG>281201</ARTG></ARTGs><MinimumBenefit>1394</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA217</BillingCode><Name>Lifestent</Name><Description>Laser cut nitinol self expanding stent</Description><Size>Diameter 5mm to 10mm; length 150mm - 200mm</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113027</SubGroupID><ARTGs><ARTG>160453</ARTG></ARTGs><MinimumBenefit>1394</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI415</BillingCode><Name>Abre venous stent system</Name><Description>The Abre stent system consists of a stent and stent delivery system designed specifically for implantation in the peripheral venous system. The system consists of a flexible self expanding stent made of a nickel-titanium alloy (nitinol) provided in multiple lengths and diameters and an over-the wire stent delivery system.</Description><Size>Length: 150mm.  Diameter: 10mm-20mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113027</SubGroupID><ARTGs><ARTG>315001</ARTG></ARTGs><MinimumBenefit>1394</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ448</BillingCode><PriorBillingCodes><PriorBillingCode>AY042</PriorBillingCode></PriorBillingCodes><Name>Supera Peripheral Stent System</Name><Description>Interwooven Self-Expanding Nitinol Stent</Description><Size>Stent inner diameter: 4.0 mm - 6.0 mm  Stent outer diameter: 4.5 mm - 6.5 mm  Stent length: 150 mm - 200mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113027</SubGroupID><ARTGs><ARTG>227976</ARTG></ARTGs><MinimumBenefit>1394</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA270</BillingCode><Name>Bard Venous Stent</Name><Description>Self Expanding Venous Stent</Description><Size>Length ≥150mm</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113027</SubGroupID><ARTGs><ARTG>409902</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>1394</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ447</BillingCode><PriorBillingCodes><PriorBillingCode>AY036</PriorBillingCode></PriorBillingCodes><Name>Absolute Pro (Long Length)</Name><Description>Laser cut nitinol self expanding stent ≥150</Description><Size>Diameter 5mm to 10mm; length 150mm, 170mm, 200mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113027</SubGroupID><ARTGs><ARTG>146848</ARTG></ARTGs><MinimumBenefit>1394</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS197</BillingCode><Name>Innova Self-Expanding Stent</Name><Description>Nitinol, self expanding stent</Description><Size>Diameters up to 8mm, Lengths greater than 150mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113027</SubGroupID><ARTGs><ARTG>104281</ARTG></ARTGs><MinimumBenefit>1394</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS195</BillingCode><Name>EverFlex Peripheral Stent</Name><Description>EverFlex is a self expanding Nitinol stent premounted on an OTW delivery system.</Description><Size>Diameter 5-8mm, Length 150mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113027</SubGroupID><ARTGs><ARTG>215979</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Size</ChangeExplanation><MinimumBenefit>1394</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT132</BillingCode><Name>Pulsar 35 Peripheral self-expanding Nitinol stent system</Name><Description>Pulsar 35 Peripheral self-expanding Nitinol stent system</Description><Size>Diameter: 5-7mm; Length: 150-200mm; Catheter length: 90cm, 135cm</Size><SupplierCode>39967</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113027</SubGroupID><ARTGs><ARTG>142025</ARTG></ARTGs><MinimumBenefit>1394</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC285</BillingCode><Name>Zilver® Flex35™ Vascular Stent</Name><Description>The Zilver® Flex35™ Stent (ZFV) is a self-expandable stent made of nitinol.  The special laser-cut pattern of the nitinol tube provides a construction with a strong radial force and high flexibility.  The stent has radiopaque markers at both ends.</Description><Size>Diameter: 5-8mm; Length:170mm and 200mm</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113027</SubGroupID><ARTGs><ARTG>183865</ARTG></ARTGs><MinimumBenefit>1394</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VD002</BillingCode><Name>JAGUAR Self-Expanding Stent with Delivery System (Long)</Name><Description>The JAGUAR Self-Expanding Stent with Delivery System consists of a laser-cut self-expanding nitinol stent loaded onto the end of a delivery system. The device is intended for percutaneous intravascular implantation to maintain patency and improve luminal diamater of peripheral arteries in patients with atherosclerotic, radiation induced and post-traumatic lesions causing vessel stenosis</Description><Size>Stent Diameter: 4-14mm  Stent Length: 150mm  Guidewire Diameter: 0.018"-0.035"  Guidewire Length: 80-135cm</Size><SupplierCode>40269</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113027</SubGroupID><ARTGs><ARTG>316740</ARTG></ARTGs><MinimumBenefit>1394</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JW009</BillingCode><PriorBillingCodes><PriorBillingCode>DO013</PriorBillingCode></PriorBillingCodes><Name>SMART Nitinol Stent System</Name><Description>Long 150mm stent, 6F compatible</Description><Size>6-8mm diameter, 150mm length, 120cm delivery system</Size><SupplierCode>40402</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113027</SubGroupID><ARTGs><ARTG>151011</ARTG></ARTGs><MinimumBenefit>1394</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JW002</BillingCode><PriorBillingCodes><PriorBillingCode>DO004</PriorBillingCode></PriorBillingCodes><Name>S.M.A.R.T. Flex Vascular Stent System</Name><Description>A fully connected, laser cut nitinol stent </Description><Size>5-8mm diameter, 150-200mm length</Size><SupplierCode>40402</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113027</SubGroupID><ARTGs><ARTG>223910</ARTG></ARTGs><MinimumBenefit>1394</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT127</BillingCode><Name>Pulsar 18 Peripheral self expanding Nitinol stent system</Name><Description>Pulsar 18  self expanding Nitinol stent system</Description><Size>Stent: 4-7mm Stent length: 150-200mm Catheter length: 90-135mm</Size><SupplierCode>39967</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113027</SubGroupID><ARTGs><ARTG>169368</ARTG><ARTG>313356</ARTG></ARTGs><MinimumBenefit>1394</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER542</BillingCode><Name>Tack Endovascular System</Name><Description>The Tack Endovascular System is a dissection repair device that is purpose-built to provide precision treatment of peripheral arterial dissections following balloon angioplasty. </Description><Size>Diameter: 5.7-9.8mm (unconstrained); Diameter treatment range: 1.5-8.0 mm;  Length: ~6-8mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113028</SubGroupID><ARTGs><ARTG>352394</ARTG></ARTGs><MinimumBenefit>1119</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC316</BillingCode><Name>Zenith Dissection Endovascular Stent with the Z-Trak Plus Introduction System</Name><Description>Dissection Endovascular Stent</Description><Size>Diameter: 36mm and 46mm
Lengths: 80mm, 120mm, 180mm, 185mm</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109303</GroupID><SubGroupID>113029</SubGroupID><ARTGs><ARTG>208854</ARTG></ARTGs><MinimumBenefit>4197</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS327</BillingCode><Name>Eluvia</Name><Description>Drug Eluting Vascular Stent System</Description><Size>Diameter 6-7mm, Length 40-120mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109304</GroupID><SubGroupID>113030</SubGroupID><Suffix>&lt;150mm</Suffix><ARTGs><ARTG>285061</ARTG></ARTGs><MinimumBenefit>2033</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS328</BillingCode><Name>Eluvia</Name><Description>Drug Eluting Vascular Stent System</Description><Size>Diameter 6-7mm, Length 150-200mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107791</SubCategoryID><GroupID>109304</GroupID><SubGroupID>113030</SubGroupID><Suffix>≥150mm</Suffix><ARTGs><ARTG>285061</ARTG></ARTGs><MinimumBenefit>2643</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC324</BillingCode><Name>Zenith Alpha Thoracic Endovascular Graft Proximal Component</Name><Description>Straight Thoracic Proximal Graft (short)</Description><Size>Diameter: 24-46mm. Length: 105-179mm.</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109309</GroupID><SubGroupID>113033</SubGroupID><ARTGs><ARTG>281253</ARTG></ARTGs><MinimumBenefit>9952</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT259</BillingCode><Name>Conformable GORE TAG Thoracic Endoprosthesis</Name><Description>Conformable GORE TAG</Description><Size>Straight Stent Grafts:
Diameters (mm): 21, 26, 28, 31, 34, 37, 40, 45
Length (cm): 10
Tapered Stent Grafts:
Diameters (mm): 26x21; 31x26
Lengths (cm): 10</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109309</GroupID><SubGroupID>113033</SubGroupID><ARTGs><ARTG>157814</ARTG></ARTGs><MinimumBenefit>9952</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC240</BillingCode><Name>Zenith Thoracic Endovascular Graft</Name><Description>Thoracic Distal Graft</Description><Size>26mm to 42mm diameter, 127mm to 179mm Length</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109309</GroupID><SubGroupID>113033</SubGroupID><ARTGs><ARTG>164328</ARTG></ARTGs><MinimumBenefit>9952</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC307</BillingCode><Name>Zenith TX2 Dissection Endovascular Graft with Pro-Form and the Z-Trak Plus Introduction System (Short proximal component)</Name><Description>Short Thoracic Proximal Graft</Description><Size>Diameter 22mm - 42mm 
Length 117mm - 165</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109309</GroupID><SubGroupID>113033</SubGroupID><ARTGs><ARTG>197412</ARTG></ARTGs><MinimumBenefit>9952</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC326</BillingCode><Name>Zenith Alpha Thoracic Endovascular Graft Proximal Tapered Component</Name><Description>Tapered Thoracic Proximal Graft (short)</Description><Size>Proximal diameter: 32-46mm.  Length: 161-179mm.</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109309</GroupID><SubGroupID>113033</SubGroupID><ARTGs><ARTG>281255</ARTG></ARTGs><MinimumBenefit>9952</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT260</BillingCode><Name>Conformable GORE TAG Thoracic Endoprosthesis</Name><Description>Conformable GORE TAG</Description><Size>Diameters (mm): 21, 26, 28, 31, 34, 37, 40, 45
Length (cm) 15</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109309</GroupID><SubGroupID>113033</SubGroupID><ARTGs><ARTG>157814</ARTG></ARTGs><MinimumBenefit>9952</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC960</BillingCode><Name>Valiant Captivia</Name><Description>Valiant Stent Graft with captivia delivery system</Description><Size>22 - 46 mm diameter: 100mm length</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109309</GroupID><SubGroupID>113033</SubGroupID><ARTGs><ARTG>169353</ARTG></ARTGs><MinimumBenefit>9952</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC275</BillingCode><Name>Zenith TX2 TAA Endovascular Graft with Pro_Form and the Z-Trak Plus Introduction System Short Proximal Component</Name><Description>Short Thoracic Proximal Graft</Description><Size>Diameter 22mm - 42mm
Length 115mm - 167mm</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109309</GroupID><SubGroupID>113033</SubGroupID><ARTGs><ARTG>164328</ARTG></ARTGs><MinimumBenefit>9952</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI149</BillingCode><Name>Valiant Thoracic FreeFlo Tapered stent graft</Name><Description>Valiant Thoracic FreeFlo Tapered Stent Graft with Captivia Delivery System</Description><Size>Proximal diameter: 26 to 46 mm; distal diameter: 22 to 42 mm; stent graft covered length: 152 to 162 mm. Catheter outer diameter: 22 to 25F</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109309</GroupID><SubGroupID>113033</SubGroupID><ARTGs><ARTG>169353</ARTG></ARTGs><MinimumBenefit>9952</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC952</BillingCode><Name>Valiant Captivia</Name><Description>Valient Stent Graft with Captivia Delivery System</Description><Size>22-46mm diameter, 150mm length</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109309</GroupID><SubGroupID>113033</SubGroupID><ARTGs><ARTG>169353</ARTG></ARTGs><MinimumBenefit>9952</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC322</BillingCode><Name>Zenith Alpha Thoracic Endovascular Graft Distal Component</Name><Description>Thoracic Distal Graft (short)</Description><Size>Diameter: 28-46mm.  Length: 142-160mm.</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109309</GroupID><SubGroupID>113033</SubGroupID><ARTGs><ARTG>281254</ARTG></ARTGs><MinimumBenefit>9952</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC305</BillingCode><Name>Zenith TX2 Dissection Endovascular Graft with Pro-Form and the Z-Trak Plus Introduction System (Long proximal component)</Name><Description>Long thoracic proximal graft</Description><Size>Diameter 28mm-42mm; Length 194mm-218</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109309</GroupID><SubGroupID>113034</SubGroupID><ARTGs><ARTG>197412</ARTG></ARTGs><MinimumBenefit>13086</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC241</BillingCode><Name>Zenith Thoracic Endovascular Graft</Name><Description>Thoracic Distal Graft</Description><Size>26mm to 42mm diameter, 180mm to 207mm Length</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109309</GroupID><SubGroupID>113034</SubGroupID><ARTGs><ARTG>164328</ARTG></ARTGs><MinimumBenefit>13086</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC276</BillingCode><Name>Zenith TX2 TAA Endovascular Graft with Pro-Form and the Z-Trak Plus Introduction System - Long Proximal Component</Name><Description>Long Thoracic Proximal Endovascular Graft</Description><Size>Diameter: 22mm-42mm Length: 192mm-216mm</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109309</GroupID><SubGroupID>113034</SubGroupID><ARTGs><ARTG>164328</ARTG></ARTGs><MinimumBenefit>13086</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC325</BillingCode><Name>Zenith Alpha Thoracic Endovascular Graft Proximal Component</Name><Description>Straight Thoracic Proximal Graft (long)</Description><Size>Diameter: 28-46mm.  Length: 201-233mm.</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109309</GroupID><SubGroupID>113034</SubGroupID><ARTGs><ARTG>281253</ARTG></ARTGs><MinimumBenefit>13086</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC323</BillingCode><Name>Zenith Alpha Thoracic Endovascular Graft Distal Component</Name><Description>Thoracic Distal Graft (long)</Description><Size>Diameter: 28-46mm.  Length: 190-229mm.</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109309</GroupID><SubGroupID>113034</SubGroupID><ARTGs><ARTG>281254</ARTG></ARTGs><MinimumBenefit>13086</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC327</BillingCode><Name>Zenith Alpha Thoracic Endovascular Graft Proximal Tapered Component</Name><Description>Tapered Thoracic Proximal Graft (long)</Description><Size>Proximal diameter: 32-46mm. Length: 201-233mm.</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109309</GroupID><SubGroupID>113034</SubGroupID><ARTGs><ARTG>281255</ARTG></ARTGs><MinimumBenefit>13086</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC958</BillingCode><Name>Valiant Captivia</Name><Description>Valiant Stent Graft with Captivia Delivery System</Description><Size>24-46mm diameter, 200mm length</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109309</GroupID><SubGroupID>113034</SubGroupID><ARTGs><ARTG>169353</ARTG></ARTGs><MinimumBenefit>13086</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT261</BillingCode><Name>Conformable GORE TAG Thoracic Endoprosthesis</Name><Description>Conformable GORE TAG</Description><Size>Diameters (mm): 21, 26, 28, 31, 34, 37, 40, 45
Length (cm): 20</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109309</GroupID><SubGroupID>113034</SubGroupID><ARTGs><ARTG>157814</ARTG></ARTGs><MinimumBenefit>13086</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU002</BillingCode><Name>Anaconda Endovascular Graft System</Name><Description>Bifurcated Aortic System, Ultra thin woven polyester, nitinol ring stents, tantalum markers</Description><Size>18 - 34mm</Size><SupplierCode>40450</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109312</GroupID><SubGroupID>113035</SubGroupID><ARTGs><ARTG>172404</ARTG></ARTGs><MinimumBenefit>11196</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC997</BillingCode><Name>Endurant II AAA Stent Graft Bifurcation</Name><Description>Endurant II Endoluminal Stent Graft System - Bifurcated Graft</Description><Size>Proximal diameters: 23 to 36mm; Distal diameters: 13 to 20mm; Covered lengths: 124 to 166mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109312</GroupID><SubGroupID>113036</SubGroupID><ARTGs><ARTG>197540</ARTG><ARTG>302574</ARTG></ARTGs><MinimumBenefit>8082</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JY007</BillingCode><Name>E-tegra Main Body</Name><Description>E-tegra Stent Graft system - Bifurcated Graft Main Body</Description><Size>Diameters 23-36mm (proximal)    Length: 100-160mm (covered)    Length: 85, 100mm (trunk),   Diameter : 13,16,19mm (distal)</Size><SupplierCode>40391</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109312</GroupID><SubGroupID>113036</SubGroupID><ARTGs><ARTG>388374</ARTG></ARTGs><MinimumBenefit>8082</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI173</BillingCode><Name>Endurant IIs AAA Stent Graft</Name><Description>Endurant IIs Endoluminal Stent Graft System - Bifurcated Graft (body + single limb configuration), shorter ipsilateral leg</Description><Size>Proximal diameters: 23 to 36 mm; Distal diameters: 14 mm; Covered length: 103 mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109312</GroupID><SubGroupID>113036</SubGroupID><ARTGs><ARTG>235711</ARTG><ARTG>302575</ARTG></ARTGs><MinimumBenefit>8082</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT263</BillingCode><Name>GORE EXCLUDER AAA Endoprosthesis</Name><Description>AAA Stent Graft Nitinol &amp; ePTFE Two piece system (1/2) Trunk-ipsilateral component</Description><Size>Diameters: 23, 26, 28.5, 35mm
Lengths: 12, 14, 16, 18cm
Diameters: 31mm
Lengths: 13, 15, 17cm
Diameters: 35mm
Lengths: 14, 16, 18cm</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109312</GroupID><SubGroupID>113036</SubGroupID><ARTGs><ARTG>157813</ARTG></ARTGs><MinimumBenefit>8082</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC277</BillingCode><Name>Zenith Flex AAA Endovascular Graft with the Z-Trak Introduction System - main body</Name><Description>Zenith Flex with Z-trak main body - AAA endovascular graft</Description><Size>Diameter - 22mm - 36mm. Length 82mm - 149mm.</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109312</GroupID><SubGroupID>113037</SubGroupID><ARTGs><ARTG>161932</ARTG></ARTGs><MinimumBenefit>5229</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JW003</BillingCode><PriorBillingCodes><PriorBillingCode>DO006</PriorBillingCode></PriorBillingCodes><Name>InCraft AAA Stent-Graft System - Aortic Bifurcate</Name><Description>Bifurcated main body</Description><Size>22-34mm diameter, 86-94mm length</Size><SupplierCode>40402</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109312</GroupID><SubGroupID>113037</SubGroupID><ARTGs><ARTG>231895</ARTG></ARTGs><MinimumBenefit>5229</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC261</BillingCode><Name>Zenith Fenestrated AAA Endovascular Graft with Flexor</Name><Description>Distal Bifurcated Body with Flexor sheath</Description><Size>Diameter 12 - 24mm, 1st length 28 - 62mm, 2nd length 76 - 121mm</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109312</GroupID><SubGroupID>113037</SubGroupID><ARTGs><ARTG>138797</ARTG></ARTGs><MinimumBenefit>5229</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC332</BillingCode><Name>Zenith Alpha Abdominal Endovascular Graft </Name><Description>Bifurcated main body graft</Description><Size>Diameters:22-36mm.  Lengths: 70-128mm</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109312</GroupID><SubGroupID>113037</SubGroupID><ARTGs><ARTG>265762</ARTG></ARTGs><MinimumBenefit>5229</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC313</BillingCode><Name>Zenith t-Branch Endovascular Graft</Name><Description>The t-Branch is an endovascular graft designed for use in the thoracabdominal aorta.</Description><Size>Diameter: 34mm  Length: 202mm</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109313</GroupID><SubGroupID>113039</SubGroupID><Suffix>L</Suffix><ARTGs><ARTG>228114</ARTG></ARTGs><MinimumBenefit>13086</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC312</BillingCode><Name>Zenith Universal Distal Body Endovascular Graft</Name><Description>The Zenith Universal Distal Body Endovascular Graft (Unibody) consists of a bifurcated graft loaded into the H&amp;L-B One-Shot delivery system</Description><Size>Diameters: 22 - 24mm
Lengths: 81 - 132mm</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109313</GroupID><SubGroupID>113039</SubGroupID><ARTGs><ARTG>208899</ARTG></ARTGs><MinimumBenefit>6769</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC306</BillingCode><Name>Zenith TX2 Dissection Endovascular Graft with Pro-Form and the Z-Trak Plus Introduction System (thoracic body extension)</Name><Description>Thoracic Proximal Extension</Description><Size>Diameter 22mm - 42mm; Length 79mm - 83mm</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109315</GroupID><SubGroupID>113040</SubGroupID><ARTGs><ARTG>197412</ARTG></ARTGs><MinimumBenefit>5686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC328</BillingCode><Name>Zenith Alpha Thoracic Endovascular Graft Distal Extension</Name><Description>Thoracic Distal Extension</Description><Size>Diameter: 18-46mm.  Length: 91-160mm</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109315</GroupID><SubGroupID>113040</SubGroupID><ARTGs><ARTG>281256</ARTG></ARTGs><MinimumBenefit>5686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC274</BillingCode><Name>Zenith TX2 TAA Endovascular Graft with Pro-Form and the Z-Trak Plus Introduction System (thoracic body extension)</Name><Description>Thoracic Proximal Extension</Description><Size>Diameter - 22mm - 42mm Length - 77mm - 81mm</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109315</GroupID><SubGroupID>113040</SubGroupID><ARTGs><ARTG>164328</ARTG></ARTGs><MinimumBenefit>5686</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC048</BillingCode><Name>Zenith Endovascular Graft</Name><Description>Body Extensions</Description><Size>Diameter 22 through 36</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109315</GroupID><SubGroupID>113041</SubGroupID><ARTGs><ARTG>206326</ARTG></ARTGs><MinimumBenefit>2306</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT189</BillingCode><Name>GORE EXCLUDER AAA Endoprosthesis</Name><Description>Abdominal Stent Graft Nitinol &amp; ePTFE - Aortic Extender</Description><Size>Diameters: 23, 26, 28.5mm
Lengths: 3.3cm
Diameters: 32mm
Length: 4.5cm
Diameter: 36mm
Length: 4.5cm</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109315</GroupID><SubGroupID>113041</SubGroupID><ARTGs><ARTG>158681</ARTG></ARTGs><MinimumBenefit>2306</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC045</BillingCode><Name>Zenith Endovascular Graft</Name><Description>Converter</Description><Size>Diameter 20 through 36   Length 80-85</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109315</GroupID><SubGroupID>113041</SubGroupID><ARTGs><ARTG>205724</ARTG></ARTGs><MinimumBenefit>2306</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC302</BillingCode><Name>Zenith Low Profile AAA Endovascular Graft - Converter</Name><Description>Converter</Description><Size>Proximal Diameter: 24-36mm, Distal Diameter: 12mm, Working Length: 66mm</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109315</GroupID><SubGroupID>113041</SubGroupID><ARTGs><ARTG>227127</ARTG></ARTGs><MinimumBenefit>2306</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC303</BillingCode><Name>Zenith Low Profile AAA Endovascular Graft - Main Body Extension</Name><Description>Main Body Extension</Description><Size>Diameter: 22-36mm, Working Length: 45-58mm</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109315</GroupID><SubGroupID>113041</SubGroupID><ARTGs><ARTG>227126</ARTG></ARTGs><MinimumBenefit>2306</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JY005</BillingCode><Name>E-tegra Aortic Extension</Name><Description>E-tegra Stent Graft System - Aortic Extension</Description><Size>Length: 50mm    Diameter (proximal): 23-38mm    Diameter (distal): 23-38mm</Size><SupplierCode>40391</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109315</GroupID><SubGroupID>113041</SubGroupID><ARTGs><ARTG>388372</ARTG></ARTGs><MinimumBenefit>2306</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU003</BillingCode><Name>Anaconda Endovascular Graft System</Name><Description>Aortic Extension Cuff. Ultrathin woven polyester, nitinol ring stents, tantalum markers</Description><Size>18 - 34mm</Size><SupplierCode>40450</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109315</GroupID><SubGroupID>113041</SubGroupID><ARTGs><ARTG>172404</ARTG><ARTG>173321</ARTG></ARTGs><MinimumBenefit>2306</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JW017</BillingCode><PriorBillingCodes><PriorBillingCode>DO019</PriorBillingCode></PriorBillingCodes><Name>Incraft AAA Stent Graft System - Aortic Extension</Name><Description>Aortic Extension</Description><Size>Aortic Extension Diameter (mm): 22, 26, 30, 34</Size><SupplierCode>40402</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109315</GroupID><SubGroupID>113041</SubGroupID><ARTGs><ARTG>231895</ARTG></ARTGs><MinimumBenefit>2306</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI061</BillingCode><Name>Endurant II AAA Aortic Extension</Name><Description>Endurant II Endoluminal Stent Graft System - Aortic Extension</Description><Size>Proximal diameter: 23 to 36mm; distal diameter: 23 to 36mm; Covered length: 49mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109315</GroupID><SubGroupID>113041</SubGroupID><ARTGs><ARTG>202372</ARTG></ARTGs><MinimumBenefit>2306</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT296</BillingCode><Name>GORE® VIABAHN® VBX Balloon Expandable Endoprosthesis</Name><Description>The GORE® VIABAHN® VBX Balloon Expandable Endoprosthesis consists of a 316L surgical grade stainless steel balloon expandable stent and a fluoropolymer graft. The CBAS® Heparin Surface on the GORE® VIABAHN® VBX Balloon Expandable Endoprosthesis consists of stable, covalent, end-point attached heparin of porcine origin. The endoprosthesis is premounted on a delivery system equipped with a balloon. The delivery system has two radiopaque balloon markers embedded in the shaft (denoting the effective balloon length) to aid in the placement of the endoprosthesis. The delivery system is compatible with 0.035" (0.89 mm) guidewires. The delivery system can be used for initial stent placement and post stent dilatation. The premounted stent system is available in a variety of endoprosthesis lengths from 15 to 79 mm and in a variety of diameters from 5 to 11 mm (See Table 1). The premounted endoprosthesis system balloon catheter is also offered in two shaft lengths. This product is supplied sterile. It should not be resterilized.</Description><Size>5mm-11mm diameter 
15mm, 19mm, 29mm, 39mm &amp; 59mm lengths</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109318</GroupID><SubGroupID>113042</SubGroupID><Suffix>H (heparin)</Suffix><ARTGs><ARTG>311474</ARTG></ARTGs><MinimumBenefit>3867</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT295</BillingCode><Name>GORE® VIABAHN® VBX Balloon Expandable Endoprosthesis</Name><Description>The GORE® VIABAHN® VBX Balloon Expandable Endoprosthesis consists of a 316L surgical grade stainless steel balloon expandable stent and a fluoropolymer graft. The CBAS® Heparin Surface on the GORE® VIABAHN® VBX Balloon Expandable Endoprosthesis consists of stable, covalent, end-point attached heparin of porcine origin. The endoprosthesis is premounted on a delivery system equipped with a balloon. The delivery system has two radiopaque balloon markers embedded in the shaft (denoting the effective balloon length) to aid in the placement of the endoprosthesis. The delivery system is compatible with 0.035" (0.89 mm) guidewires. The delivery system can be used for initial stent placement and post stent dilatation. The premounted stent system is available in a variety of endoprosthesis lengths from 15 to 79 mm and in a variety of diameters from 5 to 11 mm (See Table 1). The premounted endoprosthesis system balloon catheter is also offered in two shaft lengths. This product is supplied sterile. It should not be resterilized.</Description><Size>5mm-11mm diameter
79mm length</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109318</GroupID><SubGroupID>113042</SubGroupID><Suffix>H (heparin)</Suffix><ARTGs><ARTG>311474</ARTG></ARTGs><MinimumBenefit>3867</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PY039</BillingCode><Name>BeGraft Peripheral Stent Graft System</Name><Description>Balloon Expandable "One layer" Biocompatible CoCr Alloy and Micro-porous ePTFE Peripheral Vascular Stent</Description><Size>Diameter: 5mm to 12mm
Length: 18mm to 58mm</Size><SupplierCode>40093</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109318</GroupID><SubGroupID>113042</SubGroupID><ARTGs><ARTG>280061</ARTG></ARTGs><MinimumBenefit>3258</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA264</BillingCode><Name>LifeStream Balloon Expandable Covered Stent</Name><Description>The LifeStream Balloon Expandable Vascular Covered Stent is comprised of an ectropolished balloon-expandable stent made from 316L stainless steel, encapsulated between two layers of ePTFE.</Description><Size>Implant Length: 16mm, 26mm, 37/38mm*,58mm
Implant Diameter: 5mm, 6mm, 7mm, 8mm, 9mm, 10mm, 12mm
* Diameters 5-8mm are offered in 37mm length, and diameters 9-12 are offered in 38mm length</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109318</GroupID><SubGroupID>113042</SubGroupID><ARTGs><ARTG>265593</ARTG></ARTGs><MinimumBenefit>3258</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GX009</BillingCode><PriorBillingCodes><PriorBillingCode>MQ006</PriorBillingCode></PriorBillingCodes><Name>Advant PTFE V12 Stent Graft System</Name><Description>Balloon Expandable PTFE Encapsulated Stainless Steel Peripheral Vascular Stent</Description><Size>5mm - 12mm Diameter</Size><SupplierCode>39943</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109318</GroupID><SubGroupID>113042</SubGroupID><ARTGs><ARTG>156635</ARTG><ARTG>200244</ARTG></ARTGs><MinimumBenefit>3258</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT294</BillingCode><Name>GORE® VIABAHN® VBX Balloon Expandable Endoprosthesis</Name><Description>The GORE® VIABAHN® VBX Balloon Expandable Endoprosthesis consists of a 316L surgical grade stainless steel balloon expandable stent and a fluoropolymer graft. The CBAS® Heparin Surface on the GORE® VIABAHN® VBX Balloon Expandable Endoprosthesis consists of stable, covalent, end-point attached heparin of porcine origin. The endoprosthesis is premounted on a delivery system equipped with a balloon. The delivery system has two radiopaque balloon markers embedded in the shaft (denoting the effective balloon length) to aid in the placement of the endoprosthesis. The delivery system is compatible with 0.035" (0.89 mm) guidewires. The delivery system can be used for initial stent placement and post stent dilatation. The premounted stent system is available in a variety of endoprosthesis lengths from 15 to 79 mm and in a variety of diameters from 5 to 11 mm (See Table 1). The premounted endoprosthesis system balloon catheter is also offered in two shaft lengths. This product is supplied sterile. It should not be resterilized.</Description><Size>8mm expanding to 16mm
29mm, 39mm, 59mm, 79mm lengths</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109318</GroupID><SubGroupID>113043</SubGroupID><Suffix>H (heparin)</Suffix><ARTGs><ARTG>311474</ARTG></ARTGs><MinimumBenefit>5230</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PY045</BillingCode><Name>BeGraft Aortic Stent Graft System</Name><Description>Aortic Stent Graft System</Description><Size>Expanded Diameter: 12mm to 30mm
Stent Length:  19mm to 59mm
Catheter Length: 75cm and 120cm</Size><SupplierCode>40093</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109318</GroupID><SubGroupID>113043</SubGroupID><ARTGs><ARTG>286040</ARTG></ARTGs><MinimumBenefit>5140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GX010</BillingCode><PriorBillingCodes><PriorBillingCode>MQ035</PriorBillingCode></PriorBillingCodes><Name>Advanta V12 Stent Graft System</Name><Description>Balloon Expandable PTFE Encapsulated Stainless Steel Vascular Stent</Description><Size>Large Diameter 12 -16mm. 80 and 120cm catheter lengths</Size><SupplierCode>39943</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109318</GroupID><SubGroupID>113043</SubGroupID><ARTGs><ARTG>156635</ARTG></ARTGs><MinimumBenefit>5140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT225</BillingCode><Name>GORE® VIABAHN® Endoprosthesis with Propaten Bioactive Surface</Name><Description>GORE® VIABAHN® Endoprosthesis with Propaten Bioactive Surface is a flexible, self expanding endoluminal device consisting of an ePTFE lining with external nitinol support</Description><Size>5mmx2.5cm 120cm 5mmx5cm 120cm 6mmx2.5cm 120cm 6mmx5cm 75cm 6mmx5cm 120cm 7mmx2.5cm 120cm 7mmx5cm 75cm   7mmx5cm 120cm 8mmx2.5cm 120cm 8mmx5cm 75cm 8mmx5cm 120cm 9mmx 5cm 75cm 9mmx 5cm 120cm 10mmx 5cm 75cm   10mmx 5cm 120cm 11mmx 5cm 75cm   11mmx 5cm 120cm 13mmx 5cm 75cm 13mmx 5cm 120cm</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109319</GroupID><SubGroupID>113045</SubGroupID><Suffix>H (heparin)</Suffix><ARTGs><ARTG>160210</ARTG></ARTGs><MinimumBenefit>3154</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT227</BillingCode><Name>GORE® VIABAHN® Endoprosthesis with Propaten Bioactive Surface</Name><Description>GORE® VIABAHN® Endoprosthesis with Propaten Bioactive Surfaceis a flexible, self expandinbg endoluminal device consisting of an ePTFE lining with external nitinol support</Description><Size>5mmx 10cm 120cm 6mmx 10cm 75cm 6mmx 10cm 120cm 7mmx 10cm 75cm 7mmx 10cm 120cm 8mmx 10cm 75cm 8mmx 10cm 120cm   9mmx 10cm 75cm 9mmx 10cm 120cm   10mmx 10cm 75cm 10mmx 10cm 120cm   11mmx 10cm 75cm 11mmx 10cm 120cm   13mmx 10cm 75cm 13mmx 10cm 120cm</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109319</GroupID><SubGroupID>113045</SubGroupID><Suffix>H (heparin)</Suffix><ARTGs><ARTG>160210</ARTG></ARTGs><MinimumBenefit>3154</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA297</BillingCode><Name>Bard COVERA Vascular Covered Stent</Name><Description>The Covera™ Vascular Covered Stent is a flexible, self-expanding endoprosthesis comprised of expanded ePTFE encapsulating a nitinol stent framework. The inner lumen of the covered stent is carbon impregnated. Available in flared and straight end configurations allow for optimal sizing and adaption to the venous vessel wall. Straight device configurations are intended for use in anatomies where the diameter of the outflow vessel is equal to or smaller than the diameter of the inflow vessel. Flared device configurations are intended for use in anatomies where the diameter of the outflow vessel segment is larger than the inflow segment. The Covera™ Vascular Covered Stent device is an over-the-wire delivery system. The delivery system is compatible with 0.035 inch guidewires and 8F or 9F introducer sheaths. The delivery system is available in working lengths of 80 cm and 120 cm. Triaxial delivery system thumb wheel delivery facilitates accurate placement control.</Description><Size>Implant diameter: 6mm, 7mm, 8mm, 9mm,10 mm    Implant lengths: 30mm*, 40 mm, 60 mm, 80 mm, 100 mm      *30 mm length available in straight configurations</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109319</GroupID><SubGroupID>113045</SubGroupID><ARTGs><ARTG>321442</ARTG></ARTGs><MinimumBenefit>3064</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA219</BillingCode><Name>Encapsulated Carbon Lined Stent Graft</Name><Description>PTFE covered nitinol self-expanding stent</Description><Size>4mm - 13.5mm diameter, 2cm - 12cm length</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109319</GroupID><SubGroupID>113045</SubGroupID><ARTGs><ARTG>143665</ARTG></ARTGs><MinimumBenefit>3064</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT029</BillingCode><Name>Gore Tips Endoprosthesis</Name><Description>ePTFE</Description><Size>8-12mm Diameter 4-8cm Graft-Lined Length 2cm Unlined Length</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109319</GroupID><SubGroupID>113045</SubGroupID><ARTGs><ARTG>94146</ARTG></ARTGs><MinimumBenefit>3064</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT226</BillingCode><Name>GORE® VIABAHN® Endoprosthesis with Propaten Bioactive Surface</Name><Description>GORE® VIABAHN® Endoprosthesis with Propaten Bioactive Surface is a flexible, self expanding endoluminal device consisting of an ePTFE lining with external nitinol support</Description><Size>5mmx 15cm 120cm, 6mmx 15cm 75cm 6mmx 15cm 120cm 7mmx 15cm 75cm 7mmx 15cm 120cm 8mmx 15cm 75cm 8mmx 15cm 120cm 9mmx 15cm 75cm 9mmx 15cm 120cm 10mmx 15cm 75cm, 10mmx 15cm 120cm 11mmx 15cm 75cm 11mmx 15cm 120cm 13mmx 15cm  75cm 13mmx 15cm 120cm</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109319</GroupID><SubGroupID>113046</SubGroupID><Suffix>H (heparin)</Suffix><ARTGs><ARTG>160210</ARTG></ARTGs><MinimumBenefit>3723</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT262</BillingCode><Name>GORE® VIABAHN® Endoprosthesis with Propaten Bioactive Surface</Name><Description>GORE® VIABAHN® Endoprosthesis with Propaten Bioactive Surface  is a flexible, self expanding endoluminal device consisting of an ePTFE lining with external nitinol support</Description><Size>5mm x 25cm x 120CATH  6mm x 25cm x 120CATH  7mm x 25cm x 120CATH  8mm x 25cm x 120CATH</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107792</SubCategoryID><GroupID>109319</GroupID><SubGroupID>113047</SubGroupID><Suffix>H (heparin)</Suffix><ARTGs><ARTG>160210</ARTG></ARTGs><MinimumBenefit>5077</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT287</BillingCode><Name>GORE-TEX® Vascular Grafts</Name><Description>Vascular Grafts - Aorto - Pulmonary &amp; Systemic Pulmonary Shunts (ePTFE) Stretch &amp; Non Stretch Standard Wall &amp; Thin Wall</Description><Size>Diameter 3 - 12mm, Length 5-10cm</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113048</SubGroupID><ARTGs><ARTG>137803</ARTG><ARTG>137804</ARTG></ARTGs><MinimumBenefit>221</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER168</BillingCode><Name>LifeSpan ePTFE vascular grafts-straight, regular or thin wall-10cm</Name><Description>LifeSpan ePTFE vascular grafts-straight, regular or thin wall-5-8 mm dia x length 10cm</Description><Size>5-8 mm dia x 10 cm long</Size><SupplierCode>40067</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113048</SubGroupID><ARTGs><ARTG>216528</ARTG></ARTGs><MinimumBenefit>221</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB025</BillingCode><Name>Vascular Uni - Graft</Name><Description>Vascular graft</Description><Size>10cm</Size><SupplierCode>40020</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113048</SubGroupID><ARTGs><ARTG>142665</ARTG></ARTGs><MinimumBenefit>221</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER679</BillingCode><Name>LeMaitre Omniflow II Vascular Prosthesis-20 cm</Name><Description>Omniflow II Vascular Prosthesis 20 cm, bioengineered, straight</Description><Size>diameter:5-8 mm  length: 20 cm</Size><SupplierCode>40067</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113049</SubGroupID><Suffix>Biologically Engineered</Suffix><ARTGs><ARTG>399614</ARTG></ARTGs><MinimumBenefit>1104</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GX026</BillingCode><PriorBillingCodes><PriorBillingCode>MQ020</PriorBillingCode></PriorBillingCodes><Name>Advanta PTFE Vascular Graft</Name><Description>Trilaminate PTFE Graft with Graft Deployment System</Description><Size>4mm - 8mm  11cm - 20cm length</Size><SupplierCode>39943</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113049</SubGroupID><Suffix>R (ringed)</Suffix><ARTGs><ARTG>279716</ARTG></ARTGs><MinimumBenefit>964</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA022</BillingCode><Name>Impra PTFE Vascular Grafts</Name><Description>ePTFE graft - radially supported, regular wall, 10-50cm long</Description><Size>4 - 19mm diameter</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113049</SubGroupID><Suffix>R (ringed)</Suffix><ARTGs><ARTG>23171</ARTG></ARTGs><MinimumBenefit>964</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GX011</BillingCode><PriorBillingCodes><PriorBillingCode>MQ018</PriorBillingCode></PriorBillingCodes><Name>Advanta PTFE Vascular Graft with Graft Deployment System</Name><Description>Trilaminate PTFE. Vascular Access PTFE</Description><Size>4mm - 8mm diameter  11cm - 20cm length</Size><SupplierCode>39943</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113049</SubGroupID><Suffix>R, ID</Suffix><ARTGs><ARTG>279716</ARTG></ARTGs><MinimumBenefit>1091</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA019</BillingCode><Name>Impra PTFE Vascular Grafts</Name><Description>ePTFE graft - radially supported, thin wall, 10 - 50cm long</Description><Size>4mm - 8mm diameter</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113049</SubGroupID><Suffix>R (ringed)</Suffix><ARTGs><ARTG>23171</ARTG></ARTGs><MinimumBenefit>964</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA020</BillingCode><Name>Impra PTFE Vascular Grafts</Name><Description>ePTFE graft - thin wall, 10 - 50cm long</Description><Size>3mm - 10mm diameter</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113049</SubGroupID><ARTGs><ARTG>23171</ARTG></ARTGs><MinimumBenefit>508</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA025</BillingCode><Name>Impra PTFE Vascular Grafts</Name><Description>ePTFE graft - regular wall, 10-50cm long</Description><Size>3 - 19mm diameter</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113049</SubGroupID><ARTGs><ARTG>23171</ARTG></ARTGs><MinimumBenefit>508</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT290</BillingCode><PriorBillingCodes><PriorBillingCode>GT009</PriorBillingCode><PriorBillingCode>GT146</PriorBillingCode><PriorBillingCode>GT283</PriorBillingCode></PriorBillingCodes><Name>GORE-TEX ® Stretch Vascular Graft</Name><Description>E-PTFE Vascular Graft</Description><Size>Diameters: 3 to 24mm
Lengths: 11-20cm</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113049</SubGroupID><ARTGs><ARTG>137804</ARTG></ARTGs><MinimumBenefit>508</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GX012</BillingCode><PriorBillingCodes><PriorBillingCode>MQ029</PriorBillingCode></PriorBillingCodes><Name>Intergard W - Woven Straight</Name><Description>Woven Straight</Description><Size>15cm</Size><SupplierCode>39943</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113049</SubGroupID><ARTGs><ARTG>145512</ARTG></ARTGs><MinimumBenefit>508</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER169</BillingCode><Name>LifeSpan ePTFE vascular grafts-straight-regular or thin wall-20cm</Name><Description>LifeSpan ePTFE vascular grafts-straight-regular or thin wall; 5-8mm dia x 20 cm long</Description><Size>5-8 mm dia x 20 cm long</Size><SupplierCode>40067</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113049</SubGroupID><ARTGs><ARTG>216528</ARTG></ARTGs><MinimumBenefit>508</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB024</BillingCode><Name>Vascular Uni - Graft</Name><Description>Vascular graft</Description><Size>15cm</Size><SupplierCode>40020</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113049</SubGroupID><ARTGs><ARTG>142665</ARTG></ARTGs><MinimumBenefit>508</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB023</BillingCode><Name>Vascular Uni - Graft</Name><Description>Vascular graft</Description><Size>20cm</Size><SupplierCode>40020</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113049</SubGroupID><ARTGs><ARTG>142665</ARTG></ARTGs><MinimumBenefit>508</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GX025</BillingCode><PriorBillingCodes><PriorBillingCode>MQ021</PriorBillingCode></PriorBillingCodes><Name>Advanta PTFE Vascular Graft</Name><Description>Trilaminate PTFE Graft with Graft Deployment System</Description><Size>4mm - 8mm diameter 21cm - 49cm length</Size><SupplierCode>39943</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113050</SubGroupID><Suffix>R (ringed)</Suffix><ARTGs><ARTG>279716</ARTG></ARTGs><MinimumBenefit>1351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BN028</BillingCode><Name>Omniflow II Vascular Prosthesis</Name><Description>Biosynthetic vascular prosthesis for peripheral revascularisation and vascular access</Description><Size>9 and 10mm internal diameter; 45 to 85cm length</Size><SupplierCode>39945</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113050</SubGroupID><ARTGs><ARTG>155500</ARTG></ARTGs><MinimumBenefit>550</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BN026</BillingCode><Name>Omniflow II Vascular Prosthesis</Name><Description>Biosynthetic vascular prosthesis for peripheral revascularisation and vascular access</Description><Size>9 and 10mm internal diameter, 20 to 40cm length</Size><SupplierCode>39945</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113050</SubGroupID><ARTGs><ARTG>155500</ARTG></ARTGs><MinimumBenefit>550</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT252</BillingCode><Name>GORE-TEX ® Stretch Vascular Graft</Name><Description>Standard Wall and Thin Wall ePTFE Vascular Grafts
Removable Rings</Description><Size>4 to 10 mm diameter
21 to 49cm lengths
various removable ring sections</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113050</SubGroupID><Suffix>R (ringed)</Suffix><ARTGs><ARTG>137805</ARTG></ARTGs><MinimumBenefit>1351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT211</BillingCode><Name>Gore-Tex Intering Vascular Graft</Name><Description>Internally radially supported vascular graft (ePTFE)</Description><Size>Diameter 6-8mm, 40cm radial supported length x 40cm length</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113050</SubGroupID><Suffix>R (ringed)</Suffix><ARTGs><ARTG>143262</ARTG></ARTGs><MinimumBenefit>1351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU019</BillingCode><Name>Gelsoft Plus Graft</Name><Description>Femoro-femoral, Polyester, Knitted, Externally reinforced</Description><Size>6mmx30cm to  8mmx40cm</Size><SupplierCode>40450</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113050</SubGroupID><Suffix>R (ringed)</Suffix><ARTGs><ARTG>125679</ARTG></ARTGs><MinimumBenefit>1351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT221</BillingCode><Name>Gore ® Propaten ® Vascular Graft</Name><Description>Stretch and Non Stretch ePTFE Graft
Standard Wall and Thin Wall Stretch  
Heparin Bonded</Description><Size>4 to 8 mm diameters
21 to 49cm lengths</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113050</SubGroupID><Suffix>H (heparin)</Suffix><ARTGs><ARTG>160152</ARTG></ARTGs><MinimumBenefit>876</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT264</BillingCode><Name>Gore ® PROPATEN ® Vascular Graft</Name><Description>Standard Wall and Thin Wall ePTFE Vascular Graft
Removable Rings 
Heparin Bonded</Description><Size>4 to 8mm diameter
21 to 49cm length
30cm ringed length</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113050</SubGroupID><Suffix>R, H</Suffix><ARTGs><ARTG>160152</ARTG></ARTGs><MinimumBenefit>1462</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GX013</BillingCode><PriorBillingCodes><PriorBillingCode>MQ019</PriorBillingCode></PriorBillingCodes><Name>Advanta PTFE Vascular Graft with Graft Deployment System</Name><Description>Trilaminate PTFE. Vascular Access PTFE</Description><Size>4mm - 8mm diameter  21cm - 49cm length</Size><SupplierCode>39943</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113050</SubGroupID><Suffix>R, ID</Suffix><ARTGs><ARTG>279716</ARTG></ARTGs><MinimumBenefit>1552</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER680</BillingCode><Name>LeMaitre Omniflow II Vascular Prosthesis-30-40cm</Name><Description>Omniflow II Vascular Prosthesis, biologically engineered, 30-40 cm, straight or curved</Description><Size>diameter: 5-8 mm  Length: 30-40 cm</Size><SupplierCode>40067</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113050</SubGroupID><Suffix>Biologically engineered</Suffix><ARTGs><ARTG>399614</ARTG><ARTG>399615</ARTG></ARTGs><MinimumBenefit>1976</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT291</BillingCode><PriorBillingCodes><PriorBillingCode>GT281</PriorBillingCode><PriorBillingCode>GT282</PriorBillingCode></PriorBillingCodes><Name>GORE-TEX ® Stretch Vascular Graft</Name><Description>E-PTFE Vascular Graft</Description><Size>Diameters: 3 to 24mm
Lengths: 21-49cm</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113050</SubGroupID><ARTGs><ARTG>137804</ARTG></ARTGs><MinimumBenefit>550</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GX014</BillingCode><Name>Maquet InterVascular Straight vascular Grafts</Name><Description>Straight Vascular Grafts</Description><Size>6mm - 38mm diameter, Length 30cm - 40cm</Size><SupplierCode>39943</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113050</SubGroupID><ARTGs><ARTG>145380</ARTG><ARTG>145510</ARTG><ARTG>145512</ARTG></ARTGs><MinimumBenefit>550</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB021</BillingCode><Name>Vascular Uni - Graft</Name><Description>Vascular graft</Description><Size>40cm</Size><SupplierCode>40020</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113050</SubGroupID><ARTGs><ARTG>142665</ARTG></ARTGs><MinimumBenefit>550</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB022</BillingCode><Name>Vascular Uni - Graft</Name><Description>Vascular graft</Description><Size>30cm</Size><SupplierCode>40020</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113050</SubGroupID><ARTGs><ARTG>142665</ARTG></ARTGs><MinimumBenefit>550</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU020</BillingCode><Name>Gelsoft Plus Graft</Name><Description>Straight, Polyester, Knitted</Description><Size>6 - 24mm x 12.5 - 30cm</Size><SupplierCode>40450</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113050</SubGroupID><ARTGs><ARTG>125679</ARTG></ARTGs><MinimumBenefit>550</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GX019</BillingCode><Name>Maquet InterVascular Straight Vascular Grafts</Name><Description>Straight Vascular Grafts</Description><Size>6mm - 32mm Diameter, 60cm -100cm length</Size><SupplierCode>39943</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113051</SubGroupID><ARTGs><ARTG>145380</ARTG><ARTG>145510</ARTG><ARTG>145512</ARTG></ARTGs><MinimumBenefit>663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT288</BillingCode><Name>GORE-TEX® Vascular Grafts</Name><Description>Standard Wall, Thin Wall and Stretch Technology (eptfe)</Description><Size>Diameters: 3-12mm
Lengths: ≥   50 cm</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113051</SubGroupID><ARTGs><ARTG>137804</ARTG><ARTG>137803</ARTG></ARTGs><MinimumBenefit>663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GX017</BillingCode><PriorBillingCodes><PriorBillingCode>MQ016</PriorBillingCode></PriorBillingCodes><Name>Advanta PTFE Vascular Graft</Name><Description>Straight PTFE Vascular Graft</Description><Size>6mm - 10mm; 50cm - 90cm</Size><SupplierCode>39943</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113051</SubGroupID><ARTGs><ARTG>279716</ARTG></ARTGs><MinimumBenefit>663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA254</BillingCode><Name>Bard Vascular Graft</Name><Description>PTFE graft</Description><Size>50 cm or &gt; 50cm</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113051</SubGroupID><ARTGs><ARTG>134452</ARTG></ARTGs><MinimumBenefit>663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU021</BillingCode><Name>Gelsoft Plus Graft</Name><Description>Straight, Polyester, Knitted</Description><Size>6-24mm x 50-60cm</Size><SupplierCode>40450</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113051</SubGroupID><ARTGs><ARTG>125679</ARTG></ARTGs><MinimumBenefit>663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB019</BillingCode><Name>Vascular Uni - Graft</Name><Description>Vascular graft</Description><Size>60cm</Size><SupplierCode>40020</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113051</SubGroupID><ARTGs><ARTG>142665</ARTG></ARTGs><MinimumBenefit>663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB020</BillingCode><Name>Vascular Uni - Graft</Name><Description>Vascular graft</Description><Size>50cm</Size><SupplierCode>40020</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113051</SubGroupID><ARTGs><ARTG>142665</ARTG></ARTGs><MinimumBenefit>663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB018</BillingCode><Name>Vascular Uni - Graft</Name><Description>Vascular graft</Description><Size>100cm</Size><SupplierCode>40020</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113051</SubGroupID><ARTGs><ARTG>142665</ARTG></ARTGs><MinimumBenefit>663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU045</BillingCode><Name>Gelsoft Plus Graft</Name><Description>Polyester, Externally Reinforced, Knitted</Description><Size>6 to 10cm x 75 to 100cm</Size><SupplierCode>40450</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113051</SubGroupID><Suffix>R (ringed)</Suffix><ARTGs><ARTG>125679</ARTG></ARTGs><MinimumBenefit>1440</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA255</BillingCode><Name>Bard Vascular Grafts</Name><Description>PFTE Graft - radial support</Description><Size>50cm or &gt; 50cm</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113051</SubGroupID><Suffix>R (ringed)</Suffix><ARTGs><ARTG>134552</ARTG></ARTGs><MinimumBenefit>1440</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER170</BillingCode><Name>LifeSpan ePTFE vascular grafts-straight-regular or thin wall, 50-100 cm</Name><Description>LifeSpan ePTFE vascular grafts-straight-regular or thin wall, 5-10 mm dia x length 50-100 cm</Description><Size>5-10 mm dia x length 50-100 cm</Size><SupplierCode>40067</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113051</SubGroupID><ARTGs><ARTG>216528</ARTG></ARTGs><MinimumBenefit>663</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT286</BillingCode><Name>GORE® INTERING® Vascular Graft</Name><Description>Stretch Thin Walled ePTFE graft with Integrated Rings</Description><Size>6-8mm diameter, 60-80 cm integrated ringed section, ≥50cm length</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113051</SubGroupID><Suffix>R (ringed)</Suffix><ARTGs><ARTG>143262</ARTG></ARTGs><MinimumBenefit>1440</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GX016</BillingCode><Name>InterVascular Radially Supported Vascular Grafts</Name><Description>Radially Supported Vascular Grafts</Description><Size>6mm - 8mm diameter, 70cm - 85cm length</Size><SupplierCode>39943</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113051</SubGroupID><Suffix>R (ringed)</Suffix><ARTGs><ARTG>145506</ARTG><ARTG>145511</ARTG></ARTGs><MinimumBenefit>1440</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER171</BillingCode><Name>LifeSpan ePTFE vascular grafts-straight-supported-regular or thin wall, 50-80 cm</Name><Description>LifeSpan ePTFE vascular grafts-straight-supported; regular and thin wall; 6-10 mm dia x 50-80 cm length; 10-80 cm external spiral support length</Description><Size>6-10 mm dia x 50-80 cm length; 10-80 cm external spiral support length</Size><SupplierCode>40067</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113051</SubGroupID><Suffix>R (ringed)</Suffix><ARTGs><ARTG>216528</ARTG></ARTGs><MinimumBenefit>1440</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT278</BillingCode><Name>GORE-TEX ® Stretch Vascular Graft</Name><Description>Standard Wall and Thin Wall
Removable Rings
ePTFE Vascular Graft</Description><Size>4 to 10 mm diameters
≥ 50cm lengths</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113051</SubGroupID><Suffix>R (ringed)</Suffix><ARTGs><ARTG>137805</ARTG></ARTGs><MinimumBenefit>1440</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT222</BillingCode><Name>Gore ® Propaten ® Vascular Graft</Name><Description>Standard Wall and Thin Wall ePTFE Graft
Stretch and Non Stretch  
Heparin Bonded</Description><Size>4 to 8mm diameter 
≥ 50cm length</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113051</SubGroupID><Suffix>H (heparin)</Suffix><ARTGs><ARTG>160152</ARTG></ARTGs><MinimumBenefit>966</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GT285</BillingCode><Name>GORE® PROPATEN® Vascular Graft</Name><Description>Standard Wall and Thin Wall ePTFE Vascular Graft
Removable Rings
Heparin Bonded</Description><Size>6-8mm diameter
30-70cm ringed section, 
≥ 50cm length</Size><SupplierCode>40435</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113051</SubGroupID><Suffix>R, H</Suffix><ARTGs><ARTG>160152</ARTG></ARTGs><MinimumBenefit>1561</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER681</BillingCode><Name>LeMaitre Omniflow II Vascular Prosthesis-≥50cm</Name><Description>Omniflow II Vascular Prosthesis-≥50cm. biologically engineered, straight</Description><Size>diameter:5-8 mm  length: 50-65 cm</Size><SupplierCode>40067</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113051</SubGroupID><Suffix>Biologically engineered</Suffix><ARTGs><ARTG>399614</ARTG></ARTGs><MinimumBenefit>2736</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>GX015</BillingCode><PriorBillingCodes><PriorBillingCode>MQ017</PriorBillingCode></PriorBillingCodes><Name>Atrium PTFE Vascular Graft</Name><Description>Ringed PTFE</Description><Size>4mm - 10mm; 50cm - 100cm</Size><SupplierCode>39943</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107793</SubCategoryID><GroupID>109320</GroupID><SubGroupID>113051</SubGroupID><Suffix>R (ringed)</Suffix><ARTGs><ARTG>279716</ARTG></ARTGs><MinimumBenefit>1440</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BN020</BillingCode><Name>Omniflow II Vascular Prostheses - Straight</Name><Description>Vascular Patch</Description><Size>1.5cm x 5cm (less than 8 sq. Cm)</Size><SupplierCode>39945</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107794</SubCategoryID><GroupID>109324</GroupID><SubGroupID>113054</SubGroupID><ARTGs><ARTG>155500</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BN021</BillingCode><Name>Omniflow II Vascular Prostheses - Straight</Name><Description>Vascular Patch</Description><Size>2.5cm x 10cm (more than 8 sq. cm</Size><SupplierCode>39945</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107794</SubCategoryID><GroupID>109324</GroupID><SubGroupID>113054</SubGroupID><ARTGs><ARTG>155500</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA257</BillingCode><Name>Bard Vascular Graft</Name><Description>Vascular Graft Patch</Description><Size>3x6cm, 2.5x15cm, 2x9cm, 5x7.5cm, 2.5x2.5cm, 10x10cm, 5.1x10.2cm, 6x5.1cm, 1.2x10cm, 5x5cm</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107794</SubCategoryID><GroupID>109324</GroupID><SubGroupID>113054</SubGroupID><ARTGs><ARTG>150354</ARTG><ARTG>150352</ARTG><ARTG>150359</ARTG><ARTG>150361</ARTG><ARTG>150353</ARTG><ARTG>150360</ARTG><ARTG>150355</ARTG><ARTG>150376</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB017</BillingCode><Name>Vascular Patch</Name><Description>Vascular patch</Description><Size>12x9 to 3x4</Size><SupplierCode>40020</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107794</SubCategoryID><GroupID>109324</GroupID><SubGroupID>113054</SubGroupID><ARTGs><ARTG>142664</ARTG></ARTGs><MinimumBenefit>166</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA258</BillingCode><Name>Bard Vascular Graft</Name><Description>Vascular Graft Patch</Description><Size>101 - 150sq cm</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107794</SubCategoryID><GroupID>109324</GroupID><SubGroupID>113055</SubGroupID><ARTGs><ARTG>150354</ARTG><ARTG>150357</ARTG><ARTG>150359</ARTG><ARTG>150361</ARTG><ARTG>150355</ARTG><ARTG>150376</ARTG></ARTGs><MinimumBenefit>239</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA259</BillingCode><Name>Bard Vascular Graft</Name><Description>Vascular Graft Patch</Description><Size>15 x 15cm</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107794</SubCategoryID><GroupID>109324</GroupID><SubGroupID>113056</SubGroupID><ARTGs><ARTG>150355</ARTG><ARTG>150376</ARTG><ARTG>150352</ARTG><ARTG>150359</ARTG><ARTG>150360</ARTG><ARTG>150361</ARTG><ARTG>150354</ARTG><ARTG>150357</ARTG></ARTGs><MinimumBenefit>324</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA039</BillingCode><Name>Grafts Vascular</Name><Description>Polyester pledgets</Description><Size>Rectangle, Oval, Circle, Square 2.9mm-8mm x 6mm - 9.5mm</Size><SupplierCode>39949</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107794</SubCategoryID><GroupID>109324</GroupID><SubGroupID>113057</SubGroupID><ARTGs><ARTG>24168</ARTG></ARTGs><MinimumBenefit>22</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PN012</BillingCode><Name>Penumbra Ruby Coil System</Name><Description>The Ruby Coil System is comprised of a platinum embolisation coil attached to a composite pusher with a radiopaque positioning marker. The coil is transferred onto the microcatheter and the coil should be advanced under fluoroscopic guidance. The detachment handle is attached and advanced over the proximal end of the delivery pusher and then the coil is detached by using the retraction button on the handle into the preferred site.</Description><Size>Diameter.mm. - Length .cm.     3 x 5   3 x 12    3 x 20     4 x 10    4 x 15     4 x 20   4 x 30     4 x 35    5 x 12     5 x 20    5 x 30   6 x 12    6 x 20      6 x 30     7 x 25      7  x40   8 x 25      8 x 40    9 x 30     10 x 35    12 x 40    12 x 60    14 x 40     14 x 60    16 x 60     18 x 57    20 x 60     24 x 57    28 x 60     32 x 60    36 x 60  40 x 60  2 x 1     2 x 2    2 x 4     3 x 5    3 x 15     4 x 6    4 x 15    6 x 20    6 x 30    8 x 35   8 x 60     10 x 35    12 x 40     16 x 50    20 x 60    </Size><SupplierCode>40107</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109332</GroupID><SubGroupID>113059</SubGroupID><Suffix>P, repositionable (Platinum, repositionable)</Suffix><ARTGs><ARTG>227196</ARTG></ARTGs><MinimumBenefit>825</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>EE034</BillingCode><Name>Concerto Detachable Coil System</Name><Description>Platinum alloy coils (including coils enlaced with PGLA filaments and Nylon Fibers)  attached to a composite implant delivery pusher with a radiopaque positioning marker. The proximal end of the pusher is loaded into the Actuator which detaches the coil.</Description><Size>Diameter:  1.5 - 25mm; Length:  1 - 50cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109332</GroupID><SubGroupID>113059</SubGroupID><Suffix>P, repositionable (Platinum, repositionable)</Suffix><ARTGs><ARTG>205313</ARTG><ARTG>337400</ARTG></ARTGs><MinimumBenefit>825</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI453</BillingCode><Name>Concerto Versa Detachable Coil</Name><Description>Platinum-tungsten embolization coil (enlaced with nylon fibers) attached to a composite delivery pusher, and a hand-held Instant Detacher.</Description><Size>Diameters 3–32 mm, Length 5-65 cm.</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109332</GroupID><SubGroupID>113059</SubGroupID><Suffix>P, repositionable (Platinum, repositionable)</Suffix><ARTGs><ARTG>337400</ARTG></ARTGs><MinimumBenefit>825</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC320</BillingCode><Name>Retracta Detachable Embolization Coil</Name><Description>The Retracta Detachable Embolization Coil is a platinum coil with spaced synthetic fibers, and is attached to a delivery wire.</Description><Size>Coiled embolus diameters: 4-20mm
Length: 7-14cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109332</GroupID><SubGroupID>113059</SubGroupID><Suffix>P, repositionable (Platinum, repositionable)</Suffix><ARTGs><ARTG>210182</ARTG></ARTGs><MinimumBenefit>825</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS021</BillingCode><Name>Interlock Detachable Coils</Name><Description>Platinum-tungsten, Fibered Occlusion System</Description><Size>Coil diameters up to 30mm and lengths up to 100cm. Delivery system lengths up 200cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109332</GroupID><SubGroupID>113059</SubGroupID><Suffix>P, ids (Platinum, integral delivery system)</Suffix><ARTGs><ARTG>322240</ARTG><ARTG>293646</ARTG></ARTGs><MinimumBenefit>825</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PY009</BillingCode><Name>Platinum Spirale and Cirrus embolisation coils 100-150mm</Name><Description>Embolisation coils with or without fibers</Description><Size>Spiral diameter: 4mm to 11mm
Length: 100mm to 150mm
Coil diameter:  0.27mm to 0.82mm</Size><SupplierCode>40093</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109332</GroupID><SubGroupID>113059</SubGroupID><Suffix>P (Platinum)</Suffix><ARTGs><ARTG>175423</ARTG><ARTG>175567</ARTG></ARTGs><MinimumBenefit>116</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PY008</BillingCode><Name>Platinum Spirale and Cirrus embolisation coils &lt;100mm</Name><Description>Embolisation coils with or without fibers</Description><Size>Spiral diameter 2mm to 16mm
Length: 25mm to 80mm
Coil diameter: 0.27mm to 0.82mm</Size><SupplierCode>40093</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109332</GroupID><SubGroupID>113059</SubGroupID><Suffix>P (Platinum)</Suffix><ARTGs><ARTG>175423</ARTG><ARTG>175567</ARTG></ARTGs><MinimumBenefit>116</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC173</BillingCode><Name>Cook Embolisation Coils</Name><Description>Nester Platinum</Description><Size>Recommended catheter ID and end hole  diameter inch: .018 and .035inch. Coiled embolus diameters:  2mm to 20mm. Extended embolus lengths: 30 to 200mm.</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109332</GroupID><SubGroupID>113059</SubGroupID><Suffix>P (Platinum)</Suffix><ARTGs><ARTG>372277</ARTG></ARTGs><MinimumBenefit>116</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC038</BillingCode><Name>Coil - Embolisation Coils MWCE-TORNADO</Name><Description>Tornado Platinum</Description><Size>Diameters: .018, .035 and .038, Coil Taper Diameters: 2mm to 10mm</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109332</GroupID><SubGroupID>113059</SubGroupID><Suffix>P (Platinum)</Suffix><ARTGs><ARTG>372277</ARTG></ARTGs><MinimumBenefit>116</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC190</BillingCode><Name>MReye Embolization Coil</Name><Description>Standard MReye</Description><Size>Diameters: .035 and .038, Extended Lengths: 1cm to 20cm, Coil Diameters: 2mm to 20mm</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109332</GroupID><SubGroupID>113059</SubGroupID><ARTGs><ARTG>372278</ARTG></ARTGs><MinimumBenefit>53</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU053</BillingCode><Name>AZUR Peripheral HydroCoil</Name><Description>AZUR Peripheral Coil, detachable</Description><Size>3-20mm diameter, length 3-50cm</Size><SupplierCode>40450</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109332</GroupID><SubGroupID>113059</SubGroupID><Suffix>P, Gel, repositionable (Platinum, Gel, repostionable)</Suffix><ARTGs><ARTG>190399</ARTG></ARTGs><MinimumBenefit>985</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS400</BillingCode><Name>EMBOLD Fully Retractable Coils</Name><Description>Platinum-tungsten, Fibered Occlusion System </Description><Size>Coil diameters up to 32mm and lengths up to 60cm, Delivery system lengths up to 200 cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109332</GroupID><SubGroupID>113059</SubGroupID><Suffix>P, repositionable (Platinum, repositionable)</Suffix><ARTGs><ARTG>322240</ARTG></ARTGs><MinimumBenefit>825</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU052</BillingCode><Name>AZUR Peripheral Framing Coil</Name><Description>AZUR Peripheral Coil,detachable, Framing Coil three dimensional complex shape</Description><Size>8-20mm diameter, length 20-50cm</Size><SupplierCode>40450</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109332</GroupID><SubGroupID>113059</SubGroupID><Suffix>P, repositionable (Platinum, repositionable)</Suffix><ARTGs><ARTG>190399</ARTG></ARTGs><MinimumBenefit>825</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PY051</BillingCode><Name>Prestige Plus Detachable Coil</Name><Description>Implantable embolization Coil comprised of platinum-tungsten alloy attached to a proximal stainless steel hypo-tube and distal body coil delivery pusher with a radiopaque distal positioning marker and a proximal fluorosafe marker.  </Description><Size>Diameter 2mm-24mm  Length 2cm-65cm</Size><SupplierCode>40093</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109332</GroupID><SubGroupID>113059</SubGroupID><Suffix>P, repositionable (Platinum, repositionable)</Suffix><ARTGs><ARTG>377475</ARTG></ARTGs><MinimumBenefit>825</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC039</BillingCode><Name>Cook Embolization Coil</Name><Description>Hilal Platinum</Description><Size>Diameters: .018, Extended Lengths: .5cm to 6cm, Coil Diameters: Straight to 10mm</Size><SupplierCode>40434</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109332</GroupID><SubGroupID>113059</SubGroupID><Suffix>P (Platinum)</Suffix><ARTGs><ARTG>142651</ARTG></ARTGs><MinimumBenefit>116</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS026</BillingCode><Name>VortX and Pushable Coils</Name><Description>Pushable coils</Description><Size>Diameters up to 30mm and lengths up to 60mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109332</GroupID><SubGroupID>113059</SubGroupID><Suffix>P (Platinum)</Suffix><ARTGs><ARTG>293646</ARTG></ARTGs><MinimumBenefit>116</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PY010</BillingCode><Name>Platinum Spirale and Cirrus embolisation coils 200-450mm</Name><Description>Embolisation coils with and without fibers</Description><Size>Spiral diameter: 5mm to 16mm
Length: 200mm to 450mm
Coil diameter: 0.82mm</Size><SupplierCode>40093</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109332</GroupID><SubGroupID>113060</SubGroupID><Suffix>P (Platinum)</Suffix><ARTGs><ARTG>175423</ARTG><ARTG>175567</ARTG></ARTGs><MinimumBenefit>231</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VN003</BillingCode><PriorBillingCodes><PriorBillingCode>BS314</PriorBillingCode></PriorBillingCodes><Name>Embozene Microspheres</Name><Description>Uniquely colour-coded microspheres used in the embolization of hypervascular tumours and arteriovenous malformations</Description><Size>In between the range of 40 - 1130 micron -  2ml</Size><SupplierCode>40439</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109333</GroupID><SubGroupID>113065</SubGroupID><ARTGs><ARTG>289243</ARTG></ARTGs><MinimumBenefit>295</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU065</BillingCode><Name>Embolization Microsphere</Name><Description>HydroPearl™ microspheres are part of a family of embolic materials based on MicroVention’s
proprietary microsphere technology. These spheres are designed to offer controlled,
targeted embolisation. HydroPearl™ is made using Poly-Ethylene Glycol and comprises
of a range of microspheres that are pre-formed, compressible, calibrated, spherical and
biocompatible.</Description><Size>75-1100 micron</Size><SupplierCode>40450</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109333</GroupID><SubGroupID>113065</SubGroupID><ARTGs><ARTG>292403</ARTG></ARTGs><MinimumBenefit>295</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OW011</BillingCode><Name>Embospheres</Name><Description>-</Description><Size>2ml per implant</Size><SupplierCode>40178</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109333</GroupID><SubGroupID>113065</SubGroupID><ARTGs><ARTG>144426</ARTG></ARTGs><MinimumBenefit>295</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI285</BillingCode><Name>VenaSeal™ Closure System</Name><Description>A system including the cyanoacrylate liquid embolic material and accessories (delivery catheter, dispensing gun, adhesive (bottle), syringe, dispenser tip, introducer, dilator, straight tip guide)</Description><Size>One system</Size><SupplierCode>40151</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109335</GroupID><SubGroupID>113067</SubGroupID><ARTGs><ARTG>421297</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Description, Size</ChangeExplanation><MinimumBenefit>713</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DL004</BillingCode><Name>VenaBlock Venous Closure System</Name><Description>VenaBlock is an n-Butyy Cyanoacrylate-polymer structure which was modified by adding a monomer synthesized by the producing company. It is a ready for use, blue colored, transparent liquid. The product exhibits a polymerization effect with embolization. When in contact with living tissue and in humid environments, it rapidly polymerises  by forming a thin, flexible membrane with high tension resistance that adheres firmly to the tissues.</Description><Size>One size</Size><SupplierCode>39987</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109335</GroupID><SubGroupID>113067</SubGroupID><ARTGs><ARTG>283020</ARTG></ARTGs><MinimumBenefit>713</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU054</BillingCode><Name>AZUR Peripheral Coil Detachment Controller</Name><Description>Hand held battery powered coil detachment controller</Description><Size>One size only</Size><SupplierCode>40450</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109336</GroupID><SubGroupID>113069</SubGroupID><ARTGs><ARTG>190400</ARTG></ARTGs><MinimumBenefit>206</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PN021</BillingCode><PriorBillingCodes><PriorBillingCode>PN016</PriorBillingCode></PriorBillingCodes><Name>POD Detachmnet Handle</Name><Description>The POD Detachment handle is a plastic handle used to mechanically detach the POD Implant. Sterile Single use patient device</Description><Size>N/A</Size><SupplierCode>40107</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109336</GroupID><SubGroupID>113069</SubGroupID><ARTGs><ARTG>233485</ARTG></ARTGs><MinimumBenefit>206</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PY052</BillingCode><Name>Ultra, Prestige Plus Coil Detachment Controller</Name><Description>Handheld battery powered coil detachment controller  </Description><Size>One Size only</Size><SupplierCode>40093</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109336</GroupID><SubGroupID>113069</SubGroupID><ARTGs><ARTG>376881</ARTG></ARTGs><MinimumBenefit>206</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PN017</BillingCode><Name>Penumbra Ruby Coil System, Detachment Handle</Name><Description>The Ruby Coil System is comprised of a platinum embolisation coil attached to a composite pusher with a radiopaque positioning marker and a Detachment Handle. The coil is transferred onto the microcatheter and the coil should be advanced under fluoroscopic guidance. The detachment handle is attached and advanced over the proximal end of the delivery pusher and then the coil is detached by using the retraction button on the handle into the preferred site.</Description><Size>N/A</Size><SupplierCode>40107</SupplierCode><CategoryID>107574</CategoryID><SubCategoryID>107799</SubCategoryID><GroupID>109336</GroupID><SubGroupID>113069</SubGroupID><ARTGs><ARTG>220462</ARTG></ARTGs><MinimumBenefit>206</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC642</BillingCode><Name>Strata Valve Assembly with Bioglide PSM range</Name><Description>CSF Flow Valves. Polypropylene and acetal plastic base. Silicone elastomer dome.</Description><Size>One size</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Antisyphon function, Coating, Distal catheter, Reservoir/Priming function</Suffix><ARTGs><ARTG>169061</ARTG></ARTGs><MinimumBenefit>2857</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB338</BillingCode><Name>Miethke proGAV with pre-attached reservoir</Name><Description>Shunt system containing an adjustable valve with a gravitational unit and a reservoir.</Description><Size>Adjustable valve: diameter 18mm, opening pressure 0-20 cmH20, height 4.5mm.  Gravitational unit: length 14.9mm, height 4.6mm, opening pressure 0-35 cmH2O  Reservoir: diameter 14/20mm.</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Antisyphon function, Distal catheter, Reservoir/Priming function</Suffix><ARTGs><ARTG>181718</ARTG><ARTG>375143</ARTG></ARTGs><MinimumBenefit>2757</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG154</BillingCode><PriorBillingCodes><PriorBillingCode>JJ159</PriorBillingCode></PriorBillingCodes><Name>Hakim Programmable Valve System</Name><Description>Standard system. Silicone casing with catheter; stainless steel ruby ball in cone mechanism with variable pressure</Description><Size>Peritoneal Catheter length 80 cm, Ventricular catheter length 14 cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Distal catheter, Proximal catheter, Reservoir/Priming function</Suffix><ARTGs><ARTG>149291</ARTG></ARTGs><MinimumBenefit>2437</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC963</BillingCode><Name>Strata NSC Burr Hole Shunt Assembly</Name><Description>Adjustable cerebrospinal fluid (CSF) flow valve. Polypropylene and acetal plastic base. Silicone elastomer dome. With integral catheter.</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Distal catheter, Reservoir/Priming function</Suffix><ARTGs><ARTG>169061</ARTG></ARTGs><MinimumBenefit>2306</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC646</BillingCode><Name>Strata Valve Assembly NSC (non siphon control) PSM range</Name><Description>Adjustable CSF valve with five symmetrical performance level steps. Includes a strata valve, an integral distal peritoneal catheter and catheter passer, and a female leur adaptor and prefill tubing.</Description><Size>One size</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Distal catheter, Reservoir/Priming function</Suffix><ARTGs><ARTG>134740</ARTG></ARTGs><MinimumBenefit>2306</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG185</BillingCode><PriorBillingCodes><PriorBillingCode>MN108</PriorBillingCode></PriorBillingCodes><Name>Codman Certas Programmable Valve - with reservoir and catheter</Name><Description>Programmable valve with reservoir and catheters</Description><Size>30-210mmH2O</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Distal catheter, Reservoir/Priming function</Suffix><ARTGs><ARTG>186232</ARTG><ARTG>186234</ARTG></ARTGs><MinimumBenefit>2306</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG166</BillingCode><PriorBillingCodes><PriorBillingCode>JJ436</PriorBillingCode></PriorBillingCodes><Name>Codman Hakim Programmable Valves</Name><Description>Programmable valve with reservoir</Description><Size>One Size Only</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Reservoir/Priming function</Suffix><ARTGs><ARTG>149291</ARTG><ARTG>140904</ARTG></ARTGs><MinimumBenefit>2139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG188</BillingCode><PriorBillingCodes><PriorBillingCode>MN111</PriorBillingCode></PriorBillingCodes><Name>Codman Certas Programmable Valve - with reservoir</Name><Description>Programmable valve with reservoir</Description><Size>30-210mmH2O</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Reservoir/Priming function</Suffix><ARTGs><ARTG>190248</ARTG></ARTGs><MinimumBenefit>2139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI082</BillingCode><Name>Strata Valve NSC PSM Range</Name><Description>Strata NSC, Strata NSC Burr Hole Valve. Adjustable cerebrospinal fluid (CSF) flow valve. Polypropylene and acetal plastic base. Silicone elastomer dome.</Description><Size>13-20mm x 23-35mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Reservoir/Priming function</Suffix><ARTGs><ARTG>129681</ARTG><ARTG>169054</ARTG></ARTGs><MinimumBenefit>2139</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB335</BillingCode><Name>Miethke proGAV with distal catheter</Name><Description>Adjustable valve with a gravitational unit and a distal catheter</Description><Size>Adjustable valve: diameter 18mm, opening pressure 0-20 cmH2O, height 4.5mm  Gravitational unit: length 14.9mm, height 4.6mm, opening pressure 0-35 cm H2O  Distal catheter: length 1200mm, inside diameter 1.2mm, outside diameter 2.5mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Antisyphon function, Distal catheter, Reservoir/Priming function</Suffix><ARTGs><ARTG>181718</ARTG></ARTGs><MinimumBenefit>2757</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI080</BillingCode><Name>Strata NSC LP Shunt Kit</Name><Description>Strata NSC LP Shunt Kit with Lumbar Catheter and Peritoneal Catheter, Small Lumen</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Distal catheter, Lumboperitoneal, Proximal catheter, Reservoir/Priming function</Suffix><ARTGs><ARTG>165018</ARTG></ARTGs><MinimumBenefit>2734</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI019</BillingCode><Name>Strata Valve with Bioglide</Name><Description>Adjustable CSF Valve with five symmetric performance level steps, surface of valve bonded with hydrogel</Description><Size>13-16mm x 35-47mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Antisyphon function, Coating, Reservoir/Priming function</Suffix><ARTGs><ARTG>129681</ARTG></ARTGs><MinimumBenefit>2689</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI087</BillingCode><Name>Strata Valve</Name><Description>Strata Valve, Strata Burr Hole Valve,. Adjustable CSF Valve with five symmetric performance level steps.</Description><Size>13-20mm x 35-50mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Antisyphon function, Reservoir/Priming function</Suffix><ARTGs><ARTG>129681</ARTG><ARTG>169054</ARTG></ARTGs><MinimumBenefit>2591</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI499</BillingCode><Name>StrataMR II Valve</Name><Description>Adjustable CSF Valve with five symmetric performance level steps</Description><Size>Small, Regular</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Antisyphon function, Reservoir/Priming function</Suffix><ARTGs><ARTG>389073</ARTG></ARTGs><MinimumBenefit>2591</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG153</BillingCode><PriorBillingCodes><PriorBillingCode>JJ158</PriorBillingCode></PriorBillingCodes><Name>Hakim Programmable Valve System</Name><Description>Valve only</Description><Size>One size only</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><ARTGs><ARTG>149291</ARTG></ARTGs><MinimumBenefit>1823</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG167</BillingCode><PriorBillingCodes><PriorBillingCode>JJ437</PriorBillingCode></PriorBillingCodes><Name>Codman Hakim Programmable Valves with Siphonguard</Name><Description>18 different pressure settings and SIPHONGUARD technology</Description><Size>One Size Only</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Antisyphon function, Reservoir/Priming function</Suffix><ARTGs><ARTG>140904</ARTG></ARTGs><MinimumBenefit>2591</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB340</BillingCode><Name>Miethke adjustable gratitational unit with differential pressure unit (miniNAV)</Name><Description>proSA and M.blue are adjustable gravitational units for the treatment of hydrocephalus. They can be combined with any differential pressure valve. miniNAV is a very small differential pressure unit, which is often used. The valves are made from titanium and are MR safe up to 3 tesla.</Description><Size>Adjustable gravitational unit: height 4.5mm, diameter 18mm, opening pressure 0-40 cmH2O.  Differential pressure unit (miniNAV): length 14.7mm, diameter 2.8mm.</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Antisyphon function, Reservoir/Priming function</Suffix><ARTGs><ARTG>181718</ARTG></ARTGs><MinimumBenefit>2591</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG186</BillingCode><PriorBillingCodes><PriorBillingCode>MN109</PriorBillingCode></PriorBillingCodes><Name>Codman Certas Programmable Valve - with Reservoir and Siphonguard</Name><Description>Programmable valve with Reservoir and Siphonguard</Description><Size>30-210mmH2O</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Antisyphon function, Reservoir/Priming function</Suffix><ARTGs><ARTG>190248</ARTG></ARTGs><MinimumBenefit>2591</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG187</BillingCode><PriorBillingCodes><PriorBillingCode>MN110</PriorBillingCode></PriorBillingCodes><Name>Codman Certas Programmable Valve - with Reservoir, Siphonguard and catheter</Name><Description>Programmable valve with reservoir, siphonguard and catheters</Description><Size>30-210mmH2O</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Antisyphon function, Distal catheter, Reservoir/Priming function</Suffix><ARTGs><ARTG>186233</ARTG><ARTG>186235</ARTG></ARTGs><MinimumBenefit>2757</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB339</BillingCode><Name>Miethke adjustable gratitational unit with differential pressure unit (miniNAV) and distal catheter</Name><Description>proSA and M.blue adjustable gravitational units for the treatment of hydracephalus. The valve can be combined with any differential pressure valve. miniNAV is a very small differential pressure unit, which is often used. The valves are made from titanium and are MR safe up to 3 tesla. The distal catheter is made of silicone.</Description><Size>Adjustable gravitational unit: height 4.5mm, diameter 18mm, opening pressure 0-40 cmH2O.  Differential pressure unit (miniNAV): length 14.7mm, diameter 2.8mm.  Distal catheter: length 1200mm, inside diameter 1.2mm, outside diameter 2.5mm.</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Antisyphon function, Distal catheter, Reservoir/Priming function</Suffix><ARTGs><ARTG>181718</ARTG></ARTGs><MinimumBenefit>2757</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI086</BillingCode><Name>Strata Shunt Assembly</Name><Description>Assembly: Strata Shunt, Strata Burr Hole Shunt, Strata Snap Shunt. Adjustable CSF Valve with five symmetric performance level steps, includes integral (distal) peritoneal catheter.</Description><Size>90-120cm, 35-50mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Antisyphon function, Distal catheter, Reservoir/Priming function</Suffix><ARTGs><ARTG>129681</ARTG><ARTG>169061</ARTG><ARTG>134740</ARTG></ARTGs><MinimumBenefit>2757</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB337</BillingCode><Name>Miethke proGAV Shunt System</Name><Description>Shunt system containing an adjustable valve with a gravitational unit, a distal catheter, a ventricular catheter and a reservoir.</Description><Size>Adjustable valve: diameter 18mm, opening pressure 0-20 cmH2O, height 4.5mm.  Gravitational unit: length 14.9mm, height 4.6mm, opening pressure 0-35 cmH2O.  Distal catheter: length 1200mm, inside diameter 1200mm, inside diameter 1.2mm, outside diameter 2.5mm.  Reservoir: diameter 14/20mm.  Ventricular catheter: 180/250mm.</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Antisyphon function, Distal catheter, Proximal catheter, Reservoir/Priming function</Suffix><ARTGs><ARTG>181718</ARTG><ARTG>375143</ARTG></ARTGs><MinimumBenefit>2888</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG158</BillingCode><PriorBillingCodes><PriorBillingCode>JJ219</PriorBillingCode></PriorBillingCodes><Name>Hakim Programmable Valve System</Name><Description>Fixed pressure hydrocephalus shunt, packaged sterile, stainless steel and ruby valve mechanism, silicone rubber ventricular and peritoneal catheters.  In line or right angled with reservoir.  Valve can be reprogrammed non-invasively 18 pressure settings a</Description><Size>One size only</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Antisyphon function, Distal catheter, Proximal catheter, Reservoir/Priming function</Suffix><ARTGs><ARTG>149291</ARTG><ARTG>140904</ARTG></ARTGs><MinimumBenefit>2888</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC640</BillingCode><Name>Strata Shunt, Unitised</Name><Description>Adjustable CSF valve with five symmetric performance level steps.  Includes strata valve, pre-attached ventricular catheter, and a pre-attached peritoneal catheter. Right Angle Clip. Disposable Quick Release Ventricular Catheter Introducer. Disposable Sub</Description><Size>8-13.5cm x 9-120cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Antisyphon function, Distal catheter, Proximal catheter, Reservoir/Priming function</Suffix><ARTGs><ARTG>145335</ARTG><ARTG>129681</ARTG></ARTGs><MinimumBenefit>2888</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH754</BillingCode><PriorBillingCodes><PriorBillingCode>LM463</PriorBillingCode></PriorBillingCodes><Name>Sterile Hydrocephalic Shunts</Name><Description>Plastic/magnetic. Programmable valve. Programmer kit and shunts kit.</Description><Size>3, 8 settings</Size><SupplierCode>40192</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Distal catheter, Proximal catheter, Reservoir/Priming function</Suffix><ARTGs><ARTG>143218</ARTG></ARTGs><MinimumBenefit>2437</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC928</BillingCode><Name>Strata NSC L-P Shunt</Name><Description>Lumboperitoneal Shunt</Description><Size>44mm x 23mm x 12mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Lumboperitoneal, Reservoir/Priming function</Suffix><ARTGs><ARTG>129681</ARTG></ARTGs><MinimumBenefit>2437</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB332</BillingCode><Name>Miethke proGAV</Name><Description>Adjustable valve with intergrated gravitational unit.  Titanium, MR safe up to 3 tesla.</Description><Size>Adjustable valve: Diameter 18mm, Opening pressure 0-20 cmH2O, Height 4.5mm.  Gravitational unit: Length 14.9mm, Height 4.6mm.</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113070</SubGroupID><Suffix>Antisyphon function, Reservoir/Priming function</Suffix><ARTGs><ARTG>181718</ARTG></ARTGs><MinimumBenefit>2591</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG018</BillingCode><Name>Precision Flow-OSV II Valve System </Name><Description>Ventricular/Atrial OSV11-Ventricular /Atrial Hydrocephalus Shunt</Description><Size>Drainage Cath 110 cm, F7. Ventricular Catheters 7,9,13 &amp; 15 cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113071</SubGroupID><Suffix>Distal catheter, Proximal catheter</Suffix><ARTGs><ARTG>151647</ARTG></ARTGs><MinimumBenefit>1300</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG160</BillingCode><PriorBillingCodes><PriorBillingCode>JJ221</PriorBillingCode></PriorBillingCodes><Name>Hakim Precision Valve System</Name><Description>Fixed pressure hydrocephalus shunt, packaged sterile, stainless steel and ruby valve mechanism, silicone rubber ventricular and peritoneal catheters.  In line or right angled with reservoir.  Opening pressure  H20; Very high 130mm, high 100mm, medium 70mm</Description><Size>One size only</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113071</SubGroupID><Suffix>Distal catheter, Proximal catheter, Reservoir/Priming function</Suffix><ARTGs><ARTG>149290</ARTG></ARTGs><MinimumBenefit>1616</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB324</BillingCode><Name>Aesculap-Miethke gravitational shunt</Name><Description>Single valve, anti-siphon gravitational shunt, titanium construction (MRI safe to 3 tesla)</Description><Size>24mm and 27mm long, 4.0mm and 4.6mm diameter, 4cmH2O and 5cmH2O-40cmH2O</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113071</SubGroupID><Suffix>Antisyphon function</Suffix><ARTGs><ARTG>375141</ARTG><ARTG>181718</ARTG><ARTG>375142</ARTG></ARTGs><MinimumBenefit>1083</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC651</BillingCode><Name>Delta Valve Assembly with Bioglide PSM range</Name><Description>CSF Flow Valves. Polypropylene and acetal plastic base. Silicone elastomer dome. Assembly system includes the valve, integral peritoneal catheter, female luer adapter and prefill tubing. Surface of the valve bonded with hydrogel (Bioglide surface modifica</Description><Size>90-120cm (0.5, 1.0, 1.5, 2.0)</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113071</SubGroupID><Suffix>Antisyphon function, Coating, Distal catheter, Reservoir/Priming function</Suffix><ARTGs><ARTG>134740</ARTG></ARTGs><MinimumBenefit>1409</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG159</BillingCode><PriorBillingCodes><PriorBillingCode>JJ220</PriorBillingCode></PriorBillingCodes><Name>Hakim Precision Valve System</Name><Description>Fixed pressure valve with reservoir, siphonguard, ventricular and peritoneal catheters</Description><Size>Very low to very high including micro</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113071</SubGroupID><Suffix>Antisyphon function, Distal catheter, Proximal catheter, Reservoir/Priming function</Suffix><ARTGs><ARTG>149290</ARTG></ARTGs><MinimumBenefit>1697</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB403</BillingCode><Name>Aesculap-Miethke GAV Shunt System  </Name><Description>Single valve, (anti-siphon) gravitational shunt, titanium construction (MRI safe to 3 tesla), with incorporated reservoir, distal catheter and ventricular catheter.      </Description><Size>Valve: do=4.2 mm, Connector: do=1.9 mm  Catheter: di=1.2 mm, do=2.5 mm,  5cmH2O-30cmH2O</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113071</SubGroupID><Suffix>Antisyphon function, Distal catheter, Proximal catheter, Reservoir/Priming function</Suffix><ARTGs><ARTG>181718</ARTG><ARTG>375142</ARTG></ARTGs><MinimumBenefit>1697</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC649</BillingCode><Name>Delta Shunt Unitised</Name><Description>Delta valve is a fixed pressure CSF valve, available in four performance levels. Delta Unitised shunt includes a delta valve, pre-attached ventricular catheter, and a pre-attached peritoneal catheter. Right Angle Clip. Disposable Quick Release Ventricular</Description><Size>Delta Unitised Shunt small (Distal 65cm-90cm, ventricular 11cm) - 0.5, 1.0, 1.5 and 2.0. Delta Unitised Shunt regular (Distal 90cm, ventricular catheter 13cm) - 0.5, 1.0, 1.5 and 2.0</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113071</SubGroupID><Suffix>Antisyphon function, Distal catheter, Proximal catheter, Reservoir/Priming function</Suffix><ARTGs><ARTG>139696</ARTG></ARTGs><MinimumBenefit>1697</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC532</BillingCode><Name>Hydrocephalus Shunt</Name><Description>With Hydrostatic Valve, Delta Valves/Shunts/BioGlide, Vent Catheters</Description><Size>12mm-90cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113071</SubGroupID><Suffix>Antisyphon function, Reservoir/Priming function</Suffix><ARTGs><ARTG>129681</ARTG></ARTGs><MinimumBenefit>1399</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG175</BillingCode><PriorBillingCodes><PriorBillingCode>JJ858</PriorBillingCode></PriorBillingCodes><Name>Codman Hakim Precision Valves</Name><Description>Valves with Siphonguard and Reservoir</Description><Size>10-130mm H2O including micro</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113071</SubGroupID><Suffix>Antisyphon function, Reservoir/Priming function</Suffix><ARTGs><ARTG>140904</ARTG></ARTGs><MinimumBenefit>1399</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC530</BillingCode><Name>Hydrocephalus Shunt</Name><Description>Ventricular/Atrial, CSF Flow Control Shunts, Cont Small Valve</Description><Size>38cm-90cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113071</SubGroupID><Suffix>Reservoir/Priming function</Suffix><ARTGs><ARTG>129681</ARTG></ARTGs><MinimumBenefit>898</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG168</BillingCode><PriorBillingCodes><PriorBillingCode>JJ440</PriorBillingCode></PriorBillingCodes><Name>Codman Hakim Precision Valve, Right Angle Reservoir</Name><Description>features 5 operating pressures</Description><Size>10, 40, 70, 100, and 130mmH2O</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113071</SubGroupID><Suffix>Reservoir/Priming function</Suffix><ARTGs><ARTG>140904</ARTG></ARTGs><MinimumBenefit>898</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LH743</BillingCode><PriorBillingCodes><PriorBillingCode>LM527</PriorBillingCode></PriorBillingCodes><Name>Sophy Valves - hydrocephalic</Name><Description>Monopressure Valve with Antechamber or Burr-Hole Reservoir  </Description><Size>50 - 170mmH2O</Size><SupplierCode>40192</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113071</SubGroupID><Suffix>Reservoir/Priming function</Suffix><ARTGs><ARTG>143218</ARTG></ARTGs><MinimumBenefit>898</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG017</BillingCode><Name>Precision Flow-OSV II Valve System</Name><Description>Lumbar peritoneal OSV11-Lumboperitoneal System Hydrocephalus Shunt</Description><Size>Lumber Catheter 80cm, F5  Peritoneal Catheter 110cm, F7</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113071</SubGroupID><Suffix>Distal catheter, Lumboperitoneal</Suffix><ARTGs><ARTG>151647</ARTG></ARTGs><MinimumBenefit>1242</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC531</BillingCode><Name>Hydrocephalus Shunt</Name><Description>Ventricular/Peritoneal. CSF Flow Control Valves, BioGlide Contoured, Ventriculostomy Kit-E, Neonatal Delta Snap Shunt</Description><Size>12mm-90cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113071</SubGroupID><Suffix>Distal catheter, Reservoir/Priming function</Suffix><ARTGs><ARTG>129681</ARTG></ARTGs><MinimumBenefit>1286</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC647</BillingCode><Name>Delta Valve with Bioglide PSM range</Name><Description>CSF Flow Valve. Polypropylene and acetal plastic base. Silicone elastomer dome. Surface of valve bonded with hydrogel (Bioglide surface modification).</Description><Size>36-40mm x 9-20mm (0.5-2.0)</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113071</SubGroupID><Suffix>Antisyphon function, Coating, Reservoir/Priming function</Suffix><ARTGs><ARTG>129681</ARTG></ARTGs><MinimumBenefit>1268</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC650</BillingCode><Name>Delta Shunt Assembly</Name><Description>Delta valve is a fixed CSF pressure valve, available in four performance levels. Includes an Integral (distal) Peritoneal Catheter, Disposable Peritoneal Catheter Passer, Female Luer Adapter and Prefill Tubing.</Description><Size>90-120cm (0.5 - 2.0)</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113071</SubGroupID><Suffix>Antisyphon function, Distal catheter, Reservoir/Priming function</Suffix><ARTGs><ARTG>134740</ARTG></ARTGs><MinimumBenefit>1563</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG152</BillingCode><PriorBillingCodes><PriorBillingCode>JJ157</PriorBillingCode></PriorBillingCodes><Name>Hakim Precision Valve System</Name><Description>Precision valve standard with reservoir, peritoneal and ventricular catheters</Description><Size>Very low to very high including micro</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113071</SubGroupID><Suffix>Distal catheter, Proximal catheter, Reservoir/Priming function</Suffix><ARTGs><ARTG>149290</ARTG></ARTGs><MinimumBenefit>1616</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG032</BillingCode><Name>Burr Hole Valve Shunt Assemblies</Name><Description>Shunt Assembly: silicone encased valve, silicone ventricular and peritoneal catheters</Description><Size>16mm or 12mm base; low, medium or high pressure, various kit configurations</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113071</SubGroupID><ARTGs><ARTG>152728</ARTG></ARTGs><MinimumBenefit>1001</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG019</BillingCode><Name>Precision Flow-OSV II Valve System</Name><Description>Ventricular/Peritoneal OSV11-  Ventricular/Peritoneal Hydrocephalus Shunt</Description><Size>Drainage Cath 110 cm, F7. Ventricular Catheters 7,9,13 &amp; 15 cm</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113071</SubGroupID><ARTGs><ARTG>151647</ARTG></ARTGs><MinimumBenefit>1001</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB325</BillingCode><Name>Aesculap-Miethke DualSwitch shunt</Name><Description>Non-adjustable valve with preset values for treatment of patients susceptible to complication due to tumour cells or high protein levels. Treats patients in both supine and upright position. Titanium construction MRI compatible to 3 tesla</Description><Size>28mm diameter, 5.7mm profile, 510-50cmH2O pressure setting</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113071</SubGroupID><ARTGs><ARTG>181718</ARTG></ARTGs><MinimumBenefit>1001</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB342</BillingCode><Name>Miethke adjustable gravitational unit with proGAV</Name><Description>proSA and M.blue are adjustable gravitational units. proGAV is an adjustable differential pressure unit. They are combined to treat pediatric and adult hydrocephalus. The valves are made from titanium and are MR safe up to 3 tesla. They are connected by a distal catheter, which is made of silicone.</Description><Size>Adjustable gravitational unit: diameter 18mm Adjustable differential pressure unit (proGAV): diameter 18mm Distal catheter: inside diameter 1.2mm, outside diameter 2.5mm  FV782T: gravitational unit adjustable between 0-40 cmH2O  proGAV adjustable between 0-20 cmH2O</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113072</SubGroupID><ARTGs><ARTG>181718</ARTG></ARTGs><MinimumBenefit>3646</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB341</BillingCode><Name>Miethke adjustable gravitational unit with proGAV and distal catheter</Name><Description>proSA and M.blue are adjustable gravitational units. proGAV is an adjustable differential pressure unit. They are combined to treat pediatric and adult hydrocephalus. The valves are made from titanium and are MR safe up to 3 tesla. The distal catheters are made of silicone.</Description><Size>Adjustable gravitational unit: diameter 18mm  Adjustable differential pressure unit (proGAV): diameter 18mm  Distal catheter: length 1200mm, inside diameter 1.2mm, outside diameter 2.5mm  Distal catheter (connection between both valves): inside diameter 1.2mm, outside diameter 2.5mm  FV783T:   proSA adjustable between 0-40 cmH2O, proGAV adjustable between 0-20 cmH2O</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113072</SubGroupID><Suffix>Distal Catheter</Suffix><ARTGs><ARTG>181718</ARTG></ARTGs><MinimumBenefit>3813</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB343</BillingCode><Name>Miethke shunt system with reservoir and distal catheter</Name><Description>Shunt system containing an adjustable gravitational unit and an adjustable differential pressure unit with distal catheters and a ventircular catheter, combined with a deflector, a pediatric prechamber or a reservoir.  There are two types of reservoirs: Control reservoir and pediatric Burrhole reservoir. The shunt system is used for the treatment of pediatric and adult hydrocephalus. The valves, the prechamber, the deflector and the reservoirs are made from titanium. The catheters are made from silicone. The shunt system is MR safe up to 3 tesla.</Description><Size>Adjustable gravitational unit: height 4.5mm, diameter 18mm  Adjustable differential pressure unit: diameter 18mm  Distal catheter: length 1200mm, inside diameter 1.2mm, outside diameter 2.5mm  Distal catheter for connections: inside diameter 1.2mm, outside diameter 2.5mm, adjustable between 0-40 cmH2O, 0-20 cmH2O.</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109273</GroupID><SubGroupID>113072</SubGroupID><Suffix>Distal Catheter, Reservoir/Priming Function</Suffix><ARTGs><ARTG>375150</ARTG><ARTG>181718</ARTG></ARTGs><MinimumBenefit>4129</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG184</BillingCode><PriorBillingCodes><PriorBillingCode>JJ934</PriorBillingCode></PriorBillingCodes><Name>Codman Hydrocephalus Connectors</Name><Description>Metal and plastic connectors</Description><Size>8mm to 20mm length</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109278</GroupID><SubGroupID>113073</SubGroupID><ARTGs><ARTG>140901</ARTG><ARTG>150104</ARTG></ARTGs><MinimumBenefit>34</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI022</BillingCode><Name>Shunt Component Connector</Name><Description>Connectors, fixation tabs</Description><Size>Various</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109278</GroupID><SubGroupID>113073</SubGroupID><ARTGs><ARTG>128403</ARTG><ARTG>134760</ARTG><ARTG>128523</ARTG><ARTG>95539</ARTG></ARTGs><MinimumBenefit>34</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB334</BillingCode><Name>Miethke Titanium connectors - right angled / shaped</Name><Description>In general, titanium connectors are preferably used with catheters of internal diameter 1.2m and external diameter 2.5mm.  Step-down connectors are designed for connecting standard catheters to lumbar catheters.  L-P connectors are designed for connecting two lumbar catheters to each other.</Description><Size>1.9mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109278</GroupID><SubGroupID>113073</SubGroupID><ARTGs><ARTG>194850</ARTG></ARTGs><MinimumBenefit>34</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BB328</BillingCode><Name>Miethke Titanium connectors &amp; deflectors</Name><Description>Titanium, (MRI safe 3 tesla), deflector allows 90 degree deflection of the ventricular catheter in the burr hole without kinking, adjustable on length of catheter, suture fixture hole</Description><Size>Radio-opaque titanium, connector diameter: 1,9mm for use with catheters of id = 1.2mm; of id 1.2mm; od = 2.5mm</Size><SupplierCode>40020</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109278</GroupID><SubGroupID>113073</SubGroupID><ARTGs><ARTG>181719</ARTG></ARTGs><MinimumBenefit>34</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG022</BillingCode><Name>Connectors</Name><Description>Silicone and Stainless Steel</Description><Size>Straight, right angle, Y, T</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109278</GroupID><SubGroupID>113073</SubGroupID><ARTGs><ARTG>151592</ARTG></ARTGs><MinimumBenefit>34</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>IG052</BillingCode><Name>Electa right angle guide</Name><Description>Silicone</Description><Size>One Size Only</Size><SupplierCode>40221</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107785</SubCategoryID><GroupID>109278</GroupID><SubGroupID>113074</SubGroupID><ARTGs><ARTG>151661</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC838</BillingCode><Name>Medtronic ACTIVA PC Neurostimulator for Deep Brain Stimulation</Name><Description>ACTIVA PC Dual channel primary cell neuro stimulator for Deep Brain Stimulation (37601)</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109280</GroupID><SubGroupID>113075</SubGroupID><Suffix>Dual Channel</Suffix><ARTGs><ARTG>392258</ARTG></ARTGs><MinimumBenefit>13592</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ206</BillingCode><Name>Libra XP DBS IPG 6644</Name><Description>Implantable pulse generation for deep brain stimulation - Dual 4 Channel</Description><Size>76mm x 58mm x 14mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109280</GroupID><SubGroupID>113075</SubGroupID><Suffix>Dual Channel</Suffix><ARTGs><ARTG>161009</ARTG></ARTGs><MinimumBenefit>13592</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ376</BillingCode><Name>Infinity IPG</Name><Description>Implantable Pulse Generator</Description><Size>55mm, 68mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109280</GroupID><SubGroupID>113075</SubGroupID><Suffix>Dual Channel</Suffix><ARTGs><ARTG>382622</ARTG><ARTG>382623</ARTG></ARTGs><MinimumBenefit>13592</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM433</BillingCode><PriorBillingCodes><PriorBillingCode>NK111</PriorBillingCode></PriorBillingCodes><Name>Dual Channel Implantable Pulse generator</Name><Description>Dual Channel Implantable Pulse generator</Description><Size>Sizes as suitable for patient anatomy</Size><SupplierCode>40194</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109280</GroupID><SubGroupID>113075</SubGroupID><Suffix>Dual Channel</Suffix><ARTGs><ARTG>307525</ARTG></ARTGs><MinimumBenefit>13592</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI401</BillingCode><Name>Medtronic Percept PC Neurostimulator for Deep Brain Stimulation</Name><Description>Percept PC Dual channel primary cell neuro stimulator for Deep Brain Stimulation with Brain Sensing Technology</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109280</GroupID><SubGroupID>113075</SubGroupID><Suffix>Dual Channel</Suffix><ARTGs><ARTG>392263</ARTG></ARTGs><MinimumBenefit>13592</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS382</BillingCode><Name>Vercise Genus </Name><Description>8, 16 &amp; 32 Contact Dual channel primary cell pulse generator with anodic stimulation</Description><Size>One size only</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109280</GroupID><SubGroupID>113075</SubGroupID><Suffix>Dual Channel</Suffix><ARTGs><ARTG>400380</ARTG><ARTG>400410</ARTG><ARTG>400422</ARTG></ARTGs><MinimumBenefit>13592</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM429</BillingCode><PriorBillingCodes><PriorBillingCode>NK107</PriorBillingCode></PriorBillingCodes><Name>Single Channel Implantable Pulse Generator</Name><Description>Single Channel Implantable Pulse Generator</Description><Size>Suitable for patient anatomy</Size><SupplierCode>40194</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109280</GroupID><SubGroupID>113075</SubGroupID><ARTGs><ARTG>307524</ARTG></ARTGs><MinimumBenefit>8168</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ197</BillingCode><Name>Libra Deep Brain Stimulation System - Libra IPG - 6608</Name><Description>Implantable pulse generator for deep brain stimulation - 8 channel</Description><Size>50mm x 54mm x 14mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109280</GroupID><SubGroupID>113075</SubGroupID><ARTGs><ARTG>161008</ARTG></ARTGs><MinimumBenefit>8168</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI031</BillingCode><Name>Medtronic Activa SC Neurostimulator for Deep Brain Stimulation</Name><Description>Single channel neurostimulator for Deep Brain stimulation</Description><Size>New or Old Header choice</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109280</GroupID><SubGroupID>113075</SubGroupID><ARTGs><ARTG>392266</ARTG><ARTG>392210</ARTG></ARTGs><MinimumBenefit>8168</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC946</BillingCode><Name>Medtronic ACTIVA RC Neurostimulator for Deep  Brain Stimulation</Name><Description>ACTIVA RC Dual channel rechargeable neurostimulator for Deep Brain Stimulation (37612)</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109280</GroupID><SubGroupID>113076</SubGroupID><Suffix>Dual Channel</Suffix><ARTGs><ARTG>392011</ARTG></ARTGs><MinimumBenefit>17283</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ202</BillingCode><Name>Brio DBS Implantable Pulse Generator 6788</Name><Description>Dual Channel 16 Contact rechargeable IPG</Description><Size>29g, 17cc</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109280</GroupID><SubGroupID>113076</SubGroupID><Suffix>Dual Channel</Suffix><ARTGs><ARTG>164510</ARTG></ARTGs><MinimumBenefit>17283</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM434</BillingCode><PriorBillingCodes><PriorBillingCode>NK112</PriorBillingCode></PriorBillingCodes><Name>Dual Channel Rechargeable Implantable Pulse Generator</Name><Description>Dual Channel Rechargeable Implantable Pulse Generator</Description><Size>Sized as suitable for patient anatomy</Size><SupplierCode>40194</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109280</GroupID><SubGroupID>113076</SubGroupID><Suffix>Dual Channel</Suffix><ARTGs><ARTG>307526</ARTG></ARTGs><MinimumBenefit>17283</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS387</BillingCode><Name>Vercise Genus</Name><Description>Dual Channel,16 &amp; 32 Contact, Zero Volt Rechargeable Deep Brain Stimulation IPG with anodic stimulation</Description><Size>52 mm x 46 mm x 11 mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109280</GroupID><SubGroupID>113076</SubGroupID><Suffix>Unlimited Deep Discharge Battery</Suffix><ARTGs><ARTG>400423</ARTG><ARTG>400411</ARTG></ARTGs><MinimumBenefit>19855</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM431</BillingCode><PriorBillingCodes><PriorBillingCode>NK109</PriorBillingCode></PriorBillingCodes><Name>Patient or Clinician Programmer</Name><Description>Patient or Clinician Programmer</Description><Size>N/A</Size><SupplierCode>40194</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109281</GroupID><SubGroupID>113077</SubGroupID><ARTGs><ARTG>308945</ARTG></ARTGs><MinimumBenefit>1264</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS243</BillingCode><Name>Vercise Remote Control, Vercise Remote Control 2, Vercise Remote Control 3, Vercise Remote Control 4</Name><Description>Remote patient control for DBS, remote patient control kit for DBS</Description><Size>One size only</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109281</GroupID><SubGroupID>113077</SubGroupID><ARTGs><ARTG>308577</ARTG><ARTG>279188</ARTG><ARTG>308575</ARTG><ARTG>202019</ARTG><ARTG>363576</ARTG></ARTGs><MinimumBenefit>1264</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI400</BillingCode><Name>Medtronic Percept PC Patient Programmer</Name><Description>Medtronic Percept PC Patient Programmer</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109281</GroupID><SubGroupID>113077</SubGroupID><ARTGs><ARTG>351590</ARTG></ARTGs><MinimumBenefit>1264</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ204</BillingCode><Name>Brio DBS Patient Controller 6856</Name><Description>Patient Controller for DBS</Description><Size>One size only</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109281</GroupID><SubGroupID>113077</SubGroupID><ARTGs><ARTG>164509</ARTG></ARTGs><MinimumBenefit>1264</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI367</BillingCode><Name>Medtronic Activa Patient Programming System</Name><Description>Medtronic Activa Patient Programming System</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109281</GroupID><SubGroupID>113077</SubGroupID><ARTGs><ARTG>339925</ARTG></ARTGs><MinimumBenefit>1264</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC837</BillingCode><Name>Medtronic Activa Patient Programmer</Name><Description>Medtronic Activa Patient Programmer (Model 37642)</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109281</GroupID><SubGroupID>113077</SubGroupID><ARTGs><ARTG>160115</ARTG></ARTGs><MinimumBenefit>1264</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS245</BillingCode><Name>Vercise Charging System</Name><Description>Recharging system for DBS</Description><Size>N/A</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109281</GroupID><SubGroupID>113078</SubGroupID><ARTGs><ARTG>202018</ARTG><ARTG>308576</ARTG><ARTG>203085</ARTG><ARTG>363579</ARTG></ARTGs><MinimumBenefit>1782</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM432</BillingCode><PriorBillingCodes><PriorBillingCode>NK110</PriorBillingCode></PriorBillingCodes><Name>Patient programmer Recharger</Name><Description>Patient programmer Recharger</Description><Size>N/A</Size><SupplierCode>40194</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109281</GroupID><SubGroupID>113078</SubGroupID><ARTGs><ARTG>309804</ARTG></ARTGs><MinimumBenefit>1782</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ351</BillingCode><Name>Brio LE Charging System 6722</Name><Description>Charging system for Brio Deep Brain Stimualtion Device</Description><Size>One size only </Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109281</GroupID><SubGroupID>113078</SubGroupID><ARTGs><ARTG>231655</ARTG></ARTGs><MinimumBenefit>1782</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC945</BillingCode><Name>Medtronic ACTIVA Recharging System for Deep Brain Stimulation</Name><Description>Recharging System for Deep Brain Stimulation</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109281</GroupID><SubGroupID>113078</SubGroupID><ARTGs><ARTG>121279</ARTG></ARTGs><MinimumBenefit>1782</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI398</BillingCode><Name>Medtronic Recharging System for Deep Brain Stimulation</Name><Description>Wireless recharging System for Deep Brain Stimulation</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109281</GroupID><SubGroupID>113078</SubGroupID><ARTGs><ARTG>341712</ARTG><ARTG>341408</ARTG><ARTG>121279</ARTG></ARTGs><MinimumBenefit>1782</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM430</BillingCode><PriorBillingCodes><PriorBillingCode>NK108</PriorBillingCode></PriorBillingCodes><Name>Implantable Lead Kits</Name><Description>Implantable Lead Kits</Description><Size>Multiple sizes suitable for patient anatomy</Size><SupplierCode>40194</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109282</GroupID><SubGroupID>113079</SubGroupID><ARTGs><ARTG>313134</ARTG></ARTGs><MinimumBenefit>3746</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS238</BillingCode><Name>Boston Scientific DBS Lead Kit</Name><Description>Deep brain stimulation lead with 8 in-line contact electrodes. Independent 19-filar platinum-core.</Description><Size>30cm - 45cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109282</GroupID><SubGroupID>113079</SubGroupID><ARTGs><ARTG>202017</ARTG></ARTGs><MinimumBenefit>3746</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC244</BillingCode><Name>Medtronic Australasia DBS Lead Model 3389,  Medtronic quadripolar Itrel II- 7424DBS, Active Implantable Stimulator &amp; Ancillary Equipment</Name><Description>Deep brain stimulation lead with four platinum iridium electrodes Models 3387 and 3389.  Electrode spacing is 1.5mm apart for Model 3387 and 0.5mm apart for Model 3389.  PTFE, polyurethane, platinum/iridium, nickel alloy, tungsten</Description><Size>28 - 40cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109282</GroupID><SubGroupID>113079</SubGroupID><ARTGs><ARTG>137138</ARTG><ARTG>137374</ARTG></ARTGs><MinimumBenefit>3746</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ148</BillingCode><Name>Libra Deep Brain Stimulation System  - Leads 6142 - 6149</Name><Description>DBS Leads 6142-6145 1.5mm electrode and space 1.5mm; 6146-6149 1.5mm electrode and 0.5mm space</Description><Size>25-40cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109282</GroupID><SubGroupID>113079</SubGroupID><ARTGs><ARTG>377342</ARTG></ARTGs><MinimumBenefit>3746</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS319</BillingCode><Name>Cartesia Directional Lead</Name><Description>Deep brain stimulation lead with 8 in-line contact electrodes. Independent 19-filar platinum-core. Contacts are separated circumferentially allowing for both axial and
rotational stimulation selectivity.</Description><Size>30cm - 45cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109282</GroupID><SubGroupID>113079</SubGroupID><Suffix>Current steering</Suffix><ARTGs><ARTG>279186</ARTG></ARTGs><MinimumBenefit>4120</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI488</BillingCode><Name>SenSight™ Directional Lead Kit</Name><Description>Deep brain stimulation lead with 8 proximal and distal contact electrodes. Distal orientation marker determines positioning of the electrodes under certain imaging modalities.</Description><Size>33cm and 42cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109282</GroupID><SubGroupID>113079</SubGroupID><Suffix>Current steering</Suffix><ARTGs><ARTG>387432</ARTG></ARTGs><MinimumBenefit>4120</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ378</BillingCode><Name>Infinity directional lead</Name><Description>Lead with 8 electrode segmented contacts. Steerable and directional current.</Description><Size>30-40cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109282</GroupID><SubGroupID>113079</SubGroupID><Suffix>Current steering</Suffix><ARTGs><ARTG>381327</ARTG></ARTGs><MinimumBenefit>4120</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ350</BillingCode><Name>8-Channel Adapter</Name><Description>8-Channel Adapter</Description><Size>10cm and 60cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109282</GroupID><SubGroupID>113080</SubGroupID><ARTGs><ARTG>378144</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC852</BillingCode><Name>Medtronic Extension for Deep Brain Stimulation</Name><Description>Medtronic ACTIVA Stretch Coil Extension for use with ACTIVA RC and PC</Description><Size>40cm, 60cm, 95cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109282</GroupID><SubGroupID>113080</SubGroupID><ARTGs><ARTG>239412</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC940</BillingCode><Name>Pocket Adaptors for Deep Brain Stimulation</Name><Description>Pocket Adaptors for Deep Brain Stimulation (Single and Dual Channel)</Description><Size>25.5cm and 27.4cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109282</GroupID><SubGroupID>113080</SubGroupID><ARTGs><ARTG>165114</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ373</BillingCode><Name>St Jude Deep Brain Stimulation System</Name><Description>Extension Lead for DBS</Description><Size>50-90cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109282</GroupID><SubGroupID>113080</SubGroupID><ARTGs><ARTG>377341</ARTG><ARTG>381326</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ234</BillingCode><Name>Pocket Adaptor</Name><Description>IS-1 Pocket Adaptor</Description><Size>25cm and 50cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109282</GroupID><SubGroupID>113080</SubGroupID><ARTGs><ARTG>383123</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>LM435</BillingCode><PriorBillingCodes><PriorBillingCode>NK113</PriorBillingCode></PriorBillingCodes><Name>Implantable Extension Kit</Name><Description>Implantable Extension Kit</Description><Size>Suitable for patient anatomy</Size><SupplierCode>40194</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109282</GroupID><SubGroupID>113080</SubGroupID><ARTGs><ARTG>313133</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS239</BillingCode><Name>Boston Scientific DBS Extension Kit</Name><Description>Deep brain stimulation extension kit</Description><Size>55 &amp; 95 cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109282</GroupID><SubGroupID>113080</SubGroupID><ARTGs><ARTG>363575</ARTG><ARTG>202034</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI491</BillingCode><Name>SenSight™ Extension Kit</Name><Description>8 contacts on the distal and proximal ends. Directional lead is connected into the distal end of the extension.</Description><Size>40 cm, 60 cm and 95 cm   </Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109282</GroupID><SubGroupID>113080</SubGroupID><ARTGs><ARTG>387436</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS324</BillingCode><Name>Vercise M8 Adapter</Name><Description>1 x 8 in-line connector designed to connect another manufacturer's previously implanted lead extensions to the Vercise Stimulator</Description><Size>15 - 55cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109282</GroupID><SubGroupID>113080</SubGroupID><ARTGs><ARTG>281579</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS293</BillingCode><Name>B26 Pocket Adaptor</Name><Description>Pocket Adaptor for Deep Brain Stimulation IPG</Description><Size>15cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109282</GroupID><SubGroupID>113080</SubGroupID><ARTGs><ARTG>231754</ARTG></ARTGs><MinimumBenefit>1895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI494</BillingCode><Name>SenSight™ Connector Plug</Name><Description>Fits into an unused socket of a dual channel neurostimulator, or the distal end of an unused DBS extension.</Description><Size>one size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109284</GroupID><SubGroupID>113084</SubGroupID><ARTGs><ARTG>387434</ARTG></ARTGs><MinimumBenefit>158</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI119</BillingCode><Name>Electrode Insertion Tube set</Name><Description>Electrode Insertion Tube Set for DBS</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109284</GroupID><SubGroupID>113084</SubGroupID><ARTGs><ARTG>212222</ARTG></ARTGs><MinimumBenefit>158</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC826</BillingCode><Name>Medtronic Accessory Kit for Deep Brain Stimulation</Name><Description>Boots accessory kit for DBS (3550-25)</Description><Size>N/A</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109284</GroupID><SubGroupID>113084</SubGroupID><ARTGs><ARTG>240576</ARTG></ARTGs><MinimumBenefit>158</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI489</BillingCode><Name>SenSight™ Lead Cap Kit</Name><Description>Protects and isolates the directional lead contacts after the implant but prior to extension connection.</Description><Size>one size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109284</GroupID><SubGroupID>113084</SubGroupID><ARTGs><ARTG>387435</ARTG></ARTGs><MinimumBenefit>158</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI493</BillingCode><Name>SenSight™ Tunneler Kit   </Name><Description>Creates a subcutaneous path for tunnelling the lead to the intended location and retains the lead position.</Description><Size>one size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109284</GroupID><SubGroupID>113084</SubGroupID><ARTGs><ARTG>372651</ARTG><ARTG>387433</ARTG></ARTGs><MinimumBenefit>158</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI003</BillingCode><Name>Medtronic DBS Tunneling Tool Accessory Kit</Name><Description>DBS Tunneling Tool Accessory Kit</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109284</GroupID><SubGroupID>113084</SubGroupID><ARTGs><ARTG>121281</ARTG></ARTGs><MinimumBenefit>158</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS241</BillingCode><Name>Boston Scientific DBS Tunneling Tool</Name><Description>Tunneling tool for DBS - straw, long</Description><Size>N/A</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109284</GroupID><SubGroupID>113084</SubGroupID><ARTGs><ARTG>156757</ARTG></ARTGs><MinimumBenefit>158</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS240</BillingCode><Name>Vercise Physician's Spare Kit</Name><Description>Boots accessory kit for DBS</Description><Size>N/A</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109284</GroupID><SubGroupID>113084</SubGroupID><ARTGs><ARTG>203998</ARTG></ARTGs><MinimumBenefit>158</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER613</BillingCode><Name>Alpha Omega Cannula</Name><Description>Alpha Omega Cannula, standard or tapered used for microelectrodes recording (MER) and for lead insertion; stylet, sterile</Description><Size>Length: 130-216.5 mm  Inner diameter: 0.6-1.6 mm  Outer diameter: 1.07-1.81 mm</Size><SupplierCode>40067</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109284</GroupID><SubGroupID>113084</SubGroupID><ARTGs><ARTG>346590</ARTG></ARTGs><MinimumBenefit>158</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS244</BillingCode><Name>SureTek Burr Hole Cover</Name><Description>Burr hole cover</Description><Size>14mm compatability</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109284</GroupID><SubGroupID>113085</SubGroupID><ARTGs><ARTG>203999</ARTG></ARTGs><MinimumBenefit>497</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ199</BillingCode><Name>Guardian Burr Hole Cover System</Name><Description>Cranial Burr Hole Cover</Description><Size>Diameter 24.89 mm; Height 3.81 mm.</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109284</GroupID><SubGroupID>113085</SubGroupID><ARTGs><ARTG>353744</ARTG></ARTGs><MinimumBenefit>497</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI492</BillingCode><Name>SenSight™ Burr Hole Device Kit</Name><Description>Intended to cover a burr hole on the skull and anchor a directional lead.</Description><Size>various</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109284</GroupID><SubGroupID>113085</SubGroupID><ARTGs><ARTG>387430</ARTG><ARTG>387431</ARTG></ARTGs><MinimumBenefit>497</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC767</BillingCode><Name>Stimloc</Name><Description>Burr Hole Cover</Description><Size>14mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109284</GroupID><SubGroupID>113085</SubGroupID><ARTGs><ARTG>151095</ARTG></ARTGs><MinimumBenefit>497</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC764</BillingCode><Name>Microelectrode Cable</Name><Description>Cable used for intracranial recording of neural activity prior to DBS</Description><Size>One size</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109284</GroupID><SubGroupID>113086</SubGroupID><ARTGs><ARTG>138186</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC770</BillingCode><Name>Snap Lid Connector</Name><Description>Connector for implanted lead to external Implantable Pulse Generator</Description><Size>2.5" x 5.0"</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109284</GroupID><SubGroupID>113086</SubGroupID><ARTGs><ARTG>119991</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI490</BillingCode><Name>SenSight™ Lead Test Cable Kit</Name><Description>Connects the External Neurostimulator (ENS) with the directional lead.</Description><Size>one size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109284</GroupID><SubGroupID>113086</SubGroupID><ARTGs><ARTG>359713</ARTG><ARTG>360032</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC843</BillingCode><Name>Medtronic Screening Cable (Alligator Clip)</Name><Description>Screening Cable with Alligator Clip for Intraoperative testing</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109284</GroupID><SubGroupID>113086</SubGroupID><ARTGs><ARTG>119991</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC842</BillingCode><Name>Medtronic Screening Cable (Twist Lock)</Name><Description>Screening Cable with Twist Lock for Intraoperative testing</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109284</GroupID><SubGroupID>113086</SubGroupID><ARTGs><ARTG>119991</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS242</BillingCode><Name>Boston Scientific DBS OR Cable &amp; Extension</Name><Description>OR cable and extension for DBS</Description><Size>One size only</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109284</GroupID><SubGroupID>113086</SubGroupID><ARTGs><ARTG>157994</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER614</BillingCode><Name>Alpha Omega Electrode cable</Name><Description>Alpha Omega Elecrode cable, sterile </Description><Size>Various</Size><SupplierCode>40067</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107786</SubCategoryID><GroupID>109284</GroupID><SubGroupID>113086</SubGroupID><ARTGs><ARTG>321642</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ432</BillingCode><Name>Proclaim XR IPG</Name><Description>Implantable pulse generator</Description><Size>55mm and 68mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109285</GroupID><SubGroupID>113087</SubGroupID><Suffix>Multi waveforms</Suffix><ARTGs><ARTG>396984</ARTG><ARTG>396985</ARTG></ARTGs><MinimumBenefit>21660</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS383</BillingCode><Name>WaveWriter Alpha</Name><Description>16 &amp; 32 output, multi-channel, neurostimulation system IPG with 3D Algorythmic Programming, Combination Therapy and Multi Waveform capability </Description><Size>One Size Only</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109285</GroupID><SubGroupID>113087</SubGroupID><Suffix>Multi waveforms</Suffix><ARTGs><ARTG>400292</ARTG><ARTG>400373</ARTG></ARTGs><MinimumBenefit>21660</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ379</BillingCode><Name>Proclaim IPG</Name><Description>Implantable pulse generator</Description><Size>55mm, 68mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109285</GroupID><SubGroupID>113087</SubGroupID><Suffix>Multi waveforms</Suffix><ARTGs><ARTG>351631</ARTG><ARTG>351632</ARTG></ARTGs><MinimumBenefit>21660</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ389</BillingCode><Name>Proclaim DRG</Name><Description>Implantable Pulse Generator</Description><Size>one size only</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109285</GroupID><SubGroupID>113087</SubGroupID><Suffix>Multi waveforms</Suffix><ARTGs><ARTG>396987</ARTG></ARTGs><MinimumBenefit>21660</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PQ004</BillingCode><Name>Reactiv8 Implantable Pulse Generator</Name><Description>Two channel implantable stimulator</Description><Size>One size only</Size><SupplierCode>40184</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109285</GroupID><SubGroupID>113087</SubGroupID><ARTGs><ARTG>327089</ARTG></ARTGs><MinimumBenefit>17283</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UY003</BillingCode><Name>Evoke Closed Loop Stimulator (CLS)  </Name><Description>A 24 contact implantable, rechargeable spinal cord stimulator capable of providing ECAP-controlled closed-loop stimulation. </Description><Size>N/A</Size><SupplierCode>40224</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109285</GroupID><SubGroupID>113088</SubGroupID><Suffix>Adaptive Stimulation, Multi waveform, Recharge protection, Unlimited Deep Discharge Battery,</Suffix><ARTGs><ARTG>336330</ARTG></ARTGs><MinimumBenefit>23465</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS389</BillingCode><Name>WaveWriter Alpha</Name><Description>16 or 32-output, multi-channel, zero-volt rechargeable neurostimulation system IPG with Combination Therapy, Sub-Perception Algorithms and Waveform Automation</Description><Size>One Size Only</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109285</GroupID><SubGroupID>113088</SubGroupID><Suffix>Adaptive Stimulation, Unlimited Deep Discharge Battery</Suffix><ARTGs><ARTG>400374</ARTG><ARTG>400392</ARTG></ARTGs><MinimumBenefit>23465</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FP001</BillingCode><Name>StimRouter Neuromodulation System Kit</Name><Description>Implantable multi-electrode lead with integrated receiver, delivery tools, external pulse transmitter, patient programmer, and charger set.</Description><Size>One size only</Size><SupplierCode>40270</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109285</GroupID><SubGroupID>113088</SubGroupID><Suffix>Integrated Leads</Suffix><ARTGs><ARTG>313344</ARTG></ARTGs><MinimumBenefit>18032</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS330</BillingCode><Name>Precision Montage MRI IPG</Name><Description>MRI Conditional, 16-output, multi-channel, zero-volt rechargeable neurostimulation system IPG with 3D algorythmic programming</Description><Size>One Size Only</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109285</GroupID><SubGroupID>113088</SubGroupID><Suffix>Multi waveform, Recharge protection</Suffix><ARTGs><ARTG>400291</ARTG></ARTGs><MinimumBenefit>23465</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ374</BillingCode><Name>Prodigy IPG</Name><Description>Implantable Pulse Generator</Description><Size>26g</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109285</GroupID><SubGroupID>113088</SubGroupID><Suffix>Multi waveform, Recharge protection</Suffix><ARTGs><ARTG>376449</ARTG></ARTGs><MinimumBenefit>23465</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WW003</BillingCode><PriorBillingCodes><PriorBillingCode>ER496</PriorBillingCode></PriorBillingCodes><Name>Senza II IPG Kit</Name><Description>Implantable Pulse Generator Kit</Description><Size>One size only</Size><SupplierCode>40398</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109285</GroupID><SubGroupID>113088</SubGroupID><Suffix>Unlimited Deep Discharge Battery, 10kHz Stimulation</Suffix><ARTGs><ARTG>186043</ARTG></ARTGs><MinimumBenefit>23465</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WW021</BillingCode><PriorBillingCodes><PriorBillingCode>ER535</PriorBillingCode></PriorBillingCodes><Name>Senza Omnia IPG Kit</Name><Description>Implantable Pulse Generator Kit</Description><Size>One size only</Size><SupplierCode>40398</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109285</GroupID><SubGroupID>113088</SubGroupID><Suffix>Unlimited Deep Discharge Battery, 10kHz Stimulation</Suffix><ARTGs><ARTG>330704</ARTG></ARTGs><MinimumBenefit>23465</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ177</BillingCode><Name>ANS Spinal Cord Stimulation System (SCS) GENESIS</Name><Description>QuikLink Patient Programmer Model 3860</Description><Size>One Size Only</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113090</SubGroupID><ARTGs><ARTG>106669</ARTG></ARTGs><MinimumBenefit>1354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ183</BillingCode><Name>Eon Neurostimulation System</Name><Description>Eon Programmer #3851</Description><Size>.</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113090</SubGroupID><ARTGs><ARTG>127127</ARTG></ARTGs><MinimumBenefit>1354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UY007</BillingCode><Name>Evoke Pocket Console </Name><Description>A handheld remote control for an implantable closed-loop stimulator.  </Description><Size>N/A</Size><SupplierCode>40224</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113090</SubGroupID><ARTGs><ARTG>336570</ARTG></ARTGs><MinimumBenefit>1354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI496</BillingCode><Name>Vanta Neurostimulator System Patient Programmer (Handset +App)</Name><Description>The patient programmer consists of a handset that hosts the MyStim PC Therapy Application (App) </Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113090</SubGroupID><ARTGs><ARTG>386871</ARTG><ARTG>391675</ARTG></ARTGs><MinimumBenefit>1354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PQ005</BillingCode><Name>Reactiv8 Activator</Name><Description>Patient Activator for use with Reactiv8 Implantable Pulse Generator </Description><Size>One size only</Size><SupplierCode>40184</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113090</SubGroupID><ARTGs><ARTG>327090</ARTG></ARTGs><MinimumBenefit>1354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ348</BillingCode><Name>Prodigy Patient Programmer</Name><Description>Prodigy Patient Programmer for use with Prodigy Neurostimulator.</Description><Size>One size. </Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113090</SubGroupID><ARTGs><ARTG>230778</ARTG></ARTGs><MinimumBenefit>1354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI138</BillingCode><Name>Surescan MRI Patient programmer</Name><Description>Patient controller for Surescan MRI Neurostimulators</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113090</SubGroupID><ARTGs><ARTG>214421</ARTG></ARTGs><MinimumBenefit>1354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI276</BillingCode><Name>Intellis Rechargeable Neurostimulation System - PTM Patient Programmer</Name><Description>External Patient Programmer Model 97745</Description><Size>One Size Only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113090</SubGroupID><ARTGs><ARTG>298760</ARTG></ARTGs><MinimumBenefit>1354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ388</BillingCode><Name>Patient Programmer</Name><Description>Patient Programmer</Description><Size>One size</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113090</SubGroupID><Suffix>Bluetooth</Suffix><ARTGs><ARTG>277756</ARTG></ARTGs><MinimumBenefit>632</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS325</BillingCode><Name>FreeLink Remote Control Kit</Name><Description>Hand held remote control/external patient programmer</Description><Size>One size only</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113090</SubGroupID><ARTGs><ARTG>283694</ARTG><ARTG>287738</ARTG><ARTG>318330</ARTG><ARTG>287237</ARTG><ARTG>318331</ARTG><ARTG>362974</ARTG><ARTG>362991</ARTG></ARTGs><MinimumBenefit>1354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS106</BillingCode><Name>Precision Plus Remote Patient Programmer; Precision Plus with MultiwaveTechnology Remote Patient Programmer</Name><Description>Hand held remote control External Patient Programmer</Description><Size>One Size Only</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113090</SubGroupID><ARTGs><ARTG>166929</ARTG><ARTG>128681</ARTG><ARTG>231196</ARTG></ARTGs><MinimumBenefit>1354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WW005</BillingCode><PriorBillingCodes><PriorBillingCode>ER608</PriorBillingCode></PriorBillingCodes><Name>Nevro PTRC2300 Patient Remote Control </Name><Description>External patient programmer for Senza spinal cord stimulation system</Description><Size>One size only</Size><SupplierCode>40398</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113090</SubGroupID><ARTGs><ARTG>330707</ARTG></ARTGs><MinimumBenefit>1354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS253</BillingCode><Name>Precision Spectra Patient Remote Programmer</Name><Description>Hand held remote control External Patient Programmer</Description><Size>One size only</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113090</SubGroupID><ARTGs><ARTG>206306</ARTG><ARTG>206305</ARTG></ARTGs><MinimumBenefit>1354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ355</BillingCode><Name>Axium Neurostimulator System - Programmer - Patient</Name><Description>Programmer - patient</Description><Size>1 size (1 presentation)</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113090</SubGroupID><ARTGs><ARTG>300051</ARTG><ARTG>202322</ARTG></ARTGs><MinimumBenefit>1354</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI497</BillingCode><Name>Patient Communicator</Name><Description>The communicator allows the MyStim PC Therapy Application on the Patient Handset (Programmer) connect to the implantable neurostimulator</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113091</SubGroupID><ARTGs><ARTG>386870</ARTG><ARTG>391675</ARTG></ARTGs><MinimumBenefit>161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC694</BillingCode><Name>Restore Rechargeable Neurostimulation System</Name><Description>External Patient Programmer Antenna Model 37092</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113091</SubGroupID><ARTGs><ARTG>146936</ARTG></ARTGs><MinimumBenefit>161</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WW008</BillingCode><PriorBillingCodes><PriorBillingCode>ER009</PriorBillingCode></PriorBillingCodes><Name>Nevro Spinal Cord Stimulation System (SCSS) - Patient Remote Kit</Name><Description>The patient remote control is a handheld, battery operated unit able to communicate via radiofrequency (RF) with the Implantable Pulse Generator and trial stimulator</Description><Size>N/A</Size><SupplierCode>40398</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113092</SubGroupID><ARTGs><ARTG>185994</ARTG></ARTGs><MinimumBenefit>1264</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WW020</BillingCode><PriorBillingCodes><PriorBillingCode>ER536</PriorBillingCode></PriorBillingCodes><Name>Senza Omnia Patient Remote</Name><Description>Handheld, battery operated unit able to communicate via radiofrequency with the Senza Omnia IPG,  </Description><Size>One size only</Size><SupplierCode>40398</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113092</SubGroupID><ARTGs><ARTG>330708</ARTG></ARTGs><MinimumBenefit>1264</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PQ001</BillingCode><Name>Reactiv8 Magnet</Name><Description>Communication Magnet</Description><Size>One size</Size><SupplierCode>40184</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113092</SubGroupID><ARTGs><ARTG>327094</ARTG></ARTGs><MinimumBenefit>1264</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ433</BillingCode><Name>ANS Spinal Cord Stimulation System (SCS) GENESIS</Name><Description>Communication Magnet 1210</Description><Size> One type only</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113092</SubGroupID><ARTGs><ARTG>342820</ARTG><ARTG>267026</ARTG></ARTGs><MinimumBenefit>1264</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WW007</BillingCode><PriorBillingCodes><PriorBillingCode>ER008</PriorBillingCode></PriorBillingCodes><Name>Nevro Spinal Cord Stimulation System (SCSS) - Charger Kit</Name><Description>The Charger is a battery powered rechargeable device intended to recharge the Implantable Pulse Generator (IPG) battery transcutaneously</Description><Size>N/A</Size><SupplierCode>40398</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113093</SubGroupID><ARTGs><ARTG>181182</ARTG></ARTGs><MinimumBenefit>1215</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS143</BillingCode><Name>Precision SCS External Patient Recharger System</Name><Description>External Patient Recharging System: Base Station, Charger, Cradle power supply, charger base station.</Description><Size>One size only</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113093</SubGroupID><ARTGs><ARTG>155924</ARTG><ARTG>149462</ARTG><ARTG>155857</ARTG><ARTG>155859</ARTG></ARTGs><MinimumBenefit>1215</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI502</BillingCode><Name>Medtronic Patient Wireless Recharger System</Name><Description>Recharging system for rechargeable implantable neurostimulators (model RS7200) that comprises a Wireless Recharger and Charging Dock</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113093</SubGroupID><ARTGs><ARTG>387302</ARTG></ARTGs><MinimumBenefit>1215</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UY005</BillingCode><Name>Evoke Charger (AU)</Name><Description>External recharging system for an implantable closed-loop stimulator.  </Description><Size>N/A</Size><SupplierCode>40224</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113093</SubGroupID><ARTGs><ARTG>338061</ARTG></ARTGs><MinimumBenefit>1215</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI277</BillingCode><Name>Intellis Rechargeable Neurostimulation System - RTM Recharger</Name><Description>External Patient Recharger Model 97755</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113093</SubGroupID><ARTGs><ARTG>397990</ARTG></ARTGs><MinimumBenefit>1215</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ352</BillingCode><Name>Eon Charging System 3726</Name><Description>Eon Charging System </Description><Size>One size</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113093</SubGroupID><ARTGs><ARTG>233616</ARTG></ARTGs><MinimumBenefit>1215</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ342</BillingCode><Name>Eon Mini Charger </Name><Description>Charger to recharge Implantable Pulse Generator</Description><Size>One size</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113093</SubGroupID><ARTGs><ARTG>221544</ARTG></ARTGs><MinimumBenefit>1215</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI139</BillingCode><Name>Medtronic Patient Recharger System</Name><Description>Recharging system for Surescan MRI Neurostimulators Model 97754</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113093</SubGroupID><ARTGs><ARTG>121279</ARTG></ARTGs><MinimumBenefit>1215</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ349</BillingCode><Name>Prodigy Charging System</Name><Description>Prodigy Charging System for use with Prodigy Neurostimulator.</Description><Size>One size</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113093</SubGroupID><ARTGs><ARTG>230779</ARTG></ARTGs><MinimumBenefit>1215</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WW019</BillingCode><PriorBillingCodes><PriorBillingCode>ER540</PriorBillingCode></PriorBillingCodes><Name>Senza Omnia Charger</Name><Description>Battery powered rechargeable device intended to recharge the Senza Omnia IPG battery transcutaneously</Description><Size>One size only</Size><SupplierCode>40398</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113093</SubGroupID><ARTGs><ARTG>328684</ARTG></ARTGs><MinimumBenefit>1215</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI280</BillingCode><Name>Intellis Wireless External Neurostimulator</Name><Description>Wireless External Neurostimulator</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113094</SubGroupID><ARTGs><ARTG>293256</ARTG></ARTGs><MinimumBenefit>1083</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WW015</BillingCode><PriorBillingCodes><PriorBillingCode>ER649</PriorBillingCode></PriorBillingCodes><Name>Nevro® Senza® Bluetooth® Trial Stimulator</Name><Description>Sterile, single-use trial stimulator device </Description><Size>One size only</Size><SupplierCode>40398</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109286</GroupID><SubGroupID>113094</SubGroupID><ARTGs><ARTG>388432</ARTG></ARTGs><MinimumBenefit>1083</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI136</BillingCode><Name>Vectris Surescan MRI Neurostimulation Leads</Name><Description>Octad Compact Lead Kit Model 977A2, Subcompact lead Kit Model 977A1</Description><Size>60cm, 75cm, 90cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109287</GroupID><SubGroupID>113096</SubGroupID><Suffix>8 electrodes</Suffix><ARTGs><ARTG>214838</ARTG><ARTG>214839</ARTG></ARTGs><MinimumBenefit>3817</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ168</BillingCode><Name>ANS Spinal Cord Stimulation System (SCS)</Name><Description>Lamitrode Plate Electrode</Description><Size>60cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109287</GroupID><SubGroupID>113096</SubGroupID><Suffix>8 electrodes</Suffix><ARTGs><ARTG>384013</ARTG></ARTGs><MinimumBenefit>3817</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ185</BillingCode><Name>Lamitrode S Series</Name><Description>Lamitrode S Series, 8 Channel</Description><Size>60 cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109287</GroupID><SubGroupID>113096</SubGroupID><Suffix>8 electrodes</Suffix><ARTGs><ARTG>384012</ARTG></ARTGs><MinimumBenefit>3817</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PQ003</BillingCode><Name>Reactiv8 Percutaneous Lead</Name><Description>Four electrode lead kit</Description><Size>45cm; 65cm</Size><SupplierCode>40184</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109287</GroupID><SubGroupID>113096</SubGroupID><Suffix>4 electrodes</Suffix><ARTGs><ARTG>327091</ARTG></ARTGs><MinimumBenefit>3041</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ474</BillingCode><Name>Slim Tip DRG lead kit</Name><Description>Implant Lead kit</Description><Size>50-90cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109287</GroupID><SubGroupID>113096</SubGroupID><Suffix>4 electrodes</Suffix><ARTGs><ARTG>333463</ARTG><ARTG>333462</ARTG></ARTGs><MinimumBenefit>3041</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ186</BillingCode><Name>Lamitrode S Series Leads</Name><Description>Lamitrode S Series, 4 Channel, Model # 3243</Description><Size>Length = 30cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109287</GroupID><SubGroupID>113096</SubGroupID><Suffix>4 electrodes</Suffix><ARTGs><ARTG>126076</ARTG></ARTGs><MinimumBenefit>3041</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ187</BillingCode><Name>Lamitrode S Series Leads</Name><Description>Lamitrode S Series, 4 Channel, Model # 3246</Description><Size>Length = 60cm, 90cm, 110cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109287</GroupID><SubGroupID>113096</SubGroupID><Suffix>4 electrodes</Suffix><ARTGs><ARTG>126076</ARTG></ARTGs><MinimumBenefit>3041</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ162</BillingCode><Name>ANS Spinal Cord Stimulation System (SCS)</Name><Description>Quattrode Lead. 4 Electrode.</Description><Size>60cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109287</GroupID><SubGroupID>113096</SubGroupID><Suffix>4 electrodes</Suffix><ARTGs><ARTG>381328</ARTG></ARTGs><MinimumBenefit>3041</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ359</BillingCode><Name>Axium Neurostimulator System - Implant Lead Kit</Name><Description>Implant lead kit and Implant lead kit, slim tip</Description><Size>Package containing either 50cm or 90cm lead</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109287</GroupID><SubGroupID>113096</SubGroupID><Suffix>4 electrodes</Suffix><ARTGs><ARTG>333462</ARTG><ARTG>202325</ARTG><ARTG>301386</ARTG><ARTG>301387</ARTG><ARTG>333463</ARTG></ARTGs><MinimumBenefit>3041</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ231</BillingCode><Name>Penta Leads</Name><Description>Paddle leads (Penta Leads have a curved paddle instead of a conventional flat paddle)</Description><Size>2-3mm, 30cm-110cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109287</GroupID><SubGroupID>113096</SubGroupID><Suffix>greater than 8 and less than 32 electrodes, Bifurcated proximal tail</Suffix><ARTGs><ARTG>170450</ARTG></ARTGs><MinimumBenefit>8123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WW022</BillingCode><PriorBillingCodes><PriorBillingCode>ER388</PriorBillingCode></PriorBillingCodes><Name>Surpass Surgical Lead</Name><Description>16 Contact Lead with two bifurcating 8 contact tails with embedded differentiating colour pigment in tail</Description><Size>Length: 30 - 90 cm</Size><SupplierCode>40398</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109287</GroupID><SubGroupID>113096</SubGroupID><Suffix>greater than 8 and less than 32 electrodes, Bifurcated proximal tail</Suffix><ARTGs><ARTG>284256</ARTG></ARTGs><MinimumBenefit>8123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS312</BillingCode><Name>Infinion CX Lead</Name><Description>1 x 16 lead with two 8 contact tails</Description><Size>50 - 70cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109287</GroupID><SubGroupID>113096</SubGroupID><Suffix>greater than 8 and less than 32 electrodes, Bifurcated proximal tail</Suffix><ARTGs><ARTG>275241</ARTG></ARTGs><MinimumBenefit>8123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WW016</BillingCode><PriorBillingCodes><PriorBillingCode>ER607</PriorBillingCode></PriorBillingCodes><Name>Surpass-C Surgical Lead</Name><Description>Surgical lead, 10, 12 and 14 electrode</Description><Size>50cm, 70cm, 90cm</Size><SupplierCode>40398</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109287</GroupID><SubGroupID>113096</SubGroupID><Suffix>greater than 8 and less than 32 electrodes, Bifurcated proximal tail</Suffix><ARTGs><ARTG>368530</ARTG></ARTGs><MinimumBenefit>8123</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS357</BillingCode><Name>ARTISAN, ARTISAN MRI Lead</Name><Description>16 contact point leads with multiple independent current control</Description><Size>50cm - 70cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109287</GroupID><SubGroupID>113096</SubGroupID><Suffix>greater than 8 and less than 32 electrodes</Suffix><ARTGs><ARTG>308180</ARTG><ARTG>163471</ARTG></ARTGs><MinimumBenefit>6895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UY009</BillingCode><Name>Evoke 12C Percutaneous Lead Kit </Name><Description>A 12 contact lead that delivers electrical stimulation to neural tissue and captures ECAPs from the same tissue. </Description><Size>60 and 90cm lengths</Size><SupplierCode>40224</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109287</GroupID><SubGroupID>113096</SubGroupID><Suffix>greater than 8 and less than 32 electrodes</Suffix><ARTGs><ARTG>336573</ARTG></ARTGs><MinimumBenefit>6895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS356</BillingCode><PriorBillingCodes><PriorBillingCode>BS110</PriorBillingCode></PriorBillingCodes><Name>INFINION Lead</Name><Description>16 contact point leads with multiple independent current control</Description><Size>50cm - 70cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109287</GroupID><SubGroupID>113096</SubGroupID><Suffix>greater than 8 and less than 32 electrodes</Suffix><ARTGs><ARTG>197909</ARTG></ARTGs><MinimumBenefit>6895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ138</BillingCode><Name>Lamitrode Lead - Tripole 16C</Name><Description>Tripole 16C</Description><Size>60cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109287</GroupID><SubGroupID>113096</SubGroupID><Suffix>greater than 8 and less than 32 electrodes</Suffix><ARTGs><ARTG>384015</ARTG></ARTGs><MinimumBenefit>6895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ169</BillingCode><Name>ANS Spinal Cord Stimulation System (SCS)</Name><Description>Lamitrode Dual 8 Plate Electrode Lead</Description><Size>One size only</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109287</GroupID><SubGroupID>113096</SubGroupID><Suffix>greater than 8 and less than 32 electrodes</Suffix><ARTGs><ARTG>377340</ARTG></ARTGs><MinimumBenefit>6895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS255</BillingCode><Name> CoverEdge 32 Contact Surgical Leads</Name><Description>CoverEdge, CoverEdge MRI, CoverEdge X, CoverEdge X MRI - 4x8 spaced electrodes.    </Description><Size>Up to 70cm in length</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109287</GroupID><SubGroupID>113096</SubGroupID><Suffix>≥32 electrodes</Suffix><ARTGs><ARTG>218230</ARTG></ARTGs><MinimumBenefit>11011</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ161</BillingCode><Name>ANS Spinal Cord Stimulation System (SCS)</Name><Description>Octrode Lead. 8 Electrode (thoracic or cervical placement).</Description><Size>30cm, 60cm, 90cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109287</GroupID><SubGroupID>113096</SubGroupID><Suffix>8 electrodes</Suffix><ARTGs><ARTG>374776</ARTG><ARTG>374775</ARTG></ARTGs><MinimumBenefit>3817</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WW006</BillingCode><PriorBillingCodes><PriorBillingCode>ER006</PriorBillingCode></PriorBillingCodes><Name>Nevro Spinal Cord Stimulation System (SCSS) - Lead Kit</Name><Description>The percutaneous lead is intended to be single use and interfaces with the Implantable Pulse Generator, lead extender OR cable, and lead accessories.</Description><Size>Spacing: 1-9mm spacing, 1-9mm in 1mm increments; Length: 30-90cm in 5cm increments</Size><SupplierCode>40398</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109287</GroupID><SubGroupID>113096</SubGroupID><Suffix>8 electrodes</Suffix><ARTGs><ARTG>185992</ARTG></ARTGs><MinimumBenefit>3817</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS331</BillingCode><Name>Avista MRI 8 Contact Lead</Name><Description>Eight contact percutaneous leads, MRI Conditional</Description><Size>56cm - 74cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109287</GroupID><SubGroupID>113096</SubGroupID><Suffix>8 electrodes</Suffix><ARTGs><ARTG>287236</ARTG></ARTGs><MinimumBenefit>3817</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS109</BillingCode><Name>Precision SCS Eight Contact Leads</Name><Description>Eight contact percutaneous leads.</Description><Size>30cm to 70cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109287</GroupID><SubGroupID>113096</SubGroupID><Suffix>8 electrodes</Suffix><ARTGs><ARTG>128775</ARTG></ARTGs><MinimumBenefit>3817</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS118</BillingCode><Name>Precision SCS Lead Blanks</Name><Description>Lead Blank</Description><Size>One Size Only</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109287</GroupID><SubGroupID>113097</SubGroupID><ARTGs><ARTG>218730</ARTG></ARTGs><MinimumBenefit>438</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI137</BillingCode><Name>Medtronic Vectris Neurostimulation Trial Lead</Name><Description>Octad Compact Trial lead Kit Model 977D2 and Subcompact Model 977D1</Description><Size>60cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109287</GroupID><SubGroupID>113097</SubGroupID><ARTGs><ARTG>219258</ARTG><ARTG>219259</ARTG></ARTGs><MinimumBenefit>438</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS248</BillingCode><Name>OR Cable</Name><Description>OR Cable</Description><Size>Lengths up to 65cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113098</SubGroupID><ARTGs><ARTG>157994</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UY002</BillingCode><Name>Evoke Lead Adapter Kit  </Name><Description>Sterile cable to connect the Evoke 12C Lead to an external stimulator. </Description><Size>N/A</Size><SupplierCode>40224</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113098</SubGroupID><ARTGs><ARTG>323488</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI049</BillingCode><Name>Medtronic Neurostimulation Screening Cable</Name><Description>Screening Cable</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113098</SubGroupID><ARTGs><ARTG>119991</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ371</BillingCode><Name>St Jude neurostimulation screening cable</Name><Description>MultiLead screening cable</Description><Size>one size only</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113098</SubGroupID><ARTGs><ARTG>343673</ARTG><ARTG>133958</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ372</BillingCode><Name>St Jude neurostimulation trial header connector</Name><Description>Trial System Header Connector</Description><Size>one size only</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113098</SubGroupID><ARTGs><ARTG>342819</ARTG><ARTG>238692</ARTG></ARTGs><MinimumBenefit>181</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI140</BillingCode><Name>Revision kit Surescan MRI leads</Name><Description>Sterile Revision Kit for Surescan MRI leads</Description><Size>60cm, 75cm, 90cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113099</SubGroupID><ARTGs><ARTG>240576</ARTG></ARTGs><MinimumBenefit>492</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ356</BillingCode><Name>Axium Neurostimulator System - Lead accessories kit</Name><Description>Lead accessories kit.</Description><Size>1 size (1 presentation)</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113099</SubGroupID><ARTGs><ARTG>297581</ARTG><ARTG>329428</ARTG><ARTG>197024</ARTG></ARTGs><MinimumBenefit>492</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ475</BillingCode><Name>DRG Large Needle and Sheath Kit</Name><Description>Lead Accessories Kit  </Description><Size>1 size  </Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113099</SubGroupID><ARTGs><ARTG>329428</ARTG></ARTGs><MinimumBenefit>492</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UY006</BillingCode><Name>Evoke Spares Kit</Name><Description>A sterile revision kit for the Evoke 12C Lead. </Description><Size>N/A</Size><SupplierCode>40224</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113099</SubGroupID><ARTGs><ARTG>336575</ARTG></ARTGs><MinimumBenefit>492</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC689</BillingCode><Name>Lead Revision Kits</Name><Description>Sterile Revision Kit for Octad leads 45cm (3550-26), Sterile Revision Kit for Octad leads 60-75cm (3550-27)</Description><Size>30 &amp; 45cm; 60 &amp; 75cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113099</SubGroupID><ARTGs><ARTG>240576</ARTG></ARTGs><MinimumBenefit>492</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC825</BillingCode><Name>Medtronic Percutaneous Quad extension</Name><Description>Percutaneous extension (in line connector for quadripolar leads only)</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113100</SubGroupID><ARTGs><ARTG>239412</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ461</BillingCode><Name>Port Plug</Name><Description>Port Plug</Description><Size>One size only</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113100</SubGroupID><ARTGs><ARTG>333461</ARTG><ARTG>278846</ARTG><ARTG>279015</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC687</BillingCode><Name>Neurostimulation System - Accessory Kits</Name><Description>Lead Accessory Plug and Closed Boot Kit Model 3550-29</Description><Size>.</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113100</SubGroupID><ARTGs><ARTG>121280</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS121</BillingCode><Name>Precision SCS IPG Port</Name><Description>IPG Port Plug</Description><Size>One Size Only</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113100</SubGroupID><ARTGs><ARTG>156761</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WW012</BillingCode><PriorBillingCodes><PriorBillingCode>ER042</PriorBillingCode></PriorBillingCodes><Name>Nevro Spinal Cord Stimulation System (SCSS) - IPG Port Plug Kit</Name><Description>The Implantable Pulse Generator (IPG) Port Plug is provided to seal the port of the IPG that is not is use.</Description><Size>N/A</Size><SupplierCode>40398</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113100</SubGroupID><ARTGs><ARTG>190837</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI051</BillingCode><Name>Medtronic Neurostimulation Tunnelling Tools</Name><Description>Tunnelling Tools</Description><Size>Various</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>121281</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ307</BillingCode><Name>Straight and Curved Stylet</Name><Description>A tool used to aid in positioning and repositioning the lead intra-operatively to ensure accurate placement.</Description><Size>30cm - 90cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>124057</ARTG><ARTG>353082</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PQ006</BillingCode><Name>Mainstay Tunneller</Name><Description>Catheter tunnellng tool to establish subcutaneous lead delivery pathway</Description><Size>One size</Size><SupplierCode>40184</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>283718</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ470</BillingCode><Name>DRG Torque Wrench</Name><Description>A tool to set or release the IPG setscrew that connects an implanted lead to the IPG header.  </Description><Size>One Size</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>353637</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC931</BillingCode><Name>3550-63 Percutaneous Lead Introducer Accessory Kit</Name><Description>Percutaneous Lead Introducer Accessory Kit</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>121280</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI038</BillingCode><Name>Medtronic Neurostimulation Accessories (Wrenches and screws)</Name><Description>Accessories for implant of neurostimulation lead</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>121280</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI039</BillingCode><Name>Medtronic Neurostimulation Accessories (Needles)</Name><Description>Accessories for implant of neurostimulation lead</Description><Size>Various</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>405626</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ315</BillingCode><Name>Standard Trial Cable Octrode and Quattrode</Name><Description>Connector which connects implanted lead to external stimulator</Description><Size>One size</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>133958</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ302</BillingCode><Name>Epidural Needle</Name><Description>A tool used to introduce a lead percutaneously.</Description><Size>14-15 Gauge, 4-6 inch</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>352928</ARTG><ARTG>133910</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WW017</BillingCode><PriorBillingCodes><PriorBillingCode>ER562</PriorBillingCode></PriorBillingCodes><Name>Nevro Spinal Cord Stimulation System (SCSS) – Lead Anchor Kit</Name><Description>The Lead Anchors are used to anchor the lead to the fascia or supraspinous ligament. Lead Anchors are designed to slide freely over the lead length to the required fixation position and sutures are then tied around the anchor clamping the sleeve in place on the lead or a torque wrench is used to tighten the anchor to the lead.</Description><Size>One size only</Size><SupplierCode>40398</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>180541</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WW013</BillingCode><PriorBillingCodes><PriorBillingCode>ER043</PriorBillingCode></PriorBillingCodes><Name>Nevro Spinal Cord Stimulation System (SCSS) - IPG Template Kit</Name><Description>The Implantable Pulse Generator (IPG) Template is an aid for the physician to assist in the proper sizing of the IPG pocket.</Description><Size>N/A</Size><SupplierCode>40398</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>185414</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ288</BillingCode><Name>Anchor (Butterfly)</Name><Description>Lead Anchor (Butterfly)</Description><Size>One size only</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>129858</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS120</BillingCode><Name>Clik Anchor Kit</Name><Description>Clik, Clik X, Clik X MRI Anchors</Description><Size>Two anchors</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>156760</ARTG></ARTGs><MinimumBenefit>303</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UY008</BillingCode><Name>Evoke Tunneling Tool  </Name><Description>Surgical tool to aid the implantation of an SCS system.</Description><Size>N/A</Size><SupplierCode>40224</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>323171</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WW014</BillingCode><PriorBillingCodes><PriorBillingCode>ER044</PriorBillingCode></PriorBillingCodes><Name>Nevro Spinal Cord Stimulation System (SCSS) - Stylet Kit</Name><Description>The Stylets are used to push and "steer" the stimulation Lead into place. These are standard configurations offered across industry offering the implanter the flexibility to maneuver the leads through the epidural space to the desired implant location.</Description><Size>Offered in Straight, Curved or Tapered versions.  Diameter:  0.35, 0.40 mm   Length: 50,70,90 cm;   Angle: 15-30 degrees </Size><SupplierCode>40398</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>180653</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WW009</BillingCode><PriorBillingCodes><PriorBillingCode>ER036</PriorBillingCode></PriorBillingCodes><Name>Nevro Spinal Cord Stimulation System (SCSS) - Coiled Lead Blank Kit</Name><Description>The Coiled Lead Blank made out of stainless steel is optionally used during surgery to clear a path for the introduction of the SCS Lead into the epidural space. The coiled lead blank is a tool used to help clear obstructions within the cannula of the insertion needle and may be used by the physician to verify access to the epidural space.</Description><Size>N/A</Size><SupplierCode>40398</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>181179</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS258</BillingCode><Name>Insertion Needles</Name><Description>Aid in placement of leads.</Description><Size>Various</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>254954</ARTG><ARTG>156758</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS259</BillingCode><Name>Passing Elevators and Paddle Blanks</Name><Description>Aid in placement of leads, helps verify that the epidural space is cleared.</Description><Size>Various</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>156762</ARTG><ARTG>218730</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI052</BillingCode><Name>Medtronic Neurostimulation Accessory Kits</Name><Description>EZ Anchor, Boot and Anchor Kit</Description><Size>Various</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>240576</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WW018</BillingCode><PriorBillingCodes><PriorBillingCode>ER557</PriorBillingCode></PriorBillingCodes><Name>Nevro Passing Elevator Tool</Name><Description>Passing elevator tool</Description><Size>One size only</Size><SupplierCode>40398</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>337490</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WW004</BillingCode><PriorBillingCodes><PriorBillingCode>ER038</PriorBillingCode></PriorBillingCodes><Name>Nevro Spinal Cord Stimulation System (SCSS) - Tunneling Tool Kit</Name><Description>The Tunneling Tool creates a subcutaneous tunnel from the Implantable Pulse Generator (IPG) site to the midline incision. The tunneling tool is passed subcutanously to deliver the leads from needle insertion site to the IPG site</Description><Size>Length: 20-50cm, in increments of 1cm</Size><SupplierCode>40398</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>180556</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ411</BillingCode><Name>Abbott IPG Pocket Sizer</Name><Description>Implant accessory designed to aid in the creation of a pocket for Abbott implantable neurostimulators</Description><Size>55-58mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>279015</ARTG><ARTG>278847</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ308</BillingCode><Name>Torque Wrench</Name><Description>A tool to set or release the IPG setscrew that connects an implanted lead to the IPG header.</Description><Size>One size</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>353637</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS257</BillingCode><Name>Wrenches</Name><Description>Used to secure leads and anchors.</Description><Size>One size only</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>157487</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS256</BillingCode><Name>Tunnelling Tools</Name><Description>Aid in placement of leads.</Description><Size>Various</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>156757</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS247</BillingCode><Name>Stylet Kit</Name><Description>Stylet Kit with steering cap and stiffer stylet</Description><Size>Stiffer stylet length: Up to 74cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>156759</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ285</BillingCode><Name>Strain Relief</Name><Description>Strain Relief</Description><Size>One size only</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>354001</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PQ002</BillingCode><Name>Reactiv8 Torque Wrench</Name><Description>A tool used to set or release the Implantable Pulse Generator (IPG) set screw  that connects an implanted lead to the IPG header.</Description><Size>One size</Size><SupplierCode>40184</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>284000</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WW011</BillingCode><PriorBillingCodes><PriorBillingCode>ER041</PriorBillingCode></PriorBillingCodes><Name>Nevro Spinal Cord Stimulation System (SCSS) - Torque Wrench Kit</Name><Description>The Torque Wrench is used to tighten the set screws that lock the lead into the Implantable Pulse Generator or to lock the lead into a lead extension</Description><Size>N/A</Size><SupplierCode>40398</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>181181</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ360</BillingCode><Name>Axium Neurostimulator System - Tunneling Tool</Name><Description>Tunneling tool.</Description><Size>30cm or 51cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>296964</ARTG><ARTG>329360</ARTG><ARTG>197024</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ304</BillingCode><Name>Introde-AK Lead Introducer</Name><Description>A flexible tool passed over a partially-implanted lead or guide wire in order to establish the appropriate pathway for a lead to follow in the epidural space despite obstructions.</Description><Size>4" and 9"</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>133910</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ477</BillingCode><Name>DRG Straight Needle</Name><Description>Straight needle  </Description><Size>4.5 inch  </Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>329428</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ476</BillingCode><Name>DRG Anchor</Name><Description>Lead Anchor</Description><Size>One size only</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>329428</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ428</BillingCode><Name>Guide Wire for Percutaneous Leads</Name><Description>A tool used to establish and/or access the appropriate pathway in the epidural space before implanting the lead. </Description><Size>One size only</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>352921</ARTG><ARTG>196837</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ472</BillingCode><Name> Straight Stylet</Name><Description>Straight Stylet</Description><Size>50-90 cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>353082</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ361</BillingCode><Name>Axium Neurostimulator System - Curved Needle</Name><Description>A curved needle (one size 14G,4.5in), a single use accessory, providing access to the epidural space during the surgical procedure of inserting a Neurostimulation System.</Description><Size>One Size - (14G, 4.5in)</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>296962</ARTG><ARTG>338752</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC951</BillingCode><Name>Multi-Lead Trialing Cable</Name><Description>Connector for implanted lead to External Neurostimulator</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>119991</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC930</BillingCode><Name>3550-P4 Passing Elevator Accessory Kit</Name><Description>Kit Contents: 4 Passing Elevators compatible with various leads</Description><Size>One size</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>121280</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI067</BillingCode><Name>Injex Anchor Kit</Name><Description>Neurostimulation Anchor Kit</Description><Size>One Size</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>133358</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS249</BillingCode><Name>Medical Adhesive</Name><Description>Medical adhesive is used to assist in fixing the lead to the suture sleeve.</Description><Size>One size</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>156755</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WW001</BillingCode><PriorBillingCodes><PriorBillingCode>ER037</PriorBillingCode></PriorBillingCodes><Name>Nevro Spinal Cord Stimulation System (SCSS) - Insertion Needle Kit</Name><Description>The Insertion Needle is used during implant surgery to introduce the Lead between the vetebra into the epidural space. The insertion needle is a two part needle that contains a cannula and stylet to facilitate access to the spinal canal for lead placement</Description><Size>Length: 5-15cm, in increments of 1cm</Size><SupplierCode>40398</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>180426</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ357</BillingCode><Name>Axium Neurostimulator System - Connector Cable Kit</Name><Description>Connector cable kit.</Description><Size>1 size (1 presentation)</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>329119</ARTG><ARTG>197025</ARTG><ARTG>296963</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ471</BillingCode><Name>Hex Key</Name><Description>Hex Key</Description><Size>One Size</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>329360</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ305</BillingCode><Name>Tunneling Tool</Name><Description>A tool used to creat a subcutaneous passage to pass the lead from the lead implant site to the IPG pocket site.</Description><Size>12", 20"</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>353157</ARTG><ARTG>134305</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ289</BillingCode><Name>Anchor (long)</Name><Description>Lead Anchor (Long)</Description><Size>One size only</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>129858</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ286</BillingCode><Name>Anchor</Name><Description>Butterfly &amp; Long lead anchors; Cinch &amp; Swift Lock Anchors</Description><Size>One size only for each anchor type</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>353993</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WW010</BillingCode><PriorBillingCodes><PriorBillingCode>ER039</PriorBillingCode></PriorBillingCodes><Name>Nevro Spinal Cord Stimulation System (SCSS) - Cable Kit</Name><Description>The cables are used during the Lead implant procedure and patient trial to make electrical and mechanical connections between the Trial Stimulator and the Lead or Lead extension. There is a separate adaptor cable that allows the use of the Medtronic lead with the Nevro Senza System</Description><Size>N/A</Size><SupplierCode>40398</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>181180</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UY001</BillingCode><Name>Evoke Epidural Needle 6.5"</Name><Description>Epidural needle for the introduction of percutaneous leads.  </Description><Size> 6.5"</Size><SupplierCode>40224</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>323172</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS246</BillingCode><Name>Introducer Kit</Name><Description>Introducer intended for the percutaneous introduction and placement of leads.</Description><Size>Length: 13cm; 23cm.</Size><SupplierCode>39966</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>166195</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WW002</BillingCode><PriorBillingCodes><PriorBillingCode>ER511</PriorBillingCode></PriorBillingCodes><Name>Senza II IPG Template</Name><Description>Aid for physicians in proper sizing of the IPG implant pocket</Description><Size>One size only</Size><SupplierCode>40398</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>186043</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ469</BillingCode><Name>DRG Tunneling Tool</Name><Description>Tunneling Tool </Description><Size>30cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>329360</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ287</BillingCode><Name>Anchor (Cinch)</Name><Description>Cinch Anchor</Description><Size>One size only</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>129858</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ473</BillingCode><Name>DRG guidewire</Name><Description>Guide Wire for Percutaneous Leads</Description><Size>one size</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113101</SubGroupID><ARTGs><ARTG>352921</ARTG></ARTGs><MinimumBenefit>152</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ283</BillingCode><Name>Epiducer - Lead Delivery System</Name><Description>Lead Delivery System</Description><Size>13cm, 19cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113102</SubGroupID><ARTGs><ARTG>352928</ARTG></ARTGs><MinimumBenefit>658</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ468</BillingCode><Name>DRG Delivery Sheath  </Name><Description>Small and Big Curve</Description><Size>22cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113102</SubGroupID><ARTGs><ARTG>329240</ARTG><ARTG>329301</ARTG></ARTGs><MinimumBenefit>658</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ354</BillingCode><Name>Axium Neurostimulator System - 22cm Delivery Sheath Kit - small curve and big curve</Name><Description>22cm delivery sheath kit - small curve and big curve.</Description><Size>2 sizes (2 presentations)  1 x Big Curve -MN23950AU  1 x Small Curve - MN23850AU</Size><SupplierCode>40062</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107787</SubCategoryID><GroupID>109289</GroupID><SubGroupID>113102</SubGroupID><ARTGs><ARTG>329301</ARTG><ARTG>197024</ARTG><ARTG>296964</ARTG><ARTG>329240</ARTG></ARTGs><MinimumBenefit>658</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI027</BillingCode><Name>Medtronic Ascenda Intrathecal Catheter</Name><Description>Intrathecal Catheter</Description><Size>114cm, 140cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107788</SubCategoryID><GroupID>109292</GroupID><SubGroupID>113104</SubGroupID><Suffix>Reinforced</Suffix><ARTGs><ARTG>192057</ARTG><ARTG>192058</ARTG></ARTGs><MinimumBenefit>993</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI030</BillingCode><Name>Medtronic Ascenda Pump Segment Revision Kit</Name><Description>Intrathecal Catheter Pump Segment Revision Kit</Description><Size>One Size</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107788</SubCategoryID><GroupID>109293</GroupID><SubGroupID>113105</SubGroupID><ARTGs><ARTG>192044</ARTG></ARTGs><MinimumBenefit>542</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC818</BillingCode><Name>Medtronic Intrathecal Catheter Revision Kit (Distal)</Name><Description>Revision kit to repair distal end of intrathecal catheter (8598A)</Description><Size>38.1cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107788</SubCategoryID><GroupID>109293</GroupID><SubGroupID>113105</SubGroupID><ARTGs><ARTG>153486</ARTG></ARTGs><MinimumBenefit>542</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC817</BillingCode><Name>Medtronic Intrathecal Catheter Revision Kit (Proximal)</Name><Description>Revision kit to repair proximal end of intrathecal catheter (8596SC)</Description><Size>66cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107788</SubCategoryID><GroupID>109293</GroupID><SubGroupID>113105</SubGroupID><ARTGs><ARTG>153487</ARTG></ARTGs><MinimumBenefit>542</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC774</BillingCode><Name>8578 Sutureless Pump Connector</Name><Description>Sutureless Pump Connector: Material radiopaque silicon titanium, nylon</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107788</SubCategoryID><GroupID>109293</GroupID><SubGroupID>113105</SubGroupID><ARTGs><ARTG>133523</ARTG></ARTGs><MinimumBenefit>542</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI029</BillingCode><Name>Medtronic Ascenda Spinal Segment Revision Kit</Name><Description>Intrathecal Catheter Spinal Segment Revision Kit</Description><Size>One Size</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107788</SubCategoryID><GroupID>109293</GroupID><SubGroupID>113105</SubGroupID><ARTGs><ARTG>192043</ARTG></ARTGs><MinimumBenefit>542</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI040</BillingCode><Name>Medtronic Infusion Pump Accessories</Name><Description>Accessories for refill/catheter access of infusion pumps</Description><Size>Various</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107788</SubCategoryID><GroupID>109293</GroupID><SubGroupID>113106</SubGroupID><ARTGs><ARTG>398941</ARTG><ARTG>398942</ARTG></ARTGs><MinimumBenefit>36</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI164</BillingCode><Name>Medtronic Infusion Pump Refill Kit</Name><Description>Bulk Refill Kit containing 8 refill packs</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107788</SubCategoryID><GroupID>109293</GroupID><SubGroupID>113106</SubGroupID><ARTGs><ARTG>133764</ARTG></ARTGs><MinimumBenefit>146</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SA191</BillingCode><Name>LivaNova PerenniaDURA Lead Model 303 for Vagus Nerve Stimulation</Name><Description>The PerenniaDURA Lead Model 303 is a silicone insulated implantable patient lead, delivering the electrical signal from the VNS Generators to the left vagus nerve.</Description><Size>Available in two sizes: Model 303.20 (2.0 millimeter inner diameter of helical coil) and Model 303.30 (3.0 millimeter inner diameter of helical coil).</Size><SupplierCode>40189</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107789</SubCategoryID><GroupID>109294</GroupID><SubGroupID>113107</SubGroupID><ARTGs><ARTG>192080</ARTG></ARTGs><MinimumBenefit>3069</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SA187</BillingCode><Name>VNS Therapy PerenniaFLEX Model 304.2 &amp; 304.3</Name><Description>Model 304 lead is a silicone insulated implantable patient lead, delivering the electrical signal from the Pulse Generator to the Vagus Nerve.</Description><Size>Lead Body 
Diameter : 2mm (.08 in)
Insulation: Silicone
Overall Length: 43cm

Inner Diameter of Helix
Model 304.20 ; 2mm (.08 in) inner diameter
Model 304.30 ; 3mm (.12 in) inner diameter</Size><SupplierCode>40189</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107789</SubCategoryID><GroupID>109294</GroupID><SubGroupID>113107</SubGroupID><ARTGs><ARTG>192081</ARTG></ARTGs><MinimumBenefit>3069</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SA175</BillingCode><Name>VNS Therapy Lead</Name><Description>Model 302</Description><Size>One size only</Size><SupplierCode>40189</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107789</SubCategoryID><GroupID>109294</GroupID><SubGroupID>113107</SubGroupID><ARTGs><ARTG>131047</ARTG></ARTGs><MinimumBenefit>3069</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SA190</BillingCode><Name>LivaNova Demipulse Duo Model 104 Generator for Vagus Nerve Stimulation</Name><Description>The LivaNova Demipulse Duo Model 104 is an implantable, dual pin lead compatible and multiprogrammable pulse generator that delivers electrical signals to the vagus nerve.</Description><Size>one size only</Size><SupplierCode>40189</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107789</SubCategoryID><GroupID>109294</GroupID><SubGroupID>113108</SubGroupID><ARTGs><ARTG>169837</ARTG></ARTGs><MinimumBenefit>11435</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SA185</BillingCode><Name>VNS Therapy Demipulse Generator 103</Name><Description>The generator is an implantable multiprogrammable pulse generator that delivers electrical signals to the vagus nerve. The pulse generator is housed in a hermetically sealed titanium case and is powered by a single battery. Electrical signals are transmitted from the pulse generator to the vagus nerve
by the lead. The VNS Therapy System is indicated for use as an adjunctive
therapy in reducing the frequency of seizures in patients whose epileptic disorder is dominated by partial seizures (with or without secondary generalization) or generalized seizures that are refractory to seizure medications.</Description><Size>Lead Receptacle 0.126 in (3.2 mm)
Dimension 1.8 in x 1.3 in x 0.27 in (45 mm x 32 mm x 6.9mm)
Weight 0.56 oz (16 g)

The 103 is smaller than previous devices, and fits in the palm of your hand and may be used in pediatric patients</Size><SupplierCode>40189</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107789</SubCategoryID><GroupID>109294</GroupID><SubGroupID>113108</SubGroupID><ARTGs><ARTG>168817</ARTG></ARTGs><MinimumBenefit>11435</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SA174</BillingCode><Name>VNS Therapy Pulse/Pulse Duo</Name><Description>Model 102/102R Generator</Description><Size>One size only</Size><SupplierCode>40189</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107789</SubCategoryID><GroupID>109294</GroupID><SubGroupID>113108</SubGroupID><ARTGs><ARTG>130202</ARTG><ARTG>131046</ARTG><ARTG>131044</ARTG><ARTG>131047</ARTG><ARTG>131045</ARTG><ARTG>168817</ARTG><ARTG>192080</ARTG><ARTG>192081</ARTG><ARTG>130203</ARTG><ARTG>169837</ARTG></ARTGs><MinimumBenefit>11435</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SA186</BillingCode><Name>Aspire SR Pulse Generator Model 106</Name><Description>The 106 VNS therapy system is indicated for use as a adjunctive therapy in reducing the frequency of seizures in patients whose epileptic disorder is dominated by partial seizures (with or without secondary generalization) or generalized seizures that are refractory to seizure medications. Model 106 has the added feature of Autostim. In patients who experience Ictal Tachycardia which is defined as an increase in heart rate during a seizure specifically from baseline to a rate greater than 100 BPM and is at least 55% increase or 35 BPM increase from baseline delivering a therapeutic stimulation automatically delivered on detection of a physiological signal indicative of the onset of a seizure.</Description><Size>Lead receptacle -  0.126 in (3.2 mm) nominal
Dimensions -2.0 in x 2.0 in x 0.27 in (52 mm x 52 mm x 6.9 mm)
Weight- 0.88 oz (25 g)</Size><SupplierCode>40189</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107789</SubCategoryID><GroupID>109294</GroupID><SubGroupID>113108</SubGroupID><ARTGs><ARTG>275135</ARTG></ARTGs><MinimumBenefit>11435</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CB015</BillingCode><Name>V-Grip Detachment Controller</Name><Description>A battery powered device used to control detachment of an implantable embolisation coil from a delivery pusher.</Description><Size>One size only</Size><SupplierCode>39993</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109299</GroupID><SubGroupID>113112</SubGroupID><ARTGs><ARTG>148674</ARTG></ARTGs><MinimumBenefit>211</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS197</BillingCode><Name>LRS Actuator</Name><Description>LRS Actuator is a sterile, hand held mechanical unit with a thumb slide that detaches the coil. When the slider is retracted while the pusher is loaded, it releases the coil into the targeted vaculature. Coils cannot be deployed without the use of the actuator.</Description><Size>Length 5.75", Diameter 1", Weight 28 grams</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109299</GroupID><SubGroupID>113112</SubGroupID><ARTGs><ARTG>150013</ARTG></ARTGs><MinimumBenefit>211</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PN015</BillingCode><Name>Penumbra Smart Coil Detachment Handle</Name><Description>The Penumbra Smart Coil System is comprised of the Penumbra Smart Coil and the Penumbra Smart Coil Detachment Handle. The SMART Coil Detachment Handle is a plastic handle used to mechanically detach the Penumbra SMART Coil Implant. The Detachment Handle is a sterile, single patient device</Description><Size>One size only</Size><SupplierCode>40107</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109299</GroupID><SubGroupID>113112</SubGroupID><ARTGs><ARTG>233479</ARTG></ARTGs><MinimumBenefit>231</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PN008</BillingCode><Name>Penumbra Coil System / Penumbra Coil Detachment Handle</Name><Description>A single detachment handle which is compatible with all Penumbra Coil configurations and can be used to detach all coils needed for a single patient.</Description><Size>One size only</Size><SupplierCode>40107</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109299</GroupID><SubGroupID>113112</SubGroupID><ARTGs><ARTG>193558</ARTG></ARTGs><MinimumBenefit>211</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ME227</BillingCode><Name>Optima XCEL Detachment Controller</Name><Description>The EXCEL Detachment Controller is used to detach the Pusher from the Coil after the coil is deployed, it is compatible with all Optima Coil configurations and is used to detach all coils needed for a single patient.</Description><Size>one size</Size><SupplierCode>40363</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109299</GroupID><SubGroupID>113112</SubGroupID><ARTGs><ARTG>312282</ARTG></ARTGs><MinimumBenefit>211</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW466</BillingCode><Name>InZone Detachment System</Name><Description>InZone Detachment System is specifically designed for use with the Target Detachable Coils</Description><Size>One size</Size><SupplierCode>40329</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109299</GroupID><SubGroupID>113112</SubGroupID><ARTGs><ARTG>208838</ARTG></ARTGs><MinimumBenefit>211</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CB013</BillingCode><Name>Scepter Occlusion Balloon Catheter</Name><Description>Intravascular occlusion balloon catheter</Description><Size>Balloon diameter: 4mm
Balloon lengths: 10 - 20mm</Size><SupplierCode>39993</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109299</GroupID><SubGroupID>113113</SubGroupID><ARTGs><ARTG>194400</ARTG></ARTGs><MinimumBenefit>1500</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AS198</BillingCode><Name>ev3 Occlusion Balloon Catheters</Name><Description>Single lumen balloon catheter to temporarily occlude the central lumen allowing inflation of the balloon during neurosurgical and vascular procedures.</Description><Size>3-7mm diameter; 7-30mm length</Size><SupplierCode>40151</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109299</GroupID><SubGroupID>113113</SubGroupID><ARTGs><ARTG>152746</ARTG></ARTGs><MinimumBenefit>1500</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>HW558</BillingCode><Name>TransForm Occlusion Balloon Catheters</Name><Description>The TransForm Occlusion Balloon Catheter consists of a single lumen catheter shaft with a balloon attached at the distal end. The balloon is available in a compliant version and a super compliant version. Radiopaque markers are located at the proximal and distal ends of the balloon to facilitate fluoroscopic visualization. The balloon catheter is recommended for use with a Stryker Neurovascular 0.014 in (0.36 mm) guidewire to seal the distal segment of the catheter lumen allowing inflation of the balloon. The guidewire can be moved distally or proximally once beyond the distal tip (seal portion) of the catheter and still maintain a positive seal for inflating the balloon. The distal outer segment of the catheter shaft is coated with a hydrophilic material that reduces friction during manipulation in the vessel. A luer fitting hub at the proximal end of the catheter is used for the attachment of accessories.</Description><Size>Effective Length: 150 cm  Balloon Outer Diameter: 3 mm - 7 mm  Balloon Nominal Length: 5 mm - 30 mm  Maximum Catheter Shaft Outer Diameter: 2.8 F</Size><SupplierCode>40329</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109299</GroupID><SubGroupID>113113</SubGroupID><ARTGs><ARTG>223661</ARTG></ARTGs><MinimumBenefit>1500</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ME215</BillingCode><Name>Copernic RC</Name><Description>Venous remodelling balloon</Description><Size>Diameter:  8.0 - 10mm
Balloon Length:  80mm
Catheter Length:  160mm</Size><SupplierCode>40363</SupplierCode><CategoryID>107573</CategoryID><SubCategoryID>107790</SubCategoryID><GroupID>109299</GroupID><SubGroupID>113113</SubGroupID><ARTGs><ARTG>170159</ARTG></ARTGs><MinimumBenefit>1500</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MB006</BillingCode><Name>Adjustable Continence Therapy for Men</Name><Description>ProACT Device: Prosthesis designed for the treatment of male SUI comprising of a single silicone balloon attached via a conduit to titanium and rubber ports allowing for post operative adjustment.</Description><Size>6 - 14cm</Size><SupplierCode>40183</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109222</GroupID><SubGroupID>113115</SubGroupID><ARTGs><ARTG>163939</ARTG></ARTGs><MinimumBenefit>3938</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MB003</BillingCode><Name>Adjustable Continence Therapy for Women</Name><Description>ACT Device: Prosthesis designed for the treatment of female SUI comprising of a single silicone balloon attached via a conduit to titanium and rubber ports allowing for post operative adjustment.</Description><Size>6 - 14cm</Size><SupplierCode>40183</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109222</GroupID><SubGroupID>113115</SubGroupID><ARTGs><ARTG>163939</ARTG></ARTGs><MinimumBenefit>3938</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MB005</BillingCode><Name>Adjustable Continence Therapy for Men</Name><Description>ProACT Device: prosthesis designed for the treatment of male SUI comprising of silicone balloons x2 attached via a conduit to titanium and rubber ports allowing for post operative adjustment.</Description><Size>6 - 14cm</Size><SupplierCode>40183</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109222</GroupID><SubGroupID>113116</SubGroupID><ARTGs><ARTG>163939</ARTG></ARTGs><MinimumBenefit>7876</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MB004</BillingCode><Name>Adjustable Continence Therapy device for women</Name><Description>ACT Device: prosthesis designed for the treatment of female SUI comprising of silicone balloons x 2 attached via a conduit to titanium and rubber ports allowing for post operative adjustment.</Description><Size>6 - 14cm</Size><SupplierCode>40183</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109222</GroupID><SubGroupID>113116</SubGroupID><ARTGs><ARTG>163939</ARTG></ARTGs><MinimumBenefit>7876</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET074</BillingCode><Name>ATOMS System</Name><Description>The ATOMS System is a long term, adjustable prostheses that substitutes urinary sphincter function in incontinent males. It is a hydraulic system comprising of a suburethral sphincter cushion/cuff which can be adjusted hydraulically intra-operatively or post-operatively through an implanted titanium port. Fixation arms and attachment sutures hold the implant in situ.</Description><Size>1 size only - ATS 5011 (Length of Implant 560mm, width of tape 12mm, dimensions of cushion 40x45mm, max. filling volume of cushion 25mL). Titanium port-reservoir with hydraulic tubing, one size.</Size><SupplierCode>40085</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109222</GroupID><SubGroupID>113116</SubGroupID><ARTGs><ARTG>154803</ARTG></ARTGs><MinimumBenefit>7876</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET075</BillingCode><Name>AMI ATOMS Infusion Port</Name><Description>Hydraulic Infusion port for use with AMI ATOMS System - seperate</Description><Size>22mm Diameter, 9.8mm High</Size><SupplierCode>40085</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109222</GroupID><SubGroupID>113117</SubGroupID><ARTGs><ARTG>148776</ARTG></ARTGs><MinimumBenefit>950</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET085</BillingCode><Name>VICTO Adjustable Artificial Sphincter Pump Replacement Kit</Name><Description>A replacement control pump for the VICTO Adjustable Artificial Sphincter, artificial urinary sphincter.</Description><Size>1 size.</Size><SupplierCode>40085</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109223</GroupID><SubGroupID>113118</SubGroupID><ARTGs><ARTG>203685</ARTG></ARTGs><MinimumBenefit>4700</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AM029</BillingCode><Name>AMS 800 Artificial Urinary Sphincter Pump</Name><Description>Control Pump</Description><Size>One size</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109223</GroupID><SubGroupID>113118</SubGroupID><ARTGs><ARTG>131706</ARTG></ARTGs><MinimumBenefit>4700</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS427</BillingCode><Name>AMS 800 Artificial Urinary Sphincter Pump</Name><Description>Control Pump</Description><Size>One size</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109223</GroupID><SubGroupID>113118</SubGroupID><ARTGs><ARTG>390349</ARTG></ARTGs><MinimumBenefit>4700</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VO008</BillingCode><Name>Conti Artificial Urinary Sphincter Control Pump (HydroShield coated)</Name><Description>Conti Artificial Urinary Sphincter Control Pump with HydroShield Hydrophilic coating for Conti Artificial Urinary Sphincter</Description><Size>Two models.</Size><SupplierCode>40243</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109223</GroupID><SubGroupID>113118</SubGroupID><Suffix>A</Suffix><ARTGs><ARTG>338270</ARTG></ARTGs><MinimumBenefit>5076</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS409</BillingCode><Name>AMS 800 Urinary Control System Pump</Name><Description>Pump with InhibiZone Antibiotic Surface Treatment</Description><Size>One size only</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109223</GroupID><SubGroupID>113118</SubGroupID><Suffix>A</Suffix><ARTGs><ARTG>352830</ARTG><ARTG>165326</ARTG></ARTGs><MinimumBenefit>5076</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET087</BillingCode><Name>VICTO Adjustable Artificial Sphincter Cuff Replacement Kit</Name><Description>A replacement cuff for a VICTO Adjustable Artificial Sphincter, artificial urinary sphincter.</Description><Size>3.7cm, 4.0cm, 4.5cm, and 5.0cm.</Size><SupplierCode>40085</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109223</GroupID><SubGroupID>113119</SubGroupID><ARTGs><ARTG>203685</ARTG></ARTGs><MinimumBenefit>2483</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS408</BillingCode><Name>AMS 800 Urinary Control System with InhibiZone - cuff</Name><Description>Occlusive Cuff with InhibiZone Antibiotic Surface Treatment</Description><Size>13 Cuff sizes from 3.5 to 11.0 cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109223</GroupID><SubGroupID>113119</SubGroupID><Suffix>A</Suffix><ARTGs><ARTG>352830</ARTG><ARTG>165326</ARTG></ARTGs><MinimumBenefit>2708</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS425</BillingCode><Name>AMS 800 Artificial Urinary Sphincter Cuff</Name><Description>Occlusive Cuff</Description><Size>13 Cuff sizes from 3.5 to 11.0 cm: Size: 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 9, 10, 11cm  </Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109223</GroupID><SubGroupID>113119</SubGroupID><ARTGs><ARTG>390349</ARTG></ARTGs><MinimumBenefit>2483</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AM021</BillingCode><Name>AMS 800 Artificial Urinary Sphincter Cuff</Name><Description>Silicone cuff for artificial urinary sphincter. For the implantation of the second cuff for the AMS 800</Description><Size>13 Cuff sizes from 3.5 to 11.0 cm: Size: 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 9, 10, 11cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109223</GroupID><SubGroupID>113119</SubGroupID><ARTGs><ARTG>131706</ARTG></ARTGs><MinimumBenefit>2483</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AM001</BillingCode><Name>AMS 800 Artificial Urinary Sphincter Cuff</Name><Description>Occlusive Cuff</Description><Size>13 Cuff sizes from 3.5 to 11.0 cm: Size: 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 9, 10, 11cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109223</GroupID><SubGroupID>113119</SubGroupID><ARTGs><ARTG>131706</ARTG></ARTGs><MinimumBenefit>2483</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VO003</BillingCode><Name>Conti Artificial Urinary Sphincter Occlusive Cuff (HydroShield coated)</Name><Description>Conti Artificial Urinary Sphincter Occlusive Cuff with HydroShield Hydrophilic coating for Conti Artificial Urinary Sphincter</Description><Size>3.5, 3.75, 4.0, 4.25, 4.5, 4.75. 5.0, 5.5, 6.0, 6.5, 7.0, 7.5, 8.0, 8.5, 9.0, 9.5, 10, 11, 12, 13cm.</Size><SupplierCode>40243</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109223</GroupID><SubGroupID>113119</SubGroupID><Suffix>A</Suffix><ARTGs><ARTG>338270</ARTG></ARTGs><MinimumBenefit>2708</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VO009</BillingCode><Name>Conti Artificial Urinary Sphincter Pressure Regulating Balloon (HydroShield coated) </Name><Description>Conti Artificial Urinary Sphincter Pressure Regulating Balloon with HydroShield Hydrophilic coating for Conti Artificial Urinary Sphincter</Description><Size>40-49cm, 50-59cm, 60-69cm, 70-79cm, 80-89cm.</Size><SupplierCode>40243</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109223</GroupID><SubGroupID>113120</SubGroupID><ARTGs><ARTG>338270</ARTG></ARTGs><MinimumBenefit>1954</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET086</BillingCode><Name>VICTO Adjustable Artificial Sphincter Balloon Replacement Kit</Name><Description>A replacement pressure regulating balloon for the VICTO Adjustable Artificial Sphincter, artificial urinary sphincter.</Description><Size>1 size.</Size><SupplierCode>40085</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109223</GroupID><SubGroupID>113120</SubGroupID><ARTGs><ARTG>203685</ARTG></ARTGs><MinimumBenefit>1954</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AM028</BillingCode><Name>AMS 800 Artificial urinary sphincter Pressure Regulating Balloon</Name><Description>Pressure Regulating Balloon</Description><Size>51 - 60cm, 61 -70cm, 71 - 80cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109223</GroupID><SubGroupID>113120</SubGroupID><ARTGs><ARTG>131706</ARTG></ARTGs><MinimumBenefit>1954</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS426</BillingCode><Name>AMS 800 Artificial urinary sphincter Pressure Regulating Balloon</Name><Description>Pressure Regulating Balloon</Description><Size>51 - 60cm, 61 -70cm, 71 - 80cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109223</GroupID><SubGroupID>113120</SubGroupID><ARTGs><ARTG>390349</ARTG></ARTGs><MinimumBenefit>1954</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS428</BillingCode><Name>AMS 800 Artificial Urinary Sphincter Accessory Kit  </Name><Description>Accessory Kit  </Description><Size>One Size  </Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109223</GroupID><SubGroupID>113122</SubGroupID><ARTGs><ARTG>390349</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AM030</BillingCode><Name>AMS 800 Artificial Urinary Sphincter Accessory Kit</Name><Description>Accessory Kit</Description><Size>One Size</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109223</GroupID><SubGroupID>113122</SubGroupID><ARTGs><ARTG>131706</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VO010</BillingCode><Name>Conti Artificial Urinary Sphincter Accessory Kit</Name><Description>Accessory Kit for Conti Artificial Urinary Sphincters with HydroShield coated connectors</Description><Size>One size</Size><SupplierCode>40243</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109223</GroupID><SubGroupID>113122</SubGroupID><ARTGs><ARTG>338270</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET057</BillingCode><Name>VICTO Artificial Urinary Sphincter</Name><Description>VICTO Artificial Urinary Sphincter with conditional occlusion, inflatable hydraulic device.</Description><Size>Four cuff sizes: 3.7cm, 4.0cm, 4.5cm, and 5.0cm.</Size><SupplierCode>40085</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109223</GroupID><SubGroupID>113123</SubGroupID><ARTGs><ARTG>203685</ARTG></ARTGs><MinimumBenefit>9500</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET084</BillingCode><Name>ATOMS with Integrated Scrotal Port</Name><Description>The ATOMS with Integrated Scrotal Port is a long-term hydraulically adjustable substitute urinary sphincter. The implant is supplied as a single piece system which includes a hydraulically adjusted urethral cuff and a silicone coated adjustment port which rests in the patient's scrotum. The pressure applied by the cuff is evenly distributed over the bulbar urethra, providing ventral closure in order to achieve continence. The adjustment port is designed to allow for non-surgical postoperative adjustment of cuff pressure.</Description><Size>1 size only  Width of tape: 12mm  Dimensions of cushion: 40 x 45mm  Port Diameter: 11mm</Size><SupplierCode>40085</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109223</GroupID><SubGroupID>113123</SubGroupID><ARTGs><ARTG>154803</ARTG></ARTGs><MinimumBenefit>9500</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET050</BillingCode><Name>ARGUS</Name><Description>Adjustable Male Sling made of silicone adjustable self fixating columns and urethral cushion</Description><Size>One size only</Size><SupplierCode>40085</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109225</GroupID><SubGroupID>113126</SubGroupID><ARTGs><ARTG>118082</ARTG></ARTGs><MinimumBenefit>5432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AM048</BillingCode><Name>AdVance XP Male Sling System</Name><Description>Sub-urethral sling implant for treatment of male stress urinary incontinence. Made from polypropylene monofilament mesh</Description><Size>Arm width: 1.2cm, Centre width: 3.55cm, Total Length: 35.5cm, 43.5cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109225</GroupID><SubGroupID>113126</SubGroupID><ARTGs><ARTG>388078</ARTG><ARTG>388082</ARTG></ARTGs><MinimumBenefit>5432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS403</BillingCode><Name>Obtryx II </Name><Description>Transobturator Mid-Urethral Sling System with Blue Prolene Polypropylene Mesh</Description><Size>One size only</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109225</GroupID><SubGroupID>113127</SubGroupID><ARTGs><ARTG>373426</ARTG></ARTGs><MinimumBenefit>822</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS404</BillingCode><Name>Advantage Fit</Name><Description>Transvaginal Mid-Urethral Sling System with Blue Prolene Polypropylene Mesh    </Description><Size>One size only</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109225</GroupID><SubGroupID>113127</SubGroupID><ARTGs><ARTG>373425</ARTG></ARTGs><MinimumBenefit>822</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ070</BillingCode><Name>GYNECARE TVT™: Device Tension Free Vaginal Tape / EXACT™ Continence System</Name><Description>Female stress urinary incontinence surgical mesh</Description><Size>Tape - 133 mm (W) x 190 mm (H); EXACT™ - Flat:460 mm (W) x 546 mm (H)</Size><SupplierCode>39932</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109225</GroupID><SubGroupID>113127</SubGroupID><ARTGs><ARTG>351635</ARTG><ARTG>351636</ARTG></ARTGs><MinimumBenefit>822</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS402</BillingCode><Name>Advantage </Name><Description>Transvaginal Mid-Urethral Sling System with Blue Prolene Polypropylene Mesh</Description><Size>One size only</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109225</GroupID><SubGroupID>113127</SubGroupID><ARTGs><ARTG>373424</ARTG></ARTGs><MinimumBenefit>822</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>JJ442</BillingCode><Name>GYNECARE TVT™ Obturator System</Name><Description>Female stress urinary incontinence surgical mesh</Description><Size>461.86 mm X 548.96 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109225</GroupID><SubGroupID>113127</SubGroupID><ARTGs><ARTG>351637</ARTG></ARTGs><MinimumBenefit>822</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN039</BillingCode><Name>GYNECARE TVT™ ABBREVO™ Continence System</Name><Description>Female stress urinary incontinence surgical mesh</Description><Size>459.91 mm X 545.9 mm</Size><SupplierCode>39932</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109225</GroupID><SubGroupID>113127</SubGroupID><ARTGs><ARTG>351638</ARTG></ARTGs><MinimumBenefit>822</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SC001</BillingCode><Name>BULKAMID Urethral Bulking System</Name><Description>Transparent polyacrylamide gel for female urinary incontinence. Kit comprises 2 syringe, 2 needles, 1 applicator</Description><Size>2 x 1ml syringes, 2 x BULKAMID 23G needles, 1 x disposable sheath</Size><SupplierCode>40336</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109226</GroupID><SubGroupID>113130</SubGroupID><ARTGs><ARTG>152085</ARTG></ARTGs><MinimumBenefit>1009</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET053</BillingCode><Name>Macroplastique</Name><Description>Sterile, textured, highly cross linked polydimethylsiloxane elastomer implants suspended in a bio-excretable carrier gel.</Description><Size>2.5ml Implants</Size><SupplierCode>40085</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107769</SubCategoryID><GroupID>109226</GroupID><SubGroupID>113131</SubGroupID><ARTGs><ARTG>146732</ARTG></ARTGs><MinimumBenefit>1262</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PY012</BillingCode><Name>Ex-Stent Tumour Ureteral Stent Set</Name><Description>Open end stent with guide wire and pusher</Description><Size>Diameter: 6Fr-8Fr
Length: 26cm-36cm</Size><SupplierCode>40093</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113133</SubGroupID><Suffix>T</Suffix><ARTGs><ARTG>171564</ARTG></ARTGs><MinimumBenefit>187</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX005</BillingCode><Name>Paediatric Ureteric Valve Stent Set</Name><Description>Fixed length wirthan stent</Description><Size>12 - 22cm</Size><SupplierCode>40451</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113133</SubGroupID><Suffix>T</Suffix><ARTGs><ARTG>136657</ARTG></ARTGs><MinimumBenefit>187</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX004</BillingCode><Name>Ureteric Stent Set</Name><Description>Open end for coaxial applications. Polyurethane stents with hydrogel coating with introducer and with/without guidewires. </Description><Size>12 - 28cm</Size><SupplierCode>40451</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113133</SubGroupID><Suffix>T</Suffix><ARTGs><ARTG>277254</ARTG></ARTGs><MinimumBenefit>187</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC022</BillingCode><Name>C-Flex Double Pigtail Ureteric Stent Set</Name><Description>Set includes: Stent, Wire, Positioner</Description><Size>Multiple French Sizes, Multi-length</Size><SupplierCode>40434</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113133</SubGroupID><Suffix>P</Suffix><ARTGs><ARTG>216072</ARTG></ARTGs><MinimumBenefit>171</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC214</BillingCode><Name>Cook Ureteral Stents</Name><Description>Amplatz Ureteral Stent Set, Ultrathane RB Design Radioplaque Band and AQ Hydrophilic Coating Set includes one stent positioner with flexible stent introducer catheter</Description><Size>8.5Fr - 12,20,22,24,26,28cm and 10.2Fr - 22,24,26,28cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113133</SubGroupID><Suffix>T</Suffix><ARTGs><ARTG>137913</ARTG></ARTGs><MinimumBenefit>187</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PY011</BillingCode><Name>Optimed Opti-J Stents</Name><Description>Dual Use directional Double J stent and delivery system. Can also be used as urinary diversion stent.</Description><Size>4.5Fr to 8Fr
Length:  22cm to 36cm</Size><SupplierCode>40093</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113133</SubGroupID><ARTGs><ARTG>171564</ARTG></ARTGs><MinimumBenefit>95</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MH010</BillingCode><Name>Silhouette Ureteral Stent</Name><Description>The Silhouette Ureteric Stent is manufactured with a soft material that provides superior comfort.  It has superior column strength through a coil-reinforced body providing effortless placement.  The tight coils prevent migration.  The smaller outside dia</Description><Size>Multiple French Sizes &amp; Lengths</Size><SupplierCode>40039</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113133</SubGroupID><ARTGs><ARTG>116728</ARTG></ARTGs><MinimumBenefit>95</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CT034</BillingCode><Name>PU-S Double Loop Ureteral Stents</Name><Description>Double Loop Ureteral Stents in Soft Polyurethane, with pusher and guidewire.</Description><Size>Various in 6 and 7Fr.
Various in 24, 26, 28 cm lengths.
Various in O/O or O/C.
With either Steerable or simple pusher.</Size><SupplierCode>40004</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113133</SubGroupID><ARTGs><ARTG>142907</ARTG></ARTGs><MinimumBenefit>95</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CT024</BillingCode><Name>PU-R Double Loop Ureteral Stents</Name><Description>Double Loop Ureteral Stents in Rigid Polyurethane, with pusher. With or without guidewire depending on the model.</Description><Size>Various in 4.8, 6, 7, 8Fr.
Various in 24, 26, 28, 30cm lengths.
Various in O/O or O/C.
Various with or without guidewire.
With either streerable or simple pusher</Size><SupplierCode>40004</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113133</SubGroupID><ARTGs><ARTG>142907</ARTG></ARTGs><MinimumBenefit>95</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC273</BillingCode><Name>Ureteric Stent Set</Name><Description>Set includes soft Aqueous Coated (AQ) ureteric stent, positioner, with or without wire guide</Description><Size>Multiple French Sizes and Lengths</Size><SupplierCode>40434</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><ARTGs><ARTG>216072</ARTG></ARTGs><MinimumBenefit>153</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CT026</BillingCode><Name>Biosoft Duo Double Loop Ureteral Stents</Name><Description>Biosoft Duo double loop ureteral stents supplied with simple or steerable pusher, with or without guidewire and with or without flush catheter depending on the model. Duration of Implantation: 12 months</Description><Size>6 - 9 Fr
20 - 30 cm
Either O/O or O/C</Size><SupplierCode>40004</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><ARTGs><ARTG>224254</ARTG><ARTG>142925</ARTG></ARTGs><MinimumBenefit>153</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CT035</BillingCode><Name>Vortek Hydro-Coated Double Loop Ureteral Stents</Name><Description>Vortek Hydro-Coated Double Loop Ureteral Stents with simple or steerable pusher and with or without guidewire</Description><Size>4.8 - 7Fr
22 - 30cm lengths</Size><SupplierCode>40004</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><ARTGs><ARTG>224254</ARTG></ARTGs><MinimumBenefit>153</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CT027</BillingCode><Name>Vortek Single Loop Ureteral Stents</Name><Description>Vortek Single Loop Ureteral Stents for drainage and urine collection</Description><Size>6, 7, 8 Fr
90cm length</Size><SupplierCode>40004</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><ARTGs><ARTG>142924</ARTG><ARTG>224254</ARTG></ARTGs><MinimumBenefit>153</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CT029</BillingCode><Name>Vortek Double Loop Ureteral Stents</Name><Description>Vortek Double Loop Ureteral Stents have a double layered structure which make them easy to insert over guidewire, the stiffness of each size has been adapted in order to keep the mechanical properties.</Description><Size>4.8, 6, 7 &amp; 8 Fr
with steerable or simple pusher
with or without guidewire
O/O or O/C</Size><SupplierCode>40004</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><ARTGs><ARTG>142924</ARTG><ARTG>224254</ARTG></ARTGs><MinimumBenefit>153</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CT032</BillingCode><Name>Silicone Double Loop Ureteral Stent</Name><Description>Silicone Double Loop Ureteral Stent with guidewire and pusher</Description><Size>6 - 8Fr
16cm - 30cm</Size><SupplierCode>40004</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><ARTGs><ARTG>142923</ARTG></ARTGs><MinimumBenefit>153</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CT030</BillingCode><Name>Biosoft Minute Stent</Name><Description>Biosoft minute double loop ureteral stent. Ready to use; the stent is in place over the guidewire and connected to the steerable pusher. Duration of implantation: 6 months.</Description><Size>6 - 8 Fr
24 - 30 cm length</Size><SupplierCode>40004</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><ARTGs><ARTG>224219</ARTG><ARTG>142925</ARTG></ARTGs><MinimumBenefit>153</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CT031</BillingCode><Name>Vortek TUMOR STENT Double loop ureteral stent</Name><Description>Vortek Tumor Stent is reinforced with stiffness of material offering excellent resistance to compression.</Description><Size>7-8Fr
26-30cm in length</Size><SupplierCode>40004</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><ARTGs><ARTG>224254</ARTG></ARTGs><MinimumBenefit>153</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL078</BillingCode><Name>Ureteral Stents </Name><Description>Diversion Stent, silicone</Description><Size>7 - 8.5 F x 90cm</Size><SupplierCode>40122</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><ARTGs><ARTG>130442</ARTG><ARTG>136671</ARTG></ARTGs><MinimumBenefit>153</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TX003</BillingCode><Name>DD Ureteric Tumor Stent Set</Name><Description>Open/Closed end with introducer and guide wire, Polyurethane</Description><Size>20 - 28cm</Size><SupplierCode>40451</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><ARTGs><ARTG>136657</ARTG></ARTGs><MinimumBenefit>153</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MB029</BillingCode><Name>YellowStar Ureteric Stent</Name><Description>PUR ureteral stent with PC treatment (Phosphorylcholine-coating) and Dirigenta Steering Device</Description><Size>4.7-8Fr   Lengths 24-30cm</Size><SupplierCode>40183</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><Suffix>Therm</Suffix><ARTGs><ARTG>327784</ARTG></ARTGs><MinimumBenefit>196</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WK001</BillingCode><Name>PLASTI-MED HydroPhilic</Name><Description>HydroPhilic Ureteral Stent</Description><Size>4Fr / 4.8Fr / 6Fr / 7Fr ( 12cm - 28cm )</Size><SupplierCode>40400</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><Suffix>Therm</Suffix><ARTGs><ARTG>389186</ARTG></ARTGs><MinimumBenefit>196</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC130</BillingCode><Name>Ureteric Stent Set</Name><Description>Set includes Aqueous Coated (AQ) firm fixed length ureteric stent, positioner, with or without wire guide</Description><Size>Multiple French Sizes, and Lengths</Size><SupplierCode>40434</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><Suffix>Therm</Suffix><ARTGs><ARTG>216072</ARTG></ARTGs><MinimumBenefit>196</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS363</BillingCode><Name>Tria Ureteral Stent</Name><Description>Tria Firm or Tria Soft ureteral stent. Tria Firm or Tria Soft ureteral stent kit with Sensor or ZIPwire Guidewire</Description><Size>Diameters up to 8Fr &amp; lengths up to 30cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><Suffix>Therm</Suffix><ARTGs><ARTG>129376</ARTG><ARTG>410924</ARTG></ARTGs><ChangeExplanation>Change to ARTG, Description</ChangeExplanation><MinimumBenefit>196</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2019-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS091</BillingCode><Name>Percuflex; Percuflex Plus; Percuflex Plus SureDrive</Name><Description>Ureteral stent with attached suture</Description><Size>Diameters up to 14Fr &amp; lengths up to 40cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><Suffix>Therm</Suffix><ARTGs><ARTG>104324</ARTG><ARTG>132306</ARTG></ARTGs><MinimumBenefit>196</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS116</BillingCode><Name>Polaris Loop Ureteral Stent</Name><Description>Dual durometer ureteral stent with attached suture</Description><Size>Diameters up to 14Fr &amp; lengths up to 40cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><Suffix>Therm</Suffix><ARTGs><ARTG>129376</ARTG><ARTG>104324</ARTG></ARTGs><MinimumBenefit>196</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WJ004</BillingCode><Name>Roca J-Fil &amp; Mini J-Fil</Name><Description>Ureteral PigTail Suture Stent &amp; Simple / Connectable Pusher &amp; Without / With GuideWire</Description><Size>4.8Fr / 7.0Fr ( 00cm - 16cm )</Size><SupplierCode>40392</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><Suffix>Therm</Suffix><ARTGs><ARTG>381055</ARTG></ARTGs><MinimumBenefit>196</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WJ003</BillingCode><Name>Roca JJ</Name><Description>Soft / Firm Ureteral Stent &amp; Simple / Connectable Pusher &amp; Without / With GuideWire</Description><Size>4.8Fr / 6Fr / 7Fr / 8Fr ( 24cm - 30cm )  </Size><SupplierCode>40392</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><Suffix>Therm</Suffix><ARTGs><ARTG>381055</ARTG></ARTGs><MinimumBenefit>196</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PY001</BillingCode><Name>Optimed Ureteral Stents</Name><Description>Soft-Polyurethane. Ureteral. Paediatric Ureteral. Renal Transplantation. Urinary Diversion.</Description><Size>Ureteral -
Diameter: 4.5Fr-8Fr
Length: 22cm-36cm
Paediatric Ureteral - Diameter: 3Fr-4Fr 
Length: 10cm-16cm
Renal Transplantation -  
Diameter: 6Fr-8Fr
Length:8cm-18cm
Urinary Diversion -
Diameter: 4.5Fr-9Fr 
Length: 70cm</Size><SupplierCode>40093</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><Suffix>SP</Suffix><ARTGs><ARTG>171564</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CT025</BillingCode><Name>Stenostent Double Loop Ureteral Stents</Name><Description>STENOSTENT® Double loop ureteral stent in silicone open/open, total reinforcement with connectable pusher and fixed core guidewire</Description><Size>16 - 30cm</Size><SupplierCode>40004</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><Suffix>SP</Suffix><ARTGs><ARTG>142923</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WJ002</BillingCode><Name>Roca Endo-Sil</Name><Description>Silicone Ureteral Stent &amp; Simple / Connectable Pusher &amp; Without / With GuideWire</Description><Size>6Fr / 7Fr / 8Fr ( 24cm-30cm )</Size><SupplierCode>40392</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><Suffix>SP</Suffix><ARTGs><ARTG>381055</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CT028</BillingCode><Name>Pyelostent Double Loop Ureteral Stent</Name><Description>Pyelostent, Silicone stent for long-term implantation (up to 12 months)</Description><Size>26 - 30cm</Size><SupplierCode>40004</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><Suffix>SP</Suffix><ARTGs><ARTG>142923</ARTG></ARTGs><MinimumBenefit>210</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MH013</BillingCode><Name>Paediatric Silhouette System Set</Name><Description>Coil reinforced body.  SL-6 hydrophilic coating.  UroWire 0.035" 3-in-1 guidewire with kink resistant nitinol core.  Design divided into 3 sections: silver section (front end) floppy SL - 6 hydrophilic coating; Blue section (mid) super stiff PTFE (not hydrophilicaly coated); and Green section (back) flexible</Description><Size>4F, 8 - 12cm</Size><SupplierCode>40039</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><Suffix>P</Suffix><ARTGs><ARTG>116727</ARTG><ARTG>116728</ARTG></ARTGs><MinimumBenefit>218</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-06-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA309</BillingCode><Name>InLay Optima® Ureteral Stent</Name><Description>The ureteral stent is intended to relieve obstruction in a variety of benign, malignant and post-traumatic conditions in the ureter in order to pass fluids to or from the ureter.</Description><Size>4.7Fr, with length 14cm, 20cm, 22cm, 24cm, 26cm, 28cm and 30cm  6Fr, with length 14cm, 20cm, 22cm, 24cm, 26cm, 28cm and 30cm   7Fr, with length 14cm, 20cm, 22cm, 24cm, 26cm, 28cm and 30cm   8Fr, with length 14cm, 20cm, 22cm, 24cm, 26cm, 28cm and 30cm</Size><SupplierCode>39949</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><Suffix>Therm</Suffix><ARTGs><ARTG>235658</ARTG></ARTGs><MinimumBenefit>196</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS093</BillingCode><Name>Retromax Plus Ureteral Stent</Name><Description>Ureteral stent</Description><Size>Diameters up to 14Fr &amp; lengths up to 40cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><Suffix>Therm</Suffix><ARTGs><ARTG>104324</ARTG><ARTG>129379</ARTG></ARTGs><MinimumBenefit>196</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS192</BillingCode><Name>Percuflex® Helical</Name><Description>Ureteral Stent with Hydro Plus™ Coating</Description><Size>6fr to 8fr and 10cm to 30cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><Suffix>Therm</Suffix><ARTGs><ARTG>129376</ARTG></ARTGs><MinimumBenefit>196</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS092</BillingCode><Name>Contour Ureteral Stent, Contour SureDrive Ureteral Stent</Name><Description>Ureteral stent with attached suture</Description><Size>Diameters up to 14Fr &amp; lengths up to 40cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><Suffix>Therm</Suffix><ARTGs><ARTG>104324</ARTG></ARTGs><MinimumBenefit>196</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS086</BillingCode><Name>Polaris Ultra Ureteral Stent</Name><Description>Dual durometer ureteral stent with attached suture</Description><Size>Diameters up to 14Fr &amp; lengths up to 40cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113134</SubGroupID><Suffix>Therm</Suffix><ARTGs><ARTG>104324</ARTG><ARTG>129379</ARTG></ARTGs><MinimumBenefit>196</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PY030</BillingCode><Name>Taewoong ePTFE covered dual nitinol ureteral/urethral stent</Name><Description>Taewoong ePTFE covered dual nitinol ureteral/urethral stent</Description><Size>Diameter: 6mm to 16mm
Length: 4cm to 20cm</Size><SupplierCode>40093</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113135</SubGroupID><Suffix>Therm</Suffix><ARTGs><ARTG>220258</ARTG><ARTG>130532</ARTG></ARTGs><MinimumBenefit>2996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2012-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MB028</BillingCode><Name>Allium URS Long Ureteral stent</Name><Description>Fully covered, flexible, extra long ureteral stent</Description><Size>9 mm diameter
200 mm length</Size><SupplierCode>40183</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113135</SubGroupID><Suffix>Therm</Suffix><ARTGs><ARTG>205005</ARTG></ARTGs><MinimumBenefit>2996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MB016</BillingCode><Name>Allium Ureteral Stent</Name><Description>Round Nitinol stent with copolymer covering and supplied premounted on a delivery tool. Intended to be inserted into the lower ureter to allow free flow of urine from the kidney to the bladder.</Description><Size>8mm x 100mm, 8mm x 120mm, 10mm x 100mm, 10mm x 120mm</Size><SupplierCode>40183</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113135</SubGroupID><Suffix>Therm</Suffix><ARTGs><ARTG>205005</ARTG></ARTGs><MinimumBenefit>2996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET055</BillingCode><Name>Memokath Ureteric Stent</Name><Description>Memokath Model 051CW.</Description><Size>30mm - 200mm</Size><SupplierCode>40085</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113135</SubGroupID><Suffix>Therm</Suffix><ARTGs><ARTG>141654</ARTG></ARTGs><MinimumBenefit>2996</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC226</BillingCode><Name>RESONANCE Metallic Ureteral Stent Set</Name><Description>Metallic Double Pigtail Stent</Description><Size> 6 Fr, lengths 12-30cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109228</GroupID><SubGroupID>113135</SubGroupID><Suffix>T</Suffix><ARTGs><ARTG>118616</ARTG></ARTGs><MinimumBenefit>1634</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-03-24</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC282</BillingCode><Name>Universa Soft Ureteral Stent Set</Name><Description>Universa Soft Ureteral Stent Set, with or without the TFE WireGuide, multi-length</Description><Size>5, 6, 7 and 8FR in multi-length (22-32CM)</Size><SupplierCode>40434</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109229</GroupID><SubGroupID>113136</SubGroupID><ARTGs><ARTG>216072</ARTG></ARTGs><MinimumBenefit>189</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2010-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BA044</BillingCode><Name>Ureteral Stent</Name><Description>Hydrophilic coated ureteral stent</Description><Size>Fr 4.7 – 8.0, Length 22-32cm</Size><SupplierCode>39949</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109229</GroupID><SubGroupID>113136</SubGroupID><ARTGs><ARTG>235658</ARTG></ARTGs><MinimumBenefit>189</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC218</BillingCode><Name>C-Flex Multilength Ureteric Stent Set</Name><Description>Set includes: Paediatric Stent, Wire, Positioner</Description><Size>3.7 Fr, Multiple Lengths</Size><SupplierCode>40434</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109229</GroupID><SubGroupID>113136</SubGroupID><Suffix>P</Suffix><ARTGs><ARTG>216072</ARTG></ARTGs><MinimumBenefit>241</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC219</BillingCode><Name>C-Flex Double Pigtail Ureteric Stent Set</Name><Description>Set includes: Paediatric Stent, Wire and Positioner</Description><Size>3.7 Fr, Multilple Lengths</Size><SupplierCode>40434</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109229</GroupID><SubGroupID>113136</SubGroupID><Suffix>P</Suffix><ARTGs><ARTG>216072</ARTG></ARTGs><MinimumBenefit>241</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WK002</BillingCode><Name>PLASTI-MED Multi-Length</Name><Description>Multi-Length Ureteral Stent</Description><Size>3Fr / 3.5Fr / 4Fr / 4.7Fr / 4.8Fr / 6Fr / 7Fr ( 8cm - 32cm )</Size><SupplierCode>40400</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109229</GroupID><SubGroupID>113136</SubGroupID><Suffix>P</Suffix><ARTGs><ARTG>389186</ARTG></ARTGs><MinimumBenefit>241</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CT023</BillingCode><Name>Biosoft Duo Multi Length Hydro-Coated Ureteral Stents</Name><Description>Biosoft Duo Multi Length Hydro-Coated Stents for drainage of upper urinary tract.</Description><Size>4.8, 6. 7 Fr</Size><SupplierCode>40004</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109229</GroupID><SubGroupID>113137</SubGroupID><ARTGs><ARTG>142925</ARTG></ARTGs><MinimumBenefit>154</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL080</BillingCode><Name>Ureteral Stents</Name><Description>Tecoflex polymer, hydrophilic coating/PTFE coating</Description><Size>4.5F-8.5F x length 8 - 32cm</Size><SupplierCode>40122</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109229</GroupID><SubGroupID>113137</SubGroupID><ARTGs><ARTG>130442</ARTG></ARTGs><MinimumBenefit>154</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC003</BillingCode><Name>Sof-Flex Multi-length Ureteric Stent Set</Name><Description>Stent and Positioner only</Description><Size>Multiple French Sizes, Multi-length</Size><SupplierCode>40434</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109229</GroupID><SubGroupID>113137</SubGroupID><ARTGs><ARTG>216072</ARTG></ARTGs><MinimumBenefit>154</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC150</BillingCode><Name>Sof-Flex Double Pigtail Ureteric Stent Set</Name><Description>Set includes: Stent, Wire, Positioner</Description><Size>Multiple French Sizes and Lengths</Size><SupplierCode>40434</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109229</GroupID><SubGroupID>113137</SubGroupID><ARTGs><ARTG>216072</ARTG></ARTGs><MinimumBenefit>154</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC104</BillingCode><Name>Cook Ureteral Stent - Sof-Flex Double Pigtail Stent Set - Special</Name><Description>Radiopaque Sof-Flex Stent, Stainless Steel Wire Guide, Radiopaque Polyurethane Catheter and Radiolucent Vinyl Positioner</Description><Size>Multiple French Sizes and Lengths</Size><SupplierCode>40434</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109229</GroupID><SubGroupID>113137</SubGroupID><ARTGs><ARTG>216072</ARTG></ARTGs><MinimumBenefit>154</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC002</BillingCode><Name>Sof-Flex Multi-length Ureteric Stent Set</Name><Description>Set includes Stent, Wire, Positioner</Description><Size>Multiple French Sizes, Multi-length</Size><SupplierCode>40434</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109229</GroupID><SubGroupID>113137</SubGroupID><ARTGs><ARTG>216072</ARTG></ARTGs><MinimumBenefit>154</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC272</BillingCode><Name>Ureteric Stent Set</Name><Description>Set includes soft Aqueous Coated (AQ) ureteric stent, positioner, with or without wire guide</Description><Size>Multiple French Sizes, multi-length</Size><SupplierCode>40434</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109229</GroupID><SubGroupID>113137</SubGroupID><ARTGs><ARTG>216072</ARTG></ARTGs><MinimumBenefit>154</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL076</BillingCode><Name>Ureteral Stents </Name><Description>Single J Ureteric Stent, silicone</Description><Size>7 - 8.5 F x 90cm</Size><SupplierCode>40122</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109229</GroupID><SubGroupID>113137</SubGroupID><ARTGs><ARTG>130442</ARTG><ARTG>136671</ARTG></ARTGs><MinimumBenefit>154</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL077</BillingCode><Name>Ureteral Stents</Name><Description>Double J Ureteric stent, silicone</Description><Size>6-8.5 F, 12 - 30 cm</Size><SupplierCode>40122</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109229</GroupID><SubGroupID>113137</SubGroupID><ARTGs><ARTG>130442</ARTG></ARTGs><MinimumBenefit>154</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC023</BillingCode><Name>Greene Renal Transplant Stent Set</Name><Description>Transplant stent set</Description><Size>Multiple French Sizes, Multi-length</Size><SupplierCode>40434</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109229</GroupID><SubGroupID>113137</SubGroupID><Suffix>SP</Suffix><ARTGs><ARTG>216072</ARTG></ARTGs><MinimumBenefit>231</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC138</BillingCode><Name>Filiform Double Pigtail Silicone Stent Set</Name><Description>Stent, Positioner</Description><Size>6-8.5Fr, 20-28cm length</Size><SupplierCode>40434</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109229</GroupID><SubGroupID>113137</SubGroupID><Suffix>T</Suffix><ARTGs><ARTG>216072</ARTG></ARTGs><MinimumBenefit>252</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC217</BillingCode><Name>Sof-Flex Multilength Ureteric Stent Set</Name><Description>Set includes: Paediatric Stent, Wire, Positioner</Description><Size>3 Fr, Multiple Lengths</Size><SupplierCode>40434</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109229</GroupID><SubGroupID>113137</SubGroupID><Suffix>P</Suffix><ARTGs><ARTG>216072</ARTG></ARTGs><MinimumBenefit>246</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC220</BillingCode><Name>Sof-Flex Double Pigtail Ureteric Stent Set</Name><Description>Set includes: Paediatric Stent, Wire, Positioner</Description><Size>3 Fr, Multiple Lengths</Size><SupplierCode>40434</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109229</GroupID><SubGroupID>113137</SubGroupID><Suffix>P</Suffix><ARTGs><ARTG>216072</ARTG></ARTGs><MinimumBenefit>246</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC035</BillingCode><Name>Ureteric Stent Set</Name><Description>Set includes Aqueous Coated (AQ) firm multilength ureteric stent, positioner, with or without wire guide</Description><Size>Multiple French Sizes, Multi-Length</Size><SupplierCode>40434</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109229</GroupID><SubGroupID>113137</SubGroupID><Suffix>Therm</Suffix><ARTGs><ARTG>216072</ARTG></ARTGs><MinimumBenefit>180</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS094</BillingCode><Name>Contour VL; Stretch VL Flexima; Ureteral Stents</Name><Description>Ureteral stent with attached suture</Description><Size>Diameters up to 14Fr &amp; lengths up to 40cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109229</GroupID><SubGroupID>113137</SubGroupID><Suffix>Therm</Suffix><ARTGs><ARTG>129376</ARTG></ARTGs><MinimumBenefit>180</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WJ001</BillingCode><Name>Roca Multi-Length</Name><Description>Soft / Firm Ureteral Stent &amp; Simple / Connectable Pusher &amp; Without / With GuideWire</Description><Size>4.8Fr / 6Fr / 7Fr ( 22cm-32cm )</Size><SupplierCode>40392</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107770</SubCategoryID><GroupID>109229</GroupID><SubGroupID>113137</SubGroupID><Suffix>Therm</Suffix><ARTGs><ARTG>381055</ARTG></ARTGs><MinimumBenefit>180</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CT008</BillingCode><Name>Titan Inflatable Penile Prosthesis (Resist Coated) - Cylinders</Name><Description>Cylinders for three component penile prosthesis (Resist Coated)</Description><Size>10, 12, 14,  16, 18, 20, 22cm</Size><SupplierCode>40004</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109242</GroupID><SubGroupID>113142</SubGroupID><Suffix>A</Suffix><ARTGs><ARTG>140111</ARTG></ARTGs><MinimumBenefit>3638</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS411</BillingCode><Name>AMS 700 Series Inflatable Penile Prostheses with Inhibizone Cylinders</Name><Description>700 Series with InhibiZone</Description><Size>12, 14, 15, 16, 18, 21, 24cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109242</GroupID><SubGroupID>113142</SubGroupID><Suffix>A</Suffix><ARTGs><ARTG>125444</ARTG><ARTG>352831</ARTG></ARTGs><MinimumBenefit>3638</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS421</BillingCode><Name>AMS 700 Series Inflatable Penile Prostheses Cylinders  </Name><Description>700 Series (Non InhibiZone)  </Description><Size>10, 12, 14, 15, 16, 18, 21, 24cm  </Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109242</GroupID><SubGroupID>113142</SubGroupID><ARTGs><ARTG>390412</ARTG></ARTGs><MinimumBenefit>3344</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AM022</BillingCode><Name>AMS 700 Series Inflatable Penile Prostheses Cylinders</Name><Description>700 Series (Non InhibiZone)</Description><Size>12, 14, 15, 16, 18, 21cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109242</GroupID><SubGroupID>113142</SubGroupID><ARTGs><ARTG>106606</ARTG></ARTGs><MinimumBenefit>3344</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AM044</BillingCode><Name>AMS 700 Series Inflatable Penile Prostheses Reservoir non Inhibizone</Name><Description>700 Series (Non InhibiZone)</Description><Size> 50, 65, 100ml</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109242</GroupID><SubGroupID>113143</SubGroupID><ARTGs><ARTG>106606</ARTG></ARTGs><MinimumBenefit>1705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS422</BillingCode><Name>AMS 700 Series Inflatable Penile Prostheses Reservoir non Inhibizone  </Name><Description>700 Series (Non InhibiZone)  </Description><Size>100ml  </Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109242</GroupID><SubGroupID>113143</SubGroupID><ARTGs><ARTG>390412</ARTG></ARTGs><MinimumBenefit>1705</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VO005</BillingCode><Name>Infla10 Inflatable Penile Prosthesis - Reservoir (HydroShield coated)</Name><Description>Reservoir for Infla10 Inflatable Penile Prosthesis (HydroShield Coated)</Description><Size>65ml, 70ml, 110ml</Size><SupplierCode>40243</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109242</GroupID><SubGroupID>113143</SubGroupID><Suffix>A</Suffix><ARTGs><ARTG>337611</ARTG></ARTGs><MinimumBenefit>1881</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CT010</BillingCode><Name>Titan Inflatable Penile Prosthesis (Resist Coated) - Lock-out Valve Reservoir</Name><Description>Reservoir for three component penile prosthesis (Resist Coated)</Description><Size>60, 75, 100ml</Size><SupplierCode>40004</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109242</GroupID><SubGroupID>113143</SubGroupID><Suffix>A</Suffix><ARTGs><ARTG>140111</ARTG></ARTGs><MinimumBenefit>1881</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS414</BillingCode><Name>AMS 700 Series Inflatable Penile Prostheses InhibiZone Reservoir</Name><Description>700 Series InhibiZone</Description><Size>50, 65, 100ml</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109242</GroupID><SubGroupID>113143</SubGroupID><Suffix>A</Suffix><ARTGs><ARTG>125444</ARTG><ARTG>352831</ARTG></ARTGs><MinimumBenefit>1881</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CT011</BillingCode><Name>Titan Inflatable Penile Prosthesis (Resist Coated) - Pump</Name><Description>Pump for three component penile prosthesis (Resist Coated)</Description><Size>One Size</Size><SupplierCode>40004</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109242</GroupID><SubGroupID>113144</SubGroupID><Suffix>A</Suffix><ARTGs><ARTG>140111</ARTG></ARTGs><MinimumBenefit>4432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS412</BillingCode><Name>AMS 700 Series Inflatable Penile Prostheses with InhibiZone Pump</Name><Description>700 Series with InhibiZone</Description><Size>One Size</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109242</GroupID><SubGroupID>113144</SubGroupID><Suffix>A</Suffix><ARTGs><ARTG>125444</ARTG><ARTG>352831</ARTG></ARTGs><MinimumBenefit>4432</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AM042</BillingCode><Name>AMS 700 Series Inflatable Penile Prostheses Pump</Name><Description>700 Series (Non InhibiZone)</Description><Size>One Size</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109242</GroupID><SubGroupID>113144</SubGroupID><ARTGs><ARTG>106606</ARTG></ARTGs><MinimumBenefit>4076</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CT012</BillingCode><Name>Titan Inflatable Penile Prosthesis (Resist Coated) - True-lock Plug</Name><Description>True Lock Plug for deactivation of three component penile prosthesis (Resist Coated)</Description><Size>One Size</Size><SupplierCode>40004</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109242</GroupID><SubGroupID>113145</SubGroupID><ARTGs><ARTG>140111</ARTG></ARTGs><MinimumBenefit>128</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS420</BillingCode><Name>AMS 700 Series Inflatable Penile Prostheses with InhibiZone Deactivation Package</Name><Description>700 Series with InhibiZone</Description><Size>One Size</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109242</GroupID><SubGroupID>113145</SubGroupID><ARTGs><ARTG>390412</ARTG></ARTGs><MinimumBenefit>128</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AM046</BillingCode><Name>AMS 700 Series Inflatable Penile Prostheses Deactivation Package</Name><Description>700 Series (Non InhibiZone)</Description><Size>One Size</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109242</GroupID><SubGroupID>113145</SubGroupID><ARTGs><ARTG>106606</ARTG></ARTGs><MinimumBenefit>128</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AM040</BillingCode><Name>AMS 700 Series Inflatable Penile Prostheses with InhibiZone Deactivation Package</Name><Description>700 Series with InhibiZone</Description><Size>One Size</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109242</GroupID><SubGroupID>113145</SubGroupID><ARTGs><ARTG>125444</ARTG></ARTGs><MinimumBenefit>128</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS423</BillingCode><Name>AMS 700 Series Inflatable Penile Prostheses Accessory Kit  </Name><Description>700 Series (Non InhibiZone)  </Description><Size>One Size  </Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109242</GroupID><SubGroupID>113146</SubGroupID><ARTGs><ARTG>390412</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>AM045</BillingCode><Name>AMS 700 Series Inflatable Penile Prostheses Accessory Kit</Name><Description>700 Series (Non InhibiZone)</Description><Size>One Size</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109242</GroupID><SubGroupID>113146</SubGroupID><ARTGs><ARTG>106606</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CT005</BillingCode><Name>Titan Inflatable Penile Prosthesis (Resist Coated) - Assembly Kit</Name><Description>Assembly kit for three component penile prosthesis (Resist Coated)</Description><Size>Standard &amp; Narrow -base</Size><SupplierCode>40004</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109242</GroupID><SubGroupID>113146</SubGroupID><Suffix>A</Suffix><ARTGs><ARTG>140111</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VO006</BillingCode><Name>Infla10 Inflatable Penile Prosthesis - Accessory Kit</Name><Description>Accessory Kit for Infla10 Inflatable Penile Prosthesis (HydroShield Coated). Accessory kit includes Easy-Click Connectors and ConnectSecure Extenders.</Description><Size>Standard &amp; Narrow </Size><SupplierCode>40243</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109242</GroupID><SubGroupID>113146</SubGroupID><Suffix>A</Suffix><ARTGs><ARTG>337611</ARTG></ARTGs><MinimumBenefit>655</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS410</BillingCode><Name>AMS 700 Series Inflatable Penile Prostheses Pump &amp; Cylinders Preconnected</Name><Description>700 Series (Non InhibiZone)</Description><Size>12, 14, 15, 16, 18, 21, 24cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109242</GroupID><SubGroupID>113147</SubGroupID><ARTGs><ARTG>106606</ARTG><ARTG>390412</ARTG></ARTGs><MinimumBenefit>7419</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS413</BillingCode><Name>AMS 700 Series Inflatable Penile Prostheses with InhibiZone Pump &amp; Cylinders  Preconnected</Name><Description>700 Series with InhibiZone</Description><Size>12-24cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109242</GroupID><SubGroupID>113147</SubGroupID><Suffix>A</Suffix><ARTGs><ARTG>352831</ARTG><ARTG>125444</ARTG></ARTGs><MinimumBenefit>8070</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>CT009</BillingCode><Name>Titan Inflatable Penile Prosthesis (Resist Coated) - Cylinders &amp; Pump Preconnected</Name><Description>Preconnected Cylinders &amp; pump for three component penile prosthesis (Resist Coated)</Description><Size>10, 12, 14, 16, 18, 20, 22cm (in both infrapubic &amp; scrotal models)</Size><SupplierCode>40004</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109242</GroupID><SubGroupID>113147</SubGroupID><Suffix>A</Suffix><ARTGs><ARTG>140111</ARTG></ARTGs><MinimumBenefit>8070</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VO007</BillingCode><Name>Infla10 Inflatable Penile Prosthesis - Pump &amp; Cylinder (HydroShield coated)</Name><Description>Preconnected Cylinders &amp; Pump for three piece penile prosthesis (Hydrophilic Coated).</Description><Size>10, 12, 14, 15, 16, 18, 22, 24cm (in both infrapubic &amp; scrotal models)</Size><SupplierCode>40243</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107773</SubCategoryID><GroupID>109242</GroupID><SubGroupID>113147</SubGroupID><Suffix>A</Suffix><ARTGs><ARTG>337611</ARTG></ARTGs><MinimumBenefit>8070</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI519</BillingCode><Name>InterStim X System – Neurostimulator</Name><Description>Recharge-free implantable neurostimulator</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109244</GroupID><SubGroupID>113149</SubGroupID><ARTGs><ARTG>421914</ARTG></ARTGs><MinimumBenefit>9606</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI443</BillingCode><Name>InterStim neurostimulator- Programmer</Name><Description>Programmer</Description><Size>One size</Size><SupplierCode>40151</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109245</GroupID><SubGroupID>113150</SubGroupID><ARTGs><ARTG>355036</ARTG></ARTGs><MinimumBenefit>1330</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI520</BillingCode><Name>InterStim™ X System – Smart Programmer Kit</Name><Description>Smart programmer kit houses the patient communicator and handset. The therapy apps are loaded onto the patient handset.</Description><Size>One size</Size><SupplierCode>40151</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109245</GroupID><SubGroupID>113150</SubGroupID><ARTGs><ARTG>402561</ARTG><ARTG>402562</ARTG><ARTG>419710</ARTG></ARTGs><MinimumBenefit>1330</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC756</BillingCode><Name>InterStim iCON Patient Programmer</Name><Description>Hand held device Model 3037 to be used with implantable neurostimulation devices</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109245</GroupID><SubGroupID>113150</SubGroupID><ARTGs><ARTG>137808</ARTG></ARTGs><MinimumBenefit>1330</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2007-12-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UW004</BillingCode><Name>Axonics Patient Remote Control</Name><Description>Remote patient controller for Axonics Sacral Neurmodulation System</Description><Size>One size only</Size><SupplierCode>40256</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109245</GroupID><SubGroupID>113150</SubGroupID><ARTGs><ARTG>325941</ARTG></ARTGs><MinimumBenefit>1330</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI451</BillingCode><Name>InterStim MRI rechargeable neurostimulator- Recharger</Name><Description>Recharger kit</Description><Size>One size</Size><SupplierCode>40151</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109245</GroupID><SubGroupID>113151</SubGroupID><ARTGs><ARTG>121279</ARTG></ARTGs><MinimumBenefit>1215</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UW005</BillingCode><Name>Axonics Charging System</Name><Description>Charger and dock with belt and adhesive carriers for Axonics Sacral Neuromodulation System</Description><Size>One size only</Size><SupplierCode>40256</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109245</GroupID><SubGroupID>113151</SubGroupID><ARTGs><ARTG>297956</ARTG></ARTGs><MinimumBenefit>1215</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI126</BillingCode><Name>Verify External Neurostimulator</Name><Description>External Neurostimulator</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109245</GroupID><SubGroupID>113152</SubGroupID><ARTGs><ARTG>215635</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UW006</BillingCode><Name>Axonics Trial Stimulator</Name><Description>External neurostimulator with belt</Description><Size>One size only</Size><SupplierCode>40256</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109245</GroupID><SubGroupID>113152</SubGroupID><ARTGs><ARTG>313220</ARTG></ARTGs><MinimumBenefit>1140</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI169</BillingCode><Name>Interstim Trial Lead and Screener Kit </Name><Description>Trial lead and screener cables kit</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109246</GroupID><SubGroupID>113153</SubGroupID><ARTGs><ARTG>137440</ARTG></ARTGs><MinimumBenefit>753</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UW002</BillingCode><Name>Axonics PNE Lead Implant Kit</Name><Description>Peripheral Nerve Evaluation Kit including lead, cables and implant tools</Description><Size>One size only</Size><SupplierCode>40256</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109246</GroupID><SubGroupID>113153</SubGroupID><ARTGs><ARTG>298140</ARTG><ARTG>312912</ARTG></ARTGs><MinimumBenefit>753</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UW007</BillingCode><Name>Axonics Tined Lead</Name><Description>Tined lead for sacral neuromodulation</Description><Size>One size only</Size><SupplierCode>40256</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109246</GroupID><SubGroupID>113154</SubGroupID><Suffix>tined</Suffix><ARTGs><ARTG>297953</ARTG></ARTGs><MinimumBenefit>4199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI074</BillingCode><Name>Sacral Nerve Stimulation Lead</Name><Description>4 Electrode tined lead (Non-MRI and MRI Leads)</Description><Size>28 - 41cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109246</GroupID><SubGroupID>113154</SubGroupID><Suffix>tined</Suffix><ARTGs><ARTG>355030</ARTG><ARTG>355041</ARTG></ARTGs><MinimumBenefit>4199</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UW011</BillingCode><Name>Axonics PNE Lead</Name><Description>Trial Lead</Description><Size>One size only</Size><SupplierCode>40256</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109246</GroupID><SubGroupID>113155</SubGroupID><ARTGs><ARTG>312912</ARTG></ARTGs><MinimumBenefit>373</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC185</BillingCode><Name>Sacral Nerve Stimulation Unilateral</Name><Description>Interstim Temporary test stimulation lead</Description><Size>Various</Size><SupplierCode>40151</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109246</GroupID><SubGroupID>113155</SubGroupID><ARTGs><ARTG>137440</ARTG></ARTGs><MinimumBenefit>373</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UW001</BillingCode><Name>Axonics Tined Lead Extension</Name><Description>Percutaneous extension</Description><Size>One size only</Size><SupplierCode>40256</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109246</GroupID><SubGroupID>113156</SubGroupID><ARTGs><ARTG>325940</ARTG><ARTG>312913</ARTG></ARTGs><MinimumBenefit>1434</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UW008</BillingCode><Name>Axonics Lead Implant Kit</Name><Description>Lead introducer kit including needles, sheath and tools</Description><Size>One size only</Size><SupplierCode>40256</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109247</GroupID><SubGroupID>113157</SubGroupID><ARTGs><ARTG>298140</ARTG></ARTGs><MinimumBenefit>514</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC775</BillingCode><Name>Interstim Lead Introducer Kit</Name><Description>Lead Introducer Kit for Sacral Nerve Stimulation</Description><Size>One size only</Size><SupplierCode>40151</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109247</GroupID><SubGroupID>113157</SubGroupID><ARTGs><ARTG>355030</ARTG><ARTG>355041</ARTG></ARTGs><MinimumBenefit>514</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI444</BillingCode><Name>InterStim neurostimulator- Extension Lead</Name><Description>Sacral Nerve Stimulation Extension Lead</Description><Size>One size</Size><SupplierCode>40151</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109247</GroupID><SubGroupID>113157</SubGroupID><ARTGs><ARTG>239412</ARTG></ARTGs><MinimumBenefit>514</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI387</BillingCode><Name>InterStim - Revision Kit</Name><Description>Revision kit includes tunneling tool, torque wrench, test stimulation cable, directional guide, lead introducer, dilator and set screws</Description><Size>One size</Size><SupplierCode>40151</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109247</GroupID><SubGroupID>113157</SubGroupID><ARTGs><ARTG>240576</ARTG></ARTGs><MinimumBenefit>514</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI333</BillingCode><PriorBillingCodes><PriorBillingCode>MC186</PriorBillingCode><PriorBillingCode>MI318</PriorBillingCode></PriorBillingCodes><Name>Sacral Nerve Stimulation Accessories</Name><Description>Foramen Needle. Sterile individual units.Stainless steel.</Description><Size>8.9 to 12.7 cm</Size><SupplierCode>40151</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109247</GroupID><SubGroupID>113158</SubGroupID><ARTGs><ARTG>121280</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UW009</BillingCode><Name>Axonics Foramen Needles</Name><Description>6 Foramen needles</Description><Size>Short and Long</Size><SupplierCode>40256</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109247</GroupID><SubGroupID>113158</SubGroupID><ARTGs><ARTG>298140</ARTG></ARTGs><MinimumBenefit>21</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI127</BillingCode><Name>Medtronic Cables</Name><Description>Stimulation Cables for Intraoperative testing</Description><Size>Various</Size><SupplierCode>40151</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109247</GroupID><SubGroupID>113159</SubGroupID><ARTGs><ARTG>355030</ARTG><ARTG>355041</ARTG></ARTGs><MinimumBenefit>190</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>UW010</BillingCode><Name>Axonics Stimulation Cable</Name><Description>Cable for trial and implant</Description><Size>One size only</Size><SupplierCode>40256</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107775</SubCategoryID><GroupID>109247</GroupID><SubGroupID>113159</SubGroupID><ARTGs><ARTG>314969</ARTG></ARTGs><MinimumBenefit>190</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FE001</BillingCode><Name>Filshie Clip</Name><Description>Titanium</Description><Size>One size only</Size><SupplierCode>40379</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107776</SubCategoryID><GroupID>109249</GroupID><SubGroupID>113160</SubGroupID><ARTGs><ARTG>153023</ARTG></ARTGs><MinimumBenefit>147</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>FE003</BillingCode><Name>Filshie Clips - Sterishot</Name><Description>With Disposable Applicator</Description><Size>One Size</Size><SupplierCode>40379</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107776</SubCategoryID><GroupID>109249</GroupID><SubGroupID>113160</SubGroupID><Suffix>With applicator</Suffix><ARTGs><ARTG>157661</ARTG></ARTGs><MinimumBenefit>389</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>OL079</BillingCode><Name>Falope-Ring Bands</Name><Description>Fallopian Tube Clip (each)</Description><Size>5mm - 12mm</Size><SupplierCode>40122</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107776</SubCategoryID><GroupID>109249</GroupID><SubGroupID>113161</SubGroupID><ARTGs><ARTG>136671</ARTG><ARTG>130442</ARTG></ARTGs><MinimumBenefit>37</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2011-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MB014</BillingCode><Name>Allium Round Posterior Urethral Stent</Name><Description>Round Nitinol stent with copolymer covering and supplied premounted on a delivery tool. For longer term temporary treatment of bladder outlet obstruction caused by  male stenotic posterior urethra or  stenotic bladder-neck.</Description><Size>The RPS has a body length of 40mm and a main body calibre of 45Fr</Size><SupplierCode>40183</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107779</SubCategoryID><GroupID>109253</GroupID><SubGroupID>113162</SubGroupID><ARTGs><ARTG>205004</ARTG></ARTGs><MinimumBenefit>2351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MB015</BillingCode><Name>Allium Triangle Prostatic Urethral Stent</Name><Description>Round Nitinol stent with copolymer covering and supplied premounted on a delivery tool. For longer term temporary treatment of bladder outlet obstruction caused by enlarged prostate.</Description><Size>Body lengths 30, 40, 50, 60, 65mm
main body calibre 45Fr</Size><SupplierCode>40183</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107779</SubCategoryID><GroupID>109253</GroupID><SubGroupID>113162</SubGroupID><ARTGs><ARTG>205004</ARTG></ARTGs><MinimumBenefit>2351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ET054</BillingCode><Name>Memokath Prostatic - Urethral Stents</Name><Description>Memokath Models: 028S, 028SW, 028T, 028TW, 044T, 044TW, 045T, 045TW, 045TTW</Description><Size> 5mm - 90mm</Size><SupplierCode>40085</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107779</SubCategoryID><GroupID>109253</GroupID><SubGroupID>113162</SubGroupID><ARTGs><ARTG>141653</ARTG></ARTGs><MinimumBenefit>2351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MB013</BillingCode><Name>Allium Bulbar Urethral Stent</Name><Description>Round Nitinol stent with co-polymer covering and supplied premounted on a delivery tool.</Description><Size>50, 55, 60, 80 mm</Size><SupplierCode>40183</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107779</SubCategoryID><GroupID>109253</GroupID><SubGroupID>113162</SubGroupID><ARTGs><ARTG>205004</ARTG></ARTGs><MinimumBenefit>2351</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2013-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC126</BillingCode><Name>Firlit-Kluge Urethral Stent</Name><Description>Firlit-Kluge urethral stent</Description><Size>Multiple French Sizes, Length 30cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107779</SubCategoryID><GroupID>109253</GroupID><SubGroupID>113163</SubGroupID><ARTGs><ARTG>214821</ARTG></ARTGs><MinimumBenefit>55</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>WC136</BillingCode><Name>Zaontz Urethral Stent</Name><Description>Zaontz Urethral Stent</Description><Size>Multiple French Sizes, Length 12cm</Size><SupplierCode>40434</SupplierCode><CategoryID>107572</CategoryID><SubCategoryID>107779</SubCategoryID><GroupID>109253</GroupID><SubGroupID>113163</SubGroupID><ARTGs><ARTG>214821</ARTG></ARTGs><MinimumBenefit>55</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ460</BillingCode><Name>MitraClip G4 system</Name><Description>Transmitral valve repair clip, steerable guide catheter, clip delivery system</Description><Size>9 - 12 mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107749</SubCategoryID><GroupID>109106</GroupID><SubGroupID>113168</SubGroupID><ARTGs><ARTG>357023</ARTG></ARTGs><MinimumBenefit>26386</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ453</BillingCode><Name>MitraClip System</Name><Description>Steerable Guide Catheter, Clip Delivery System (Delivery Catheter, Steerable sleeve and the MitraClip Implant) </Description><Size>NTR MitraClip Implant: 15-17 mm  XTR MitraClip Implant: 18-22 mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107749</SubCategoryID><GroupID>109106</GroupID><SubGroupID>113168</SubGroupID><ARTGs><ARTG>309701</ARTG><ARTG>309700</ARTG></ARTGs><MinimumBenefit>26386</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS415</BillingCode><Name>FARAPULSE Pulsed Field Ablation System</Name><Description>Pulsed Field Ablation (PFA) System - FARAWAVE PFA Catheter</Description><Size>Distal Diameter 31 - 35 mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109114</GroupID><SubGroupID>113173</SubGroupID><Suffix>Boston Scientific</Suffix><ARTGs><ARTG>407397</ARTG></ARTGs><MinimumBenefit>6399</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT225</BillingCode><Name>AlCath Flutter LT G</Name><Description>Mapping and Ablation Cardiac Catheter, Gold Tip(G) High Thermal Conduction Ablation, FullCircle Deflection, Long 8mm Tip (LT), Optimised stability,control &amp; length for flutter</Description><Size>7F , 95cm , 8mm(LT) gold tip</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113174</SubGroupID><ARTGs><ARTG>221412</ARTG></ARTGs><MinimumBenefit>900</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ430</BillingCode><Name>Abbott Non Irrigated Ablation Catheters – 8mm</Name><Description>Non Irrigated Ablation catheter</Description><Size>8mm tip</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113174</SubGroupID><ARTGs><ARTG>137384</ARTG><ARTG>136321</ARTG><ARTG>141867</ARTG></ARTGs><MinimumBenefit>900</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI428</BillingCode><Name>RF Marinr</Name><Description>The Medtronic RF Marinr catheters are steerable, flexible, radiopaque ablation catheters, designed for intracardiac radiofrequency ablation. The catheters have  intracardiac recording and stimulation capabilities. </Description><Size>5Fr, 7Fr</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113174</SubGroupID><ARTGs><ARTG>202411</ARTG><ARTG>202423</ARTG></ARTGs><MinimumBenefit>900</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN281</BillingCode><Name>CARTO System Therapeutic Catheters, NAVISTAR</Name><Description>4mm navigation, non-irrigated</Description><Size>One size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113174</SubGroupID><ARTGs><ARTG>135672</ARTG><ARTG>135731</ARTG></ARTGs><MinimumBenefit>900</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN277</BillingCode><Name>CELSIUS</Name><Description>4mm non-nav, non-irrigated</Description><Size>Various</Size><SupplierCode>39932</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113174</SubGroupID><ARTGs><ARTG>135732</ARTG><ARTG>135671</ARTG></ARTGs><MinimumBenefit>900</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ431</BillingCode><Name>Abbott Non Irrigated Ablation Catheters – 4mm</Name><Description>Non Irrigated Ablation catheter</Description><Size>4mm tip</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113174</SubGroupID><ARTGs><ARTG>141867</ARTG><ARTG>136320</ARTG><ARTG>137384</ARTG></ARTGs><MinimumBenefit>900</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT222</BillingCode><Name>AlCath G FullCircle</Name><Description>Mapping and Ablation Cardiac Catheter, Gold Tip(G) High Thermal Conduction Ablation, FullCircle Deflection, Standard or Long Tip.</Description><Size>7F, 110cm , 4 mm Tip Gold (G) and 8mm (LT) Long Tip Gold(G)</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113174</SubGroupID><ARTGs><ARTG>281003</ARTG></ARTGs><MinimumBenefit>900</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS377</BillingCode><Name>Blazer Prime </Name><Description>Non-irrigated ablation catheter</Description><Size>104-115 cm, 7F     </Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113174</SubGroupID><ARTGs><ARTG>179887</ARTG></ARTGs><MinimumBenefit>900</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS376</BillingCode><Name>IntellaTip MiFi™ XP</Name><Description>Non-irrigated ablation catheter with 3 mini-electrodes (MiFi) for more accurate mapping</Description><Size>110 cm, shaft size 7F</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113174</SubGroupID><ARTGs><ARTG>232994</ARTG></ARTGs><MinimumBenefit>900</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS391</BillingCode><Name>IntellaNav ST</Name><Description>Non-irrigated temperature ablation catheters; navigation enabled</Description><Size>110 cm, 7F</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113174</SubGroupID><ARTGs><ARTG>354210</ARTG></ARTGs><MinimumBenefit>900</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS375</BillingCode><Name>Blazer II</Name><Description>Non-irrigated temperature ablation catheters </Description><Size>104-115 cm, shaft size 6-7F</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113174</SubGroupID><ARTGs><ARTG>164506</ARTG></ARTGs><MinimumBenefit>900</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS386</BillingCode><Name>IntellaNav MiFi XP</Name><Description>Non-irrigated ablation catheter with 3 mini-electrodes (MiFi), navigation enabled</Description><Size>110 cm, shaft size 7F</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113174</SubGroupID><ARTGs><ARTG>289500</ARTG></ARTGs><MinimumBenefit>900</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF032</BillingCode><Name>FireMagic RF Ablation Catheter</Name><Description>Flexible insulative radiofrequency ablation catheter with a deflectable tip</Description><Size>7 French  90-115cm</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113174</SubGroupID><ARTGs><ARTG>333859</ARTG></ARTGs><MinimumBenefit>900</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS378</BillingCode><Name>Blazer II XP</Name><Description>Non-irrigated ablation catheters</Description><Size>104-115 cm, 8F</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113174</SubGroupID><ARTGs><ARTG>164229</ARTG></ARTGs><MinimumBenefit>900</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT223</BillingCode><Name>AlCath Flux G eXtra</Name><Description>Mapping and Ablation Cardiac Catheter, Advanced 3D irrigation (eXtra), Gold Tip(G) High Thermal Conduction Ablation, FullCircle Deflection</Description><Size>7F , 110cm , 3.5mm irrigated gold tip</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113176</SubGroupID><Suffix>Biotronik</Suffix><ARTGs><ARTG>193331</ARTG></ARTGs><MinimumBenefit>3280</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT221</BillingCode><Name>AlCath Force</Name><Description>Mapping and Ablation Cardiac Catheter, Advanced 3D irrigation (eXtra), Gold Tip(G) High Thermal Conduction Ablation, FullCircle Deflection with Optical Contact Force Sensor</Description><Size>7F, 110cm , 3.5mm tip</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113176</SubGroupID><Suffix>Biotronik</Suffix><ARTGs><ARTG>279638</ARTG></ARTGs><MinimumBenefit>3280</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT260</BillingCode><Name>AlCath Force Sensing Ablation Catheter</Name><Description>Mapping and Ablation Cardiac Catheter, Advanced 3D irrigation (eXtra), Gold Tip(G) High Thermal Conduction Ablation, FullCircle Deflection with Optical Contact Force Sensor</Description><Size>8F, 110cm , 3.5mm tip , 5 curve reaches </Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113176</SubGroupID><Suffix>Biotronik</Suffix><ARTGs><ARTG>378972</ARTG></ARTGs><MinimumBenefit>3280</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS361</BillingCode><Name>IntellaNav™ MiFi™ Open-Irrigated Ablation Catheter</Name><Description>IntellaNav™ Open-Irrigated, MiFi™ Mini-electrode Technology, Nav-abled</Description><Size>110cm, shaft size 7.5F</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113176</SubGroupID><Suffix>Boston Scientific</Suffix><ARTGs><ARTG>300198</ARTG></ARTGs><MinimumBenefit>3500</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS385</BillingCode><Name>IntellaTip MiFi™ Open Irrigated Ablation Catheter</Name><Description>Intella MiFi™ Mini- electrode Technology; Open-Irrigated</Description><Size>110cm, shaft size 7.5F</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113176</SubGroupID><Suffix>Boston Scientific</Suffix><ARTGs><ARTG>231654</ARTG></ARTGs><MinimumBenefit>3500</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS405</BillingCode><Name>INTELLANAV STABLEPOINT™ </Name><Description>Open Irrigated Ablation bidirectional catheter with Total Tip Cooling™ Design technology; Contact Force Sensing</Description><Size>110cm, shaft size 7.5F</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113176</SubGroupID><Suffix>Boston Scientific</Suffix><ARTGs><ARTG>354210</ARTG></ARTGs><MinimumBenefit>3500</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS380</BillingCode><Name>Blazer™ Open Irrigated Ablation Catheter </Name><Description>Open Irrigated Ablation bidirectional catheter with Total Tip Cooling™ Design technology</Description><Size>110cm, shaft size 7.5F</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113176</SubGroupID><Suffix>Boston Scientific</Suffix><ARTGs><ARTG>186659</ARTG></ARTGs><MinimumBenefit>3500</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN238</BillingCode><Name>CARTO System Therapeutic Catheters, THERMOCOOL SMARTTOUCH</Name><Description>Navigation, contact-force, irrigated</Description><Size>One size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113176</SubGroupID><Suffix>JJM, nav, cf</Suffix><ARTGs><ARTG>233354</ARTG><ARTG>233355</ARTG><ARTG>184035</ARTG><ARTG>198574</ARTG></ARTGs><MinimumBenefit>3700</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN304</BillingCode><Name>CARTO System Therapeutic Catheters, QDOT MICRO</Name><Description>Navigation, contact-force, irrigated, very high-power short-duration</Description><Size>One size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113176</SubGroupID><Suffix>JJM, nav, cf</Suffix><ARTGs><ARTG>345780</ARTG><ARTG>345779</ARTG></ARTGs><MinimumBenefit>3700</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ410</BillingCode><Name>TactiCath™ Contact Force Ablation Catheter</Name><Description>Sensor Enabled and Non-Sensor Enabled catheter</Description><Size>DD, DF, FF, FJ, JJ, D, F.</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113176</SubGroupID><Suffix>Abbott</Suffix><ARTGs><ARTG>327316</ARTG><ARTG>327321</ARTG></ARTGs><MinimumBenefit>3700</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ465</BillingCode><Name>TactiFlex™ Ablation Catheter, Sensor Enabled™  </Name><Description>Contact Force Sensor Enabled  </Description><Size>DD, DF, FF, FJ, JJ, D, F, J</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113176</SubGroupID><Suffix>Abbott</Suffix><ARTGs><ARTG>380982</ARTG><ARTG>380981</ARTG></ARTGs><MinimumBenefit>3700</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ409</BillingCode><Name>FlexAbility Ablation Catheter</Name><Description>Sensor Enabled and Non-Sensor Enabled</Description><Size>D, F, J, D-F, F-J, D-D, F-F, J-J</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113176</SubGroupID><Suffix>Abbott</Suffix><ARTGs><ARTG>327825</ARTG><ARTG>327823</ARTG><ARTG>327822</ARTG><ARTG>327824</ARTG></ARTGs><MinimumBenefit>3700</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF024</BillingCode><Name>FireMagic 3D Irrigated Ablation Catheter</Name><Description>Irrigated ablation catheter with a deflectable tip containing an array of platinum electrodes</Description><Size>8 French  105cm</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113176</SubGroupID><Suffix>Microport</Suffix><ARTGs><ARTG>333751</ARTG></ARTGs><MinimumBenefit>3500</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI300</BillingCode><Name>PVAC Gold Phased RF catheter</Name><Description>The Pulmonary Vein Ablation Catheter (PVAC) Gold is a three-dimensional, anatomically designed, multi-electrode phased RF catheter used to map, pace, and ablate the pulmonary veins.</Description><Size>9Fr</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113176</SubGroupID><Suffix>Medtronic, single unit</Suffix><ARTGs><ARTG>235158</ARTG></ARTGs><MinimumBenefit>6399</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI397</BillingCode><Name>DiamondTemp Ablation Catheter</Name><Description>An irrigated, multi-electrode, temperature-controlled, radio-frequency catheter for mapping, pacing and cardiac ablation</Description><Size>7.5F</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113176</SubGroupID><Suffix>Medtronic</Suffix><ARTGs><ARTG>391793</ARTG><ARTG>391792</ARTG></ARTGs><MinimumBenefit>3700</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN310</BillingCode><Name>CARTO System Therapeutic Catheters, THERMOCOOL</Name><Description>Navigation, irrigated</Description><Size>Various</Size><SupplierCode>39932</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113176</SubGroupID><Suffix>JJM, nav</Suffix><ARTGs><ARTG>178843</ARTG><ARTG>149553</ARTG><ARTG>157811</ARTG></ARTGs><MinimumBenefit>2750</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN301</BillingCode><Name>THERMOCOOL</Name><Description>Non-nav, irrigated</Description><Size>Various</Size><SupplierCode>39932</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113176</SubGroupID><Suffix>JJM, non-nav</Suffix><ARTGs><ARTG>155131</ARTG><ARTG>178844</ARTG><ARTG>149552</ARTG></ARTGs><MinimumBenefit>2000</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT224</BillingCode><Name>AlCath Flutter Flux G eXtra</Name><Description>Mapping and Ablation Cardiac Catheter, Gold Tip(G) High Thermal Conduction Ablation, Advanced 3D irrigation (eXtra), FullCircle Deflection, Optimised stability,control &amp; length for flutter</Description><Size>7F ,95cm , 3.5mm Gold tip</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113176</SubGroupID><Suffix>Biotronik</Suffix><ARTGs><ARTG>221411</ARTG></ARTGs><MinimumBenefit>3280</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ408</BillingCode><Name>EnSite Patch</Name><Description>Surface Electrodes</Description><Size>Patch/Kit</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113177</SubGroupID><Suffix>Abbott</Suffix><ARTGs><ARTG>195707</ARTG><ARTG>274633</ARTG></ARTGs><MinimumBenefit>399</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN239</BillingCode><Name>CARTO Reference</Name><Description>External Reference</Description><Size>One size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113177</SubGroupID><Suffix>JJM, nav</Suffix><ARTGs><ARTG>157549</ARTG></ARTGs><MinimumBenefit>499</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS360</BillingCode><Name>Rhythmia™ Location Reference Patch Kit</Name><Description>Rhythmia™ Location Reference Patch Kit (Box of 1)</Description><Size>50mm diameter</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113177</SubGroupID><Suffix>Boston Scientific</Suffix><ARTGs><ARTG>282996</ARTG></ARTGs><MinimumBenefit>350</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF023</BillingCode><Name>Columbus Reference Patch</Name><Description>Adhesive patch with embedded magnetic location sensors</Description><Size>One size only</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113177</SubGroupID><Suffix>Microport</Suffix><ARTGs><ARTG>323487</ARTG></ARTGs><MinimumBenefit>399</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT258</BillingCode><Name>SentiCath Patient Electrode Kit</Name><Description>SentiCath Patient Electrode Kit  compatible with the Acutus AcQMap High Resolution 3D Imaging and Mapping System </Description><Size>Localization Dispersive Electrodes,  Patient Return Electrode,  Repositionable Monitoring Electrodes</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113177</SubGroupID><Suffix>Biotronik</Suffix><ARTGs><ARTG>323077</ARTG></ARTGs><MinimumBenefit>385</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT253</BillingCode><Name>BIOTRONIK AcQMap Patient Electrode Kit</Name><Description>The BIOTRONIK AcQMap Patient Electrode Kit  compatible with the AcQMap High Resolution 3D Imaging and Mapping System </Description><Size>Localization Dispersive Electrodes,  Patient Return Electrode,  Repositionable Monitoring Electrodes </Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113177</SubGroupID><Suffix>Biotronik</Suffix><ARTGs><ARTG>323077</ARTG></ARTGs><MinimumBenefit>385</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS398</BillingCode><Name>Woven, WovenFlexi</Name><Description>Fixed Curve Diagnostic Catheter </Description><Size>Various</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>Boston Scientific, Fixed</Suffix><ARTGs><ARTG>281442</ARTG><ARTG>281436</ARTG></ARTGs><MinimumBenefit>225</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT252</BillingCode><Name>BIOTRONIK AcQMap 3D Imaging and Mapping Catheter</Name><Description>The BIOTRONIK AcQMap 3D Imaging and Mapping Catheter is an advanced, non-contact, intracardiac catheter used for mapping the atrial substrate.</Description><Size>10F x 100cm</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>Biotronik</Suffix><ARTGs><ARTG>340470</ARTG></ARTGs><MinimumBenefit>3890</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT257</BillingCode><Name>SentiCath 3D Imaging and Mapping Catheter</Name><Description>The BIOTRONIK SentiCath 3D Imaging and Mapping Catheter is an advanced, non-contact, intracardiac catheter used for imaging  and then mapping the atrial substrate.</Description><Size>10F x 100cm</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>Biotronik</Suffix><ARTGs><ARTG>407527</ARTG></ARTGs><MinimumBenefit>3890</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF039</BillingCode><Name>EasyFinder™</Name><Description>Non-navigational fixed curve diagnostic catheter</Description><Size>Length: 60-115cm   Diameter: 5-6Fr  </Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>Microport, Fix</Suffix><ARTGs><ARTG>339195</ARTG></ARTGs><MinimumBenefit>225</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT248</BillingCode><Name>ViaCath 4 &amp; 10 Pole</Name><Description>Steerable Diagnostic Catheter</Description><Size>6F , 110cm , 2mm Electrode tip , Electrode spacing's - various, Curve- standard, large, Extra large</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>Biotronik - 4 &amp; 10 pole</Suffix><ARTGs><ARTG>281000</ARTG></ARTGs><MinimumBenefit>885</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS401</BillingCode><Name>Viking, Viking Soft Tip</Name><Description>Fixed Curve Diagnostic Catheters</Description><Size>Various</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>Boston Scientific, Fixed</Suffix><ARTGs><ARTG>285279</ARTG><ARTG>281431</ARTG></ARTGs><MinimumBenefit>225</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT251</BillingCode><Name>MultiCath 4 ,5 &amp; 10 Pole</Name><Description>Steerable Diagnostic Catheter</Description><Size>4,5, 6F ;  80,100,110cm length :  Various Types ; Various Electrode Spacing's ; Curve - Standard or Soft Tipped.</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>Biotronik - MultiCath</Suffix><ARTGs><ARTG>280999</ARTG></ARTGs><MinimumBenefit>675</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF025</BillingCode><Name>EasyLoop Circular Mapping Catheter</Name><Description>Diagnostic pulmonary vein catheter for cardiac electrophysiological mapping</Description><Size>7 French  115cm</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>Microport</Suffix><ARTGs><ARTG>332882</ARTG></ARTGs><MinimumBenefit>2500</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ458</BillingCode><Name>Abbott Medical Electrophysiology mapping catheter - 4/5 pole</Name><Description>Steerable mapping catheter Livewire, Inquiry</Description><Size>4 pole, 5 pole</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>Abbott - 4/5 pole</Suffix><ARTGs><ARTG>136206</ARTG><ARTG>141868</ARTG></ARTGs><MinimumBenefit>629</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ406</BillingCode><Name>Advisor mapping catheter</Name><Description>mapping catheter</Description><Size>5F-8F</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>Abbott</Suffix><ARTGs><ARTG>327732</ARTG><ARTG>308920</ARTG><ARTG>327761</ARTG><ARTG>282187</ARTG><ARTG>327686</ARTG><ARTG>334636</ARTG><ARTG>282186</ARTG><ARTG>334635</ARTG></ARTGs><MinimumBenefit>2300</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ404</BillingCode><Name>Inquiry Optima Diagnostic Catheter</Name><Description>mapping catheter</Description><Size>5F-8F</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>Abbott</Suffix><ARTGs><ARTG>136233</ARTG></ARTGs><MinimumBenefit>2300</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ407</BillingCode><Name>Afocus II EB Inquiry Steerable Catheter</Name><Description>mapping catheter</Description><Size>5F-8F</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>Abbott</Suffix><ARTGs><ARTG>136211</ARTG></ARTGs><MinimumBenefit>2300</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ405</BillingCode><Name>Reflexion Spiral Variable Radius Catheter</Name><Description>mapping catheter</Description><Size>5F-8F</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>Abbott</Suffix><ARTGs><ARTG>145053</ARTG></ARTGs><MinimumBenefit>2300</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ454</BillingCode><Name>Livewire Electrophysiology Catheter</Name><Description>Duodecapolar 2-2-2 epi/endo VT mapping catheter  </Description><Size>115cm</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>Abbott</Suffix><ARTGs><ARTG>141868</ARTG></ARTGs><MinimumBenefit>2300</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN370</BillingCode><Name>CARTO System Diagnostic Catheters, OCTARAY</Name><Description>High Density Mapping Catheter</Description><Size>Various</Size><SupplierCode>39932</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>JJM, nav, defl, hd</Suffix><ARTGs><ARTG>357290</ARTG></ARTGs><MinimumBenefit>2200</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN240</BillingCode><Name>LASSO/ PENTARAY</Name><Description>Circular/High Density</Description><Size>Various</Size><SupplierCode>39932</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>JJM, nav, defl, hd</Suffix><ARTGs><ARTG>278955</ARTG><ARTG>278956</ARTG><ARTG>122187</ARTG><ARTG>145997</ARTG><ARTG>203362</ARTG><ARTG>121901</ARTG><ARTG>231772</ARTG></ARTGs><MinimumBenefit>2200</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN302</BillingCode><Name>WEBSTER</Name><Description>Non-nav, deflectable, 10-pole CS diagnostic</Description><Size>Various</Size><SupplierCode>39932</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>JJM, deflect, 10-pole</Suffix><ARTGs><ARTG>145984</ARTG><ARTG>219252</ARTG><ARTG>162172</ARTG></ARTGs><MinimumBenefit>750</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN303</BillingCode><Name>WEBSTER</Name><Description>Non-nav, deflectable diagnostic, less than 10-pole</Description><Size>Various</Size><SupplierCode>39932</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>JJM, defl</Suffix><ARTGs><ARTG>145984</ARTG></ARTGs><MinimumBenefit>400</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS359</BillingCode><Name>IntellaMap  Orion High Resolution Mapping Catheter</Name><Description>High resolution 64-electrode steerable mapping catheter</Description><Size>8.5F, 115cm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>Boston Scientific</Suffix><ARTGs><ARTG>271032</ARTG></ARTGs><MinimumBenefit>2549</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ457</BillingCode><Name>Abbott Medical electrophysiology mapping catheters - 10 pole</Name><Description>Steerable mapping catheter Livewire, Inquiry</Description><Size>10 pole</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>Abbott - 10 pole</Suffix><ARTGs><ARTG>141868</ARTG><ARTG>136206</ARTG></ARTGs><MinimumBenefit>829</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ456</BillingCode><Name>Abbott Medical electrophysiology mapping catheters - 20 pole</Name><Description>Steerable mapping catheter - Livewire, Inquiry </Description><Size>20 pole</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>Abbott - 20 pole</Suffix><ARTGs><ARTG>141868</ARTG><ARTG>136206</ARTG></ARTGs><MinimumBenefit>1549</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT250</BillingCode><Name>ViaCath  20- Pole</Name><Description>Steerable Diagnostic Catheter</Description><Size>6F , 90cm, 2,8,2mm electrode spacing's, 2mm tip , Curve - Extra Large</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>Biotronik - 20 pole</Suffix><ARTGs><ARTG>281001</ARTG></ARTGs><MinimumBenefit>1265</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS399</BillingCode><Name>Dynamic </Name><Description>Steerable Diagnostic Catheter</Description><Size>110 cm, 6F</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>Boston Scientific, Deflecting</Suffix><ARTGs><ARTG>281427</ARTG></ARTGs><MinimumBenefit>400</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS396</BillingCode><Name>Dynamic XT</Name><Description>Steerable Diagnostic Catheters</Description><Size>Various</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>Boston Scientific, Deflecting, 10-pole</Suffix><ARTGs><ARTG>281428</ARTG></ARTGs><MinimumBenefit>750</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS393</BillingCode><Name>Polaris X</Name><Description>Steerable Diagnostic Catheters</Description><Size>Various</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>Boston Scientific, Deflecting, 10-pole</Suffix><ARTGs><ARTG>164184</ARTG></ARTGs><MinimumBenefit>750</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN311</BillingCode><Name>CARTO System Diagnostic Catheters, DECANAV</Name><Description>Navigation, deflectable, 10-pole diagnostic</Description><Size>Various</Size><SupplierCode>39932</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>JJM, nav, defl, 10-pole</Suffix><ARTGs><ARTG>217338</ARTG></ARTGs><MinimumBenefit>799</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI486</BillingCode><Name>TORQR Quadripolar Fixed-Curve Diagnostic Catheters </Name><Description>Fixed-Curve, Quadripolar Electrode Catheter.</Description><Size>5Fr, 6Fr</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>Medtronic - Torqr quad</Suffix><ARTGs><ARTG>203290</ARTG></ARTGs><MinimumBenefit>225</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF041</BillingCode><Name>EasyFinder™</Name><Description>Non-navigational defelectable, 10-pole diagnostic catheter</Description><Size>115cm, 6Fr</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>MicroPort, deflect, 10-pole</Suffix><ARTGs><ARTG>339196</ARTG></ARTGs><MinimumBenefit>750</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF040</BillingCode><Name>EasyFinder™</Name><Description>Steerable diagnostic catheter</Description><Size>Length 115cm 6Fr</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>MicroPort, Steerable</Suffix><ARTGs><ARTG>339196</ARTG></ARTGs><MinimumBenefit>629</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ466</BillingCode><Name>Abbott Medical fixed mapping catheter 4 pole</Name><Description>Fixed diagnostic</Description><Size>Size(s):* various</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>Abbott fix 4 pole</Suffix><ARTGs><ARTG>138701</ARTG><ARTG>139001</ARTG></ARTGs><MinimumBenefit>225</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ467</BillingCode><Name>Abbott Medical fixed mapping catheter 6-10 pole</Name><Description>Fixed diagnostic</Description><Size>various</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>Abbott fix 6-10 pole</Suffix><ARTGs><ARTG>141875</ARTG><ARTG>139001</ARTG></ARTGs><MinimumBenefit>365</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN307</BillingCode><Name>WEBSTER Fixed Catheter</Name><Description>Non-navigational, fixed curve diagnostic catheter</Description><Size>Various</Size><SupplierCode>39932</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>JJM, fix</Suffix><ARTGs><ARTG>146266</ARTG><ARTG>145985</ARTG></ARTGs><MinimumBenefit>225</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN300</BillingCode><Name>WEBSTER</Name><Description>Non-nav, fixed HIS diagnostic</Description><Size>One size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>JJM, fix</Suffix><ARTGs><ARTG>219254</ARTG><ARTG>145984</ARTG></ARTGs><MinimumBenefit>225</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS392</BillingCode><Name>Blazer Dx-20</Name><Description>Steerable Diagnostic Catheter </Description><Size>Various</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113178</SubGroupID><Suffix>Boston Scientific. Deflecting, 20-pole</Suffix><ARTGs><ARTG>170631</ARTG></ARTGs><MinimumBenefit>1265</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS394</BillingCode><Name>Ultra ICE </Name><Description>Intracardiac Electrophysiology Catheter</Description><Size>One size </Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113179</SubGroupID><Suffix>Boston Scientific</Suffix><ARTGs><ARTG>284615</ARTG></ARTGs><MinimumBenefit>1550</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ455</BillingCode><Name>ViewFlex™ Xtra ICE mapping Catheter</Name><Description>Intracardiac Echocardiography (ICE) Catheter</Description><Size>9 F catheter size, 10 F introducer, 90cm insertable length</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113179</SubGroupID><ARTGs><ARTG>214203</ARTG></ARTGs><MinimumBenefit>2549</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MN333</BillingCode><Name>SOUNDSTAR</Name><Description>3D Ultrasound Diagnostic Catheter</Description><Size>One size only</Size><SupplierCode>39932</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109115</GroupID><SubGroupID>113179</SubGroupID><Suffix>JJM</Suffix><ARTGs><ARTG>221253</ARTG></ARTGs><MinimumBenefit>2200</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI399</BillingCode><Name>Freezor Cardiac Cryoablation Catheters</Name><Description>Freezor, Freezor Xtra, Freezor Max: Focal Cryoablation Catheters</Description><Size>7Fr, 9Fr</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109116</GroupID><SubGroupID>113180</SubGroupID><Suffix>Medtronic</Suffix><ARTGs><ARTG>412450</ARTG></ARTGs><ChangeExplanation>Change to ARTG</ChangeExplanation><MinimumBenefit>3550</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Update</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS406</BillingCode><Name>POLARx Cryoablation Balloon Catheter</Name><Description>Flexible, over-the-wire balloon catheter used to ablate cardiac tissue</Description><Size>28mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109116</GroupID><SubGroupID>113180</SubGroupID><ARTGs><ARTG>367270</ARTG></ARTGs><MinimumBenefit>5100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI301</BillingCode><Name>Arctic Front Advance Cardiac CryoAblation Catheter / Pro</Name><Description>A flexible, over-the-wire balloon catheter used to ablate cardiac tissue</Description><Size>23mm, 28mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109116</GroupID><SubGroupID>113180</SubGroupID><ARTGs><ARTG>396019</ARTG><ARTG>306567</ARTG></ARTGs><MinimumBenefit>5100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS418</BillingCode><Name>POLARx FIT Cryoablation Balloon Catheter</Name><Description>Flexible, over-the-wire balloon catheter used to ablate cardiac tissue</Description><Size>31mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109116</GroupID><SubGroupID>113180</SubGroupID><ARTGs><ARTG>409910</ARTG></ARTGs><MinimumBenefit>5100</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI302</BillingCode><Name>Achieve / Achieve Advance Mapping Catheter</Name><Description>Intra-cardiac electrophysiology circular mapping catheter</Description><Size>15mm, 20mm, 25mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109116</GroupID><SubGroupID>113181</SubGroupID><ARTGs><ARTG>188676</ARTG><ARTG>286735</ARTG><ARTG>231648</ARTG></ARTGs><MinimumBenefit>1299</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS407</BillingCode><Name>POLARMAP Circular Mapping Catheter</Name><Description>Multi-electrode catheter designed to record intracardiac electrograms and provide pacing stimulation during electrophysiology procedures.</Description><Size>One size</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107750</SubCategoryID><GroupID>109116</GroupID><SubGroupID>113181</SubGroupID><ARTGs><ARTG>367271</ARTG></ARTGs><MinimumBenefit>1299</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ437</BillingCode><PriorBillingCodes><PriorBillingCode>AY047</PriorBillingCode></PriorBillingCodes><Name>XIENCE Sierra Everolimus Eluting Coronary Stent System</Name><Description>Drug eluting coronary artery stent</Description><Size>Diameter: 2.00mm to 4.0mm. Length: 8mm to 38mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107766</SubCategoryID><GroupID>109186</GroupID><SubGroupID>113192</SubGroupID><ARTGs><ARTG>313811</ARTG></ARTGs><MinimumBenefit>1095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS272</BillingCode><Name>SYNERGY</Name><Description>Everolimus-Eluting Platinum Chromium Coronary Stent System with Bioabsorbable Polymer</Description><Size>8mm to 48mm in length, diameter of 2.25 mm - 5.0 mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107766</SubCategoryID><GroupID>109186</GroupID><SubGroupID>113192</SubGroupID><ARTGs><ARTG>220361</ARTG></ARTGs><MinimumBenefit>1095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2014-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS366</BillingCode><Name>Promus ELITE</Name><Description>Everolimus-Eluting Platinum Chromium Coronary Stent System</Description><Size>8mm - 38mm in length, diameter of 2.25mm - 4.0mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107766</SubCategoryID><GroupID>109186</GroupID><SubGroupID>113192</SubGroupID><ARTGs><ARTG>327735</ARTG></ARTGs><MinimumBenefit>1095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2020-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BE002</BillingCode><PriorBillingCodes><PriorBillingCode>ER375</PriorBillingCode></PriorBillingCodes><Name>CRE8 Coronary Stent</Name><Description>Coronary Artery Drug Eluting Stent</Description><Size>The stent is available in 7 diameters: 2.25mm; 2.5mm; 2.75mm; 3.0mm; 3.5mm; 4.0mm; 4.5mm and 8 lengths: 8mm; 12mm; 16mm; 20mm; 25mm; 31mm; 38 mm and 46 mm.</Size><SupplierCode>39946</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107766</SubCategoryID><GroupID>109186</GroupID><SubGroupID>113192</SubGroupID><ARTGs><ARTG>230864</ARTG><ARTG>230865</ARTG><ARTG>230863</ARTG></ARTGs><MinimumBenefit>1095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2018-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS395</BillingCode><Name>Synergy Megatron</Name><Description>Everolimus-Eluting Platinum Chromium Coronary Stent System with Bioabsorbable Polymer</Description><Size>8 mm to 32 mm in length, diameter of 3.50 mm - 5.00 mm (over expansion capability to 6.00 mm)</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107766</SubCategoryID><GroupID>109186</GroupID><SubGroupID>113192</SubGroupID><ARTGs><ARTG>380476</ARTG></ARTGs><MinimumBenefit>1095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BS397</BillingCode><Name>SYNERGY XD</Name><Description>Everolimus-Eluting Platinum Chromium Coronary Stent System with Bioabsorbable Polymer</Description><Size>8mm to 48mm in length, diameter of 2.25 mm - 5.0 mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107766</SubCategoryID><GroupID>109186</GroupID><SubGroupID>113192</SubGroupID><ARTGs><ARTG>365215</ARTG></ARTGs><MinimumBenefit>1095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF054</BillingCode><Name>Firehawk Liberty­™ </Name><Description>Rapamycin (Sirolimus) Eluting Coronary Stent System</Description><Size>Diameter: 2.25- 4.0mm  Length: 8mm -38mm</Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107766</SubCategoryID><GroupID>109186</GroupID><SubGroupID>113192</SubGroupID><ARTGs><ARTG>410930</ARTG></ARTGs><MinimumBenefit>1095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>TU064</BillingCode><Name>Ultimaster Sirolimus Eluting Coronary Stent System</Name><Description>The Ultimaster Sirolimus Eluting Coronary Stent System is a device/drug combination comprised of a Co-Cr stent coated with sirolimus in a matrix of poly(D,L-Lactide-co-Caprolactone), mounted on a balloon delivery catheter</Description><Size>length 9-38mm; diameter 2.25-4.0mm</Size><SupplierCode>40450</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107766</SubCategoryID><GroupID>109186</GroupID><SubGroupID>113192</SubGroupID><ARTGs><ARTG>288132</ARTG></ARTGs><MinimumBenefit>1095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>QQ179</BillingCode><Name>SYNERGY SHIELD</Name><Description>Everolimus-Eluting Platinum Chromium Coronary Stent System with Bioabsorbable Polymer
</Description><Size>8mm to 48mm in length, diameter of 2.25 mm - 5.0 mm</Size><SupplierCode>39966</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107766</SubCategoryID><GroupID>109186</GroupID><SubGroupID>113192</SubGroupID><ARTGs><ARTG>424111</ARTG></ARTGs><MinimumBenefit>1095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2024-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI517</BillingCode><Name>Onyx Frontier Zotarolimus-Eluting Coronary Stent System</Name><Description>Coronary stent system; drug-eluting.</Description><Size>Diameter: 2.00 to 5.00 mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107766</SubCategoryID><GroupID>109186</GroupID><SubGroupID>113192</SubGroupID><ARTGs><ARTG>408805</ARTG></ARTGs><MinimumBenefit>1095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ435</BillingCode><PriorBillingCodes><PriorBillingCode>AY040</PriorBillingCode></PriorBillingCodes><Name>XIENCE Xpedition Everolimus Eluting Coronary Stent System</Name><Description>Coronary Artery Stent, Drug Eluting</Description><Size>Xience Xpedition DES - 2.25 x (8,12,15,18,23,28) RX CE, 2.50 x (8,12,15,18,23,28,33,38,48) RX CE; 2.75 x (8,12,15,18,23,28,33,38,48) RX CE; 3.00 x (8,12,15,18,23,28,33,38,48) RX CE; 3.25 x (8,12,15,18,23,28,33,38) RX CE; 3.50 x (8,12,15,18,23,28,33,38,48) RX CE; 4.00 x (8,12,15,18,23,28,33,38) RX CE;</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107766</SubCategoryID><GroupID>109186</GroupID><SubGroupID>113192</SubGroupID><ARTGs><ARTG>264373</ARTG><ARTG>215603</ARTG><ARTG>215604</ARTG><ARTG>215602</ARTG></ARTGs><MinimumBenefit>1095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ436</BillingCode><PriorBillingCodes><PriorBillingCode>AY044</PriorBillingCode></PriorBillingCodes><Name>XIENCE Alpine Everolimus Eluting Coronary Stent System</Name><Description>Drug eluting coronary artery stent</Description><Size>2.00 mm x (08, 12, 15, 18, 23, 28) mm  2.25 mm x (08, 12, 15, 18, 23, 28) mm  2.50 mm x (08, 12, 15, 18, 23, 28, 33, 38) mm  2.75 mm x (08, 12, 15, 18, 23, 28, 33, 38) mm  3.00 mm x (08, 12, 15, 18, 23, 28, 33, 38) mm  3.25 mm x (08, 12, 15, 18, 23, 28, 33, 38) mm  3.50 mm x (08, 12, 15, 18, 23, 28, 33, 38) mm  4.00 mm x (08, 12, 15, 18, 23, 28, 33, 38) mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107766</SubCategoryID><GroupID>109186</GroupID><SubGroupID>113192</SubGroupID><ARTGs><ARTG>266175</ARTG></ARTGs><MinimumBenefit>1095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI189</BillingCode><Name>Resolute Onyx Zotarolimus-Eluting Coronary Stent System</Name><Description>coronary stent system; drug eluting</Description><Size>diameter: 2mm to 5mm</Size><SupplierCode>40151</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107766</SubCategoryID><GroupID>109186</GroupID><SubGroupID>113192</SubGroupID><ARTGs><ARTG>263413</ARTG></ARTGs><MinimumBenefit>1095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2016-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>RF037</BillingCode><Name>Firehawk™</Name><Description>Sirolimus - Eluting Coronary Stent System</Description><Size>Length - 13mm - 38mm  Diameter -  2.25mm - 4.0mm </Size><SupplierCode>40271</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107766</SubCategoryID><GroupID>109186</GroupID><SubGroupID>113192</SubGroupID><ARTGs><ARTG>381401</ARTG></ARTGs><MinimumBenefit>1095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>DO001</BillingCode><Name>BioFreedom Drug Coated Coronary Stent System</Name><Description>Coronary Artery Stent, Drug Coated</Description><Size>Diameter: 2.25mm to 4.0mm
Length: 8mm to 36mm</Size><SupplierCode>39963</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107766</SubCategoryID><GroupID>109186</GroupID><SubGroupID>113192</SubGroupID><ARTGs><ARTG>280282</ARTG></ARTGs><MinimumBenefit>1095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BE003</BillingCode><Name>CRE8 EVO</Name><Description>Coronary Artery Drug Eluting Stent </Description><Size>Stent Diameter (mm) 2.00, 2.25, 2.50, 2.75, 3.00, 3.50, 4.00, 4.50                           Stent Length(mm): 9, 13, 16, 20, 26, 33, 40, 46</Size><SupplierCode>39946</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107766</SubCategoryID><GroupID>109186</GroupID><SubGroupID>113192</SubGroupID><ARTGs><ARTG>347172</ARTG><ARTG>347171</ARTG></ARTGs><MinimumBenefit>1095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT178</BillingCode><Name>Orsiro</Name><Description>Sirolimus Coronary Artery Stent, Drug Eluting Co/Cr Alloy coated in PLLA</Description><Size>Stent diameters ø 2.25 -4.0mm Lengths: 9-40mm</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107766</SubCategoryID><GroupID>109186</GroupID><SubGroupID>113192</SubGroupID><ARTGs><ARTG>220414</ARTG></ARTGs><MinimumBenefit>1095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2015-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT254</BillingCode><Name>ORSIRO Mission</Name><Description>Sirolimus Coronary Artery Stent, Drug Eluting Co/Cr Alloy coated in PLLA</Description><Size>Stent diameters ø 2.25 - 4.0mm Lengths: 9-40mm  </Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107766</SubCategoryID><GroupID>109186</GroupID><SubGroupID>113192</SubGroupID><ARTGs><ARTG>352490</ARTG></ARTGs><MinimumBenefit>1095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ478</BillingCode><Name>XIENCE Skypoint Everolimus Eluting Coronary Stent System</Name><Description>Drug eluting coronary artery stent</Description><Size>Stent diameters 2.0 - 4.0 mm in lengths 8 mm - 38 mm;  Stent diameters 2.5 - 4.0 mm in 48 mm length; Stent diameters 4.5 - 5.0 mm in lengths 12 mm - 33 mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107766</SubCategoryID><GroupID>109186</GroupID><SubGroupID>113192</SubGroupID><ARTGs><ARTG>393511</ARTG></ARTGs><MinimumBenefit>1095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2022-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ434</BillingCode><PriorBillingCodes><PriorBillingCode>AY037</PriorBillingCode></PriorBillingCodes><Name>Xience PRIME LL Everolimus Eluting Coronary Stent; Xience PRIME Everolimus Eluting Coronary Stent;  Xience PRIME SV Everolimus Eluting Coronary Stent</Name><Description>Coronary Artery Stent, Drug Eluting</Description><Size>XIENCE PRIME LL 2.50; 2.75; 3.00; 3.50; 4.0 x 33MM;  XIENCE PRIME LL 2.50; 2.75; 3.00; 3.50; 4.0 x 38MM;  XIENCE PRIME SV 2.25 x 08; 12; 15; 18; 23; 28MM; XIENCE PRIME 2.50 x 08; 12; 15; 18; 23; 28MM;  XIENCE PRIME 2.75 x 08; 12; 15; 18; 23; 28MM;  XIENCE PRIME 3.00 x 08; 12; 15; 18; 23; 28MM;  XIENCE PRIME 3.50 x 08; 12; 15; 18; 23; 28MM;  XIENCE PRIME 4.00 x 08; 12; 15; 18; 23; 28MM</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107766</SubCategoryID><GroupID>109186</GroupID><SubGroupID>113192</SubGroupID><ARTGs><ARTG>167879</ARTG><ARTG>167859</ARTG><ARTG>167878</ARTG></ARTGs><MinimumBenefit>1095</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2021-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT107</BillingCode><Name>PRO-Kinetic Energy</Name><Description>Balloon-expandable cobalt chromium (CoCr) stent. The stent surface is fully coated with amorphous hydrogen-rich silicon carbide (aSiC:H).</Description><Size>Lengths: 8 - 40mm, Diameters: 2.0 - 5.0mm.</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107766</SubCategoryID><GroupID>109187</GroupID><SubGroupID>113194</SubGroupID><ARTGs><ARTG>159908</ARTG></ARTGs><MinimumBenefit>336</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2009-08-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>BT220</BillingCode><Name>PK Papyrus Covered Coronary Stent System</Name><Description>Highly flexible, low profile , polyurethane/CoCr Covered Coronary Stent System</Description><Size>Length – 15,20,26mm     Diameter – 5F:2.5,3,3.5,4mm   6F:4.5,5mm</Size><SupplierCode>39967</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107766</SubCategoryID><GroupID>109187</GroupID><SubGroupID>113195</SubGroupID><Suffix>l, m</Suffix><ARTGs><ARTG>307104</ARTG></ARTGs><MinimumBenefit>2146</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-03-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SJ483</BillingCode><Name>GRAFTMASTER RX Coronary Stent Graft</Name><Description>Stainless Steel/PTFE</Description><Size>16-26 mm x 2.8 - 4.8 mm</Size><SupplierCode>40062</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107766</SubCategoryID><GroupID>109187</GroupID><SubGroupID>113195</SubGroupID><Suffix>l, m</Suffix><ARTGs><ARTG>398152</ARTG></ARTGs><MinimumBenefit>2146</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2023-11-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>PY050</BillingCode><Name>BeGraft Coronary Stent Graft System</Name><Description>Coronary Stent Graft System</Description><Size>Diameter: 2.50mm, 2.75mm, 3.00mm, 3.50mm, 4.00mm, 4.50mm, 5.00m  Length: 8mm, 12mm, 16mm, 18mm, 21mm, 24mm</Size><SupplierCode>40093</SupplierCode><CategoryID>107571</CategoryID><SubCategoryID>107766</SubCategoryID><GroupID>109187</GroupID><SubGroupID>113195</SubGroupID><Suffix>l, m</Suffix><ARTGs><ARTG>278654</ARTG></ARTGs><MinimumBenefit>2146</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>No Change</ActionFlag><CycleStartDate>2019-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI495</BillingCode><Name>Vanta™ Recharge-Free Neurostimulator </Name><Description>16 electrode recharge-free INS for pain management with AdaptiveStim and Surescan MRI technology</Description><Size>One size only</Size><SupplierCode>31223</SupplierCode><CategoryID>33980</CategoryID><SubCategoryID>34194</SubCategoryID><GroupID>35880</GroupID><SubGroupID>38453</SubGroupID><Suffix>Adaptive Stimulation</Suffix><ARTGs><ARTG>389797</ARTG></ARTGs><ChangeExplanation>DELETE</ChangeExplanation><MinimumBenefit>19088</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Delete</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI135</BillingCode><Name>PrimeAdvanced Surescan MRI Neurostimulator</Name><Description>16 electrode non-rechargeable implantable neurostimulator for pain management with Surescan MRI technology Model 97702</Description><Size>One size only</Size><SupplierCode>31223</SupplierCode><CategoryID>33980</CategoryID><SubCategoryID>34194</SubCategoryID><GroupID>35880</GroupID><SubGroupID>38453</SubGroupID><ARTGs><ARTG>215751</ARTG></ARTGs><ChangeExplanation>DELETE</ChangeExplanation><MinimumBenefit>17283</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Delete</ActionFlag><CycleStartDate>2014-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>ER650</BillingCode><Name>Apollo Endosurgery X-Tack™ Endoscopic HeliX Tacking System</Name><Description>The X-Tack™ System is intended for approximation of soft tissue in minimally invasive gastroenterology procedures (e.g. closure and healing of ESD/EMR sites, and closing of fistula, perforation or leaks).using tensioned helical tacks.     The X-Tack system comprises respective delivery systems for tacking and cinching; tethered stainless steel HeliX tacks; and a PEEK cinch system.    1. The delivery system is composed of biocompatible plastic and drives the HeliX tacks into the tissue. This is replaced with the PEEK cinching system when the defect is ready for compression.  2. The stainless steel HeliX tacks are placed around the defect with the tether providing compression when tensioned and so enabling closure.  Compression is maintained using a PEEK cinch which terminates the closing construct.  3. The PEEK cinching system is a delivery system that deploys a PEEK plug/collar to the tethering system to ensure the tissue in the defect area remains compressed.</Description><Size>160 and 235 cm</Size><SupplierCode>31139</SupplierCode><CategoryID>33961</CategoryID><SubCategoryID>34002</SubCategoryID><GroupID>35740</GroupID><SubGroupID>38179</SubGroupID><Suffix>Endoscopic, OTS</Suffix><ARTGs><ARTG>376194</ARTG></ARTGs><ChangeExplanation>DELETE</ChangeExplanation><MinimumBenefit>2002</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Delete</ActionFlag><CycleStartDate>2022-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>VL002</BillingCode><PriorBillingCodes><PriorBillingCode>RJ007</PriorBillingCode></PriorBillingCodes><Name>Su-Por Sphere</Name><Description>An implantable device made of high-density polyethylene material with an interconnecting pore structure that supports tissue ingrowth. The device is available in sizes to meet the patient's specific needs.  Used for orbital reconstruction following enucleation and evisceration procedure.</Description><Size>14mm, 16mm, 18mm, 20mm, 22mm, 24mm (diameter)</Size><SupplierCode>31318</SupplierCode><CategoryID>33966</CategoryID><SubCategoryID>34052</SubCategoryID><GroupID>34302</GroupID><SubGroupID>36869</SubGroupID><Suffix>vp</Suffix><ARTGs><ARTG>335454</ARTG></ARTGs><ChangeExplanation>DELETE</ChangeExplanation><MinimumBenefit>1741</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Delete</ActionFlag><CycleStartDate>2020-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>SY195</BillingCode><Name>Orthopaedic External Fixator Systems</Name><Description>Protective caps for rods, protection caps</Description><Size>One size only</Size><SupplierCode>31004</SupplierCode><CategoryID>33973</CategoryID><SubCategoryID>34114</SubCategoryID><GroupID>35378</GroupID><SubGroupID>38853</SubGroupID><ARTGs><ARTG>155806</ARTG></ARTGs><ChangeExplanation>DELETE</ChangeExplanation><MinimumBenefit>10</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Delete</ActionFlag><CycleStartDate>2005-10-31</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC712</BillingCode><Name>Neurostimulation System - Octad Leads</Name><Description>Octad Compact Lead Kit with Percutaneous Extension Model 3878</Description><Size>45, 60 &amp; 75cm</Size><SupplierCode>31223</SupplierCode><CategoryID>33980</CategoryID><SubCategoryID>34194</SubCategoryID><GroupID>35882</GroupID><SubGroupID>38585</SubGroupID><Suffix>8 electrodes</Suffix><ARTGs><ARTG>123243</ARTG></ARTGs><ChangeExplanation>DELETE</ChangeExplanation><MinimumBenefit>3817</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Delete</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC710</BillingCode><Name>Neurostimulation System - Octad Leads</Name><Description>Octad Standard Lead Kit with Percutaneous extension model 3877</Description><Size>45, 60 &amp; 75cm</Size><SupplierCode>31223</SupplierCode><CategoryID>33980</CategoryID><SubCategoryID>34194</SubCategoryID><GroupID>35882</GroupID><SubGroupID>38585</SubGroupID><Suffix>8 electrodes</Suffix><ARTGs><ARTG>123241</ARTG></ARTGs><ChangeExplanation>DELETE</ChangeExplanation><MinimumBenefit>3817</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Delete</ActionFlag><CycleStartDate>2006-11-30</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC827</BillingCode><Name>Medtronic Pisces Quad Leads</Name><Description>Pisces Quad Lead (3487A), Pisces Quad Compact Lead (3887), Pisces Quad Plus Lead (3888)</Description><Size>Various</Size><SupplierCode>31223</SupplierCode><CategoryID>33980</CategoryID><SubCategoryID>34194</SubCategoryID><GroupID>35882</GroupID><SubGroupID>38585</SubGroupID><Suffix>4 electrodes</Suffix><ARTGs><ARTG>137348</ARTG><ARTG>143034</ARTG><ARTG>143035</ARTG></ARTGs><ChangeExplanation>DELETE</ChangeExplanation><MinimumBenefit>3041</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Delete</ActionFlag><CycleStartDate>2009-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI199</BillingCode><Name>Specify SureScan MRI 5-6-5 Lead Kit</Name><Description>Triple Array 16 Electrode Surgical Lead MRICS</Description><Size>65 - 90 cms</Size><SupplierCode>31223</SupplierCode><CategoryID>33980</CategoryID><SubCategoryID>34194</SubCategoryID><GroupID>35882</GroupID><SubGroupID>38585</SubGroupID><Suffix>greater than 8 and less than 32 electrodes</Suffix><ARTGs><ARTG>280179</ARTG></ARTGs><ChangeExplanation>DELETE</ChangeExplanation><MinimumBenefit>6895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Delete</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MC776</BillingCode><Name>Specify 5-6-5 Surgical Lead</Name><Description>Triple Array 16 Electrode Surgical Lead with Duraloc Technology</Description><Size>30, 65cm</Size><SupplierCode>31223</SupplierCode><CategoryID>33980</CategoryID><SubCategoryID>34194</SubCategoryID><GroupID>35882</GroupID><SubGroupID>38585</SubGroupID><Suffix>greater than 8 and less than 32 electrodes</Suffix><ARTGs><ARTG>148397</ARTG></ARTGs><ChangeExplanation>DELETE</ChangeExplanation><MinimumBenefit>6895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Delete</ActionFlag><CycleStartDate>2008-07-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI209</BillingCode><Name>Specify SureScan MRI 2x8 Surgical Lead Kit</Name><Description>MRI conditional surgical lead</Description><Size>65-90cms</Size><SupplierCode>31223</SupplierCode><CategoryID>33980</CategoryID><SubCategoryID>34194</SubCategoryID><GroupID>35882</GroupID><SubGroupID>38585</SubGroupID><Suffix>greater than 8 and less than 32 electrodes</Suffix><ARTGs><ARTG>280180</ARTG></ARTGs><ChangeExplanation>DELETE</ChangeExplanation><MinimumBenefit>6895</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Delete</ActionFlag><CycleStartDate>2017-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem><ProsthesisItem><ItemType>Prescribed List item</ItemType><BillingCode>MI274</BillingCode><Name>Intellis AdaptiveStim Neurostimulator</Name><Description>16 Electrode Rechargeable, multi-channel, implantable Neurostimulator for pain management with AdaptiveStim, SureScan MRI, and Overdrive technology</Description><Size>One size only</Size><SupplierCode>31223</SupplierCode><CategoryID>33980</CategoryID><SubCategoryID>34194</SubCategoryID><GroupID>35880</GroupID><SubGroupID>38454</SubGroupID><Suffix>Adaptive Stimulation, Multi waveform, Recharge protection, Unlimited Deep Discharge Battery,</Suffix><ARTGs><ARTG>392267</ARTG></ARTGs><ChangeExplanation>DELETE</ChangeExplanation><MinimumBenefit>23465</MinimumBenefit><MaximumBenefit>0</MaximumBenefit><HumanTissueAmount>0</HumanTissueAmount><ActionFlag>Delete</ActionFlag><CycleStartDate>2018-02-01</CycleStartDate><CycleEndDate>2024-08-08</CycleEndDate></ProsthesisItem></ProsthesisItems></Prosthesis>