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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><