﻿<?xml version="1.0" encoding="utf-8"?>
<NominativeListDetail xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns="http://www.riziv.fgov.be/xsd/cti/201411">
  <Header>
    <SequenceNumber>138</SequenceNumber>
    <ModificationsFrom>2023-03-21</ModificationsFrom>
    <ModificationsTo>2023-03-29</ModificationsTo>
  </Header>
  <Data>
    <NominativeListGroupCode>324</NominativeListGroupCode>
    <NominativeListCode>32402</NominativeListCode>
    <IdentificationCode>324020005966</IdentificationCode>
    <OldCode />
    <Version>1</Version>
    <Distributor>Terumo</Distributor>
    <ProductName>Ultimaster Nagomi Sirolimus eluting coronary stent system</ProductName>
    <ProductReference>DE-RS20xxASM / DE-RS22xxASM / DE-RS25xxASM / DE-RS27xxASM / DE-RS30xxASM / DE-RS35xxASM / DE-RS40xxASM / DE-RS45xxASM</ProductReference>
    <ValidFrom>2023-04-01</ValidFrom>
    <ModificationTypes>
      <ModificationType>A</ModificationType>
    </ModificationTypes>
    <LastModified>2023-03-29</LastModified>
    <Published>2023-03-29</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>340</NominativeListGroupCode>
    <NominativeListCode>34001</NominativeListCode>
    <IdentificationCode>340010003828</IdentificationCode>
    <OldCode />
    <Version>1</Version>
    <Distributor>Medacta</Distributor>
    <ProductName>MOTO TiNbN Femoral Component</ProductName>
    <ProductReference>02.18.70xLM / 02.18.70xRM / 02.18.70xLLRL</ProductReference>
    <ProductPrice>1154.11</ProductPrice>
    <Reimbursement>961.76</Reimbursement>
    <PatientSupplement>192.35</PatientSupplement>
    <DeliveryMargin>115.41</DeliveryMargin>
    <ValidFrom>2023-04-01</ValidFrom>
    <ModificationTypes>
      <ModificationType>A</ModificationType>
    </ModificationTypes>
    <LastModified>2023-03-29</LastModified>
    <Published>2023-03-29</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>340</NominativeListGroupCode>
    <NominativeListCode>34011</NominativeListCode>
    <IdentificationCode>340110003009</IdentificationCode>
    <OldCode />
    <Version>1</Version>
    <Distributor>Medacta</Distributor>
    <ProductName>GMK HINGE TINBN</ProductName>
    <ProductReference>02.09.270xR / 02.09.270xL</ProductReference>
    <ProductPrice>2228.06</ProductPrice>
    <Reimbursement>1968.13</Reimbursement>
    <PatientSupplement>259.93</PatientSupplement>
    <DeliveryMargin>148.74</DeliveryMargin>
    <ValidFrom>2023-04-01</ValidFrom>
    <ModificationTypes>
      <ModificationType>A</ModificationType>
    </ModificationTypes>
    <LastModified>2023-03-29</LastModified>
    <Published>2023-03-29</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>340</NominativeListGroupCode>
    <NominativeListCode>34041</NominativeListCode>
    <IdentificationCode>340410002728</IdentificationCode>
    <OldCode />
    <Version>1</Version>
    <Distributor>Medacta</Distributor>
    <ProductName>GMK HINGE TINBN</ProductName>
    <ProductReference>02.09.480xR / 02.09.480xL</ProductReference>
    <ProductPrice>1346.95</ProductPrice>
    <Reimbursement>1189.81</Reimbursement>
    <PatientSupplement>157.14</PatientSupplement>
    <DeliveryMargin>134.69</DeliveryMargin>
    <ValidFrom>2023-04-01</ValidFrom>
    <ModificationTypes>
      <ModificationType>A</ModificationType>
    </ModificationTypes>
    <LastModified>2023-03-29</LastModified>
    <Published>2023-03-29</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>343</NominativeListGroupCode>
    <NominativeListCode>34314</NominativeListCode>
    <IdentificationCode>343140002895</IdentificationCode>
    <OldCode>179016000344</OldCode>
    <Version>1</Version>
    <Distributor>Arthrex</Distributor>
    <ProductName>PEEKPower Humeral Fracture Plate</ProductName>
    <ProductReference>AR-14003P / AR-14005P</ProductReference>
    <ProductPrice>403.17</ProductPrice>
    <Reimbursement>403.17</Reimbursement>
    <PatientSupplement>0.00</PatientSupplement>
    <DeliveryMargin>40.31</DeliveryMargin>
    <ValidFrom>2014-07-01</ValidFrom>
    <ValidTo>2023-03-31</ValidTo>
    <ModificationTypes>
      <ModificationType>A</ModificationType>
    </ModificationTypes>
    <LastModified>2023-03-29</LastModified>
    <Published>2014-07-15</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>343</NominativeListGroupCode>
    <NominativeListCode>34314</NominativeListCode>
    <IdentificationCode>343140002895</IdentificationCode>
    <OldCode>179016000344</OldCode>
    <Version>2</Version>
    <Distributor>Arthrex</Distributor>
    <ProductName>PEEKPower Humeral Fracture Plate</ProductName>
    <ProductReference>AR-14003P / AR-14005P</ProductReference>
    <ProductPrice>624.64</ProductPrice>
    <Reimbursement>520.54</Reimbursement>
    <PatientSupplement>104.10</PatientSupplement>
    <DeliveryMargin>62.46</DeliveryMargin>
    <ValidFrom>2023-04-01</ValidFrom>
    <ModificationTypes>
      <ModificationType>PW</ModificationType>
    </ModificationTypes>
    <LastModified>2023-03-29</LastModified>
    <Published>2023-03-29</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>343</NominativeListGroupCode>
    <NominativeListCode>34317</NominativeListCode>
    <IdentificationCode>343170007074</IdentificationCode>
    <OldCode />
    <Version>2</Version>
    <Distributor>Arthrex</Distributor>
    <ProductName>Volar Distal Radius Plate Sterile</ProductName>
    <ProductReference>AR-8916VXX-0x(S)</ProductReference>
    <ProductPrice>330.15</ProductPrice>
    <Reimbursement>330.15</Reimbursement>
    <PatientSupplement>0.00</PatientSupplement>
    <DeliveryMargin>33.01</DeliveryMargin>
    <ValidFrom>2019-11-01</ValidFrom>
    <ValidTo>2023-03-31</ValidTo>
    <ModificationTypes>
      <ModificationType>NP</ModificationType>
      <ModificationType>RW</ModificationType>
    </ModificationTypes>
    <LastModified>2023-03-29</LastModified>
    <Published>2019-10-30</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>343</NominativeListGroupCode>
    <NominativeListCode>34317</NominativeListCode>
    <IdentificationCode>343170007074</IdentificationCode>
    <OldCode />
    <Version>3</Version>
    <Distributor>Arthrex</Distributor>
    <ProductName>Volar Distal Radius Plate Sterile</ProductName>
    <ProductReference>AR-8916VXX-0x(S)</ProductReference>
    <ProductPrice>475.93</ProductPrice>
    <Reimbursement>396.61</Reimbursement>
    <PatientSupplement>79.32</PatientSupplement>
    <DeliveryMargin>47.59</DeliveryMargin>
    <ValidFrom>2023-04-01</ValidFrom>
    <ModificationTypes>
      <ModificationType>PW</ModificationType>
    </ModificationTypes>
    <LastModified>2023-03-29</LastModified>
    <Published>2023-03-29</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>343</NominativeListGroupCode>
    <NominativeListCode>34324</NominativeListCode>
    <IdentificationCode>343240004452</IdentificationCode>
    <OldCode>179013000616</OldCode>
    <Version>2</Version>
    <Distributor>Arthrex</Distributor>
    <ProductName>Locking Deltoid Avulsion Plate (Sterile)</ProductName>
    <ProductReference>AR-8943H-0x(S)</ProductReference>
    <ProductPrice>400.66</ProductPrice>
    <Reimbursement>400.66</Reimbursement>
    <PatientSupplement>0.00</PatientSupplement>
    <DeliveryMargin>40.06</DeliveryMargin>
    <ValidFrom>2019-10-01</ValidFrom>
    <ValidTo>2023-03-31</ValidTo>
    <ModificationTypes>
      <ModificationType>NP</ModificationType>
      <ModificationType>NR</ModificationType>
    </ModificationTypes>
    <LastModified>2023-03-29</LastModified>
    <Published>2019-09-24</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>343</NominativeListGroupCode>
    <NominativeListCode>34324</NominativeListCode>
    <IdentificationCode>343240004452</IdentificationCode>
    <OldCode>179013000616</OldCode>
    <Version>3</Version>
    <Distributor>Arthrex</Distributor>
    <ProductName>Locking Deltoid Avulsion Plate (Sterile)</ProductName>
    <ProductReference>AR-8943H-0x(S)</ProductReference>
    <ProductPrice>475.93</ProductPrice>
    <Reimbursement>441.22</Reimbursement>
    <PatientSupplement>34.71</PatientSupplement>
    <DeliveryMargin>47.59</DeliveryMargin>
    <ValidFrom>2023-04-01</ValidFrom>
    <ModificationTypes>
      <ModificationType>PW</ModificationType>
    </ModificationTypes>
    <LastModified>2023-03-29</LastModified>
    <Published>2023-03-29</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>343</NominativeListGroupCode>
    <NominativeListCode>34325</NominativeListCode>
    <IdentificationCode>343250001489</IdentificationCode>
    <OldCode>179023000195</OldCode>
    <Version>3</Version>
    <Distributor>Arthrex</Distributor>
    <ProductName>Locking Distal Fibular Plate (Sterile)</ProductName>
    <ProductReference>AR-8943BX(S)-0x</ProductReference>
    <ProductPrice>400.66</ProductPrice>
    <Reimbursement>396.61</Reimbursement>
    <PatientSupplement>4.05</PatientSupplement>
    <DeliveryMargin>40.06</DeliveryMargin>
    <ValidFrom>2019-10-01</ValidFrom>
    <ValidTo>2023-03-31</ValidTo>
    <ModificationTypes>
      <ModificationType>NP</ModificationType>
      <ModificationType>NR</ModificationType>
    </ModificationTypes>
    <LastModified>2023-03-29</LastModified>
    <Published>2019-09-24</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>343</NominativeListGroupCode>
    <NominativeListCode>34325</NominativeListCode>
    <IdentificationCode>343250001489</IdentificationCode>
    <OldCode>179023000195</OldCode>
    <Version>4</Version>
    <Distributor>Arthrex</Distributor>
    <ProductName>Locking Distal Fibular Plate (Sterile)</ProductName>
    <ProductReference>AR-8943BX(S)-0x</ProductReference>
    <ProductPrice>475.93</ProductPrice>
    <Reimbursement>396.61</Reimbursement>
    <PatientSupplement>79.32</PatientSupplement>
    <DeliveryMargin>47.59</DeliveryMargin>
    <ValidFrom>2023-04-01</ValidFrom>
    <ModificationTypes>
      <ModificationType>PW</ModificationType>
    </ModificationTypes>
    <LastModified>2023-03-29</LastModified>
    <Published>2023-03-29</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>343</NominativeListGroupCode>
    <NominativeListCode>34325</NominativeListCode>
    <IdentificationCode>343250001588</IdentificationCode>
    <OldCode>179023000204</OldCode>
    <Version>3</Version>
    <Distributor>Arthrex</Distributor>
    <ProductName>Locking Fibula Avulsion Plate (Sterile)</ProductName>
    <ProductReference>AR-8943TH-0x(S)</ProductReference>
    <ProductPrice>400.66</ProductPrice>
    <Reimbursement>396.61</Reimbursement>
    <PatientSupplement>4.05</PatientSupplement>
    <DeliveryMargin>40.06</DeliveryMargin>
    <ValidFrom>2019-10-01</ValidFrom>
    <ValidTo>2023-03-31</ValidTo>
    <ModificationTypes>
      <ModificationType>NP</ModificationType>
      <ModificationType>NR</ModificationType>
    </ModificationTypes>
    <LastModified>2023-03-29</LastModified>
    <Published>2019-09-24</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>343</NominativeListGroupCode>
    <NominativeListCode>34325</NominativeListCode>
    <IdentificationCode>343250001588</IdentificationCode>
    <OldCode>179023000204</OldCode>
    <Version>4</Version>
    <Distributor>Arthrex</Distributor>
    <ProductName>Locking Fibula Avulsion Plate (Sterile)</ProductName>
    <ProductReference>AR-8943TH-0x(S)</ProductReference>
    <ProductPrice>475.93</ProductPrice>
    <Reimbursement>396.61</Reimbursement>
    <PatientSupplement>79.32</PatientSupplement>
    <DeliveryMargin>47.59</DeliveryMargin>
    <ValidFrom>2023-04-01</ValidFrom>
    <ModificationTypes>
      <ModificationType>PW</ModificationType>
    </ModificationTypes>
    <LastModified>2023-03-29</LastModified>
    <Published>2023-03-29</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>343</NominativeListGroupCode>
    <NominativeListCode>34325</NominativeListCode>
    <IdentificationCode>343250003469</IdentificationCode>
    <OldCode />
    <Version>1</Version>
    <Distributor>Arthrex</Distributor>
    <ProductName>Locking Distal Fibula Plate, SS</ProductName>
    <ProductReference>AR-8943DX-0x(S) / AR-8943DX-1xS</ProductReference>
    <ProductPrice>400.66</ProductPrice>
    <Reimbursement>396.61</Reimbursement>
    <PatientSupplement>4.05</PatientSupplement>
    <DeliveryMargin>40.06</DeliveryMargin>
    <ValidFrom>2022-02-01</ValidFrom>
    <ValidTo>2023-03-31</ValidTo>
    <ModificationTypes>
      <ModificationType>A</ModificationType>
    </ModificationTypes>
    <LastModified>2023-03-29</LastModified>
    <Published>2022-01-31</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>343</NominativeListGroupCode>
    <NominativeListCode>34325</NominativeListCode>
    <IdentificationCode>343250003469</IdentificationCode>
    <OldCode />
    <Version>2</Version>
    <Distributor>Arthrex</Distributor>
    <ProductName>Locking Distal Fibula Plate, SS</ProductName>
    <ProductReference>AR-8943DX-0x(S) / AR-8943DX-1xS</ProductReference>
    <ProductPrice>475.93</ProductPrice>
    <Reimbursement>396.61</Reimbursement>
    <PatientSupplement>79.32</PatientSupplement>
    <DeliveryMargin>47.59</DeliveryMargin>
    <ValidFrom>2023-04-01</ValidFrom>
    <ModificationTypes>
      <ModificationType>PW</ModificationType>
    </ModificationTypes>
    <LastModified>2023-03-29</LastModified>
    <Published>2023-03-29</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>343</NominativeListGroupCode>
    <NominativeListCode>34327</NominativeListCode>
    <IdentificationCode>343270002988</IdentificationCode>
    <OldCode>179025000357</OldCode>
    <Version>2</Version>
    <Distributor>Arthrex</Distributor>
    <ProductName>Clavicle Plate</ProductName>
    <ProductReference>AR-265xXX(S)</ProductReference>
    <ProductPrice>395.50</ProductPrice>
    <Reimbursement>395.50</Reimbursement>
    <PatientSupplement>0.00</PatientSupplement>
    <DeliveryMargin>39.55</DeliveryMargin>
    <ValidFrom>2019-10-01</ValidFrom>
    <ValidTo>2023-03-31</ValidTo>
    <ModificationTypes>
      <ModificationType>NR</ModificationType>
    </ModificationTypes>
    <LastModified>2023-03-29</LastModified>
    <Published>2019-09-24</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>343</NominativeListGroupCode>
    <NominativeListCode>34327</NominativeListCode>
    <IdentificationCode>343270002988</IdentificationCode>
    <OldCode>179025000357</OldCode>
    <Version>3</Version>
    <Distributor>Arthrex</Distributor>
    <ProductName>Clavicle Plate</ProductName>
    <ProductReference>AR-265xXX(S)</ProductReference>
    <ProductPrice>624.64</ProductPrice>
    <Reimbursement>520.54</Reimbursement>
    <PatientSupplement>104.10</PatientSupplement>
    <DeliveryMargin>62.46</DeliveryMargin>
    <ValidFrom>2023-04-01</ValidFrom>
    <ModificationTypes>
      <ModificationType>PW</ModificationType>
    </ModificationTypes>
    <LastModified>2023-03-29</LastModified>
    <Published>2023-03-29</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>343</NominativeListGroupCode>
    <NominativeListCode>34327</NominativeListCode>
    <IdentificationCode>343270003582</IdentificationCode>
    <OldCode />
    <Version>1</Version>
    <Distributor>Arthrex</Distributor>
    <ProductName>Distal Clavicula Plate / Clavicula fracture plate</ProductName>
    <ProductReference>AR-2622DX / AR-2685DX-10 / AR-2680ST</ProductReference>
    <ProductPrice>395.50</ProductPrice>
    <Reimbursement>395.50</Reimbursement>
    <PatientSupplement>0.00</PatientSupplement>
    <DeliveryMargin>39.55</DeliveryMargin>
    <ValidFrom>2016-06-01</ValidFrom>
    <ValidTo>2023-03-31</ValidTo>
    <ModificationTypes>
      <ModificationType>A</ModificationType>
    </ModificationTypes>
    <LastModified>2023-03-29</LastModified>
    <Published>2016-05-09</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>343</NominativeListGroupCode>
    <NominativeListCode>34327</NominativeListCode>
    <IdentificationCode>343270003582</IdentificationCode>
    <OldCode />
    <Version>2</Version>
    <Distributor>Arthrex</Distributor>
    <ProductName>Distal Clavicula Plate / Clavicula fracture plate</ProductName>
    <ProductReference>AR-2622DX / AR-2685DX-10 / AR-2680ST</ProductReference>
    <ProductPrice>624.64</ProductPrice>
    <Reimbursement>520.54</Reimbursement>
    <PatientSupplement>104.10</PatientSupplement>
    <DeliveryMargin>62.46</DeliveryMargin>
    <ValidFrom>2023-04-01</ValidFrom>
    <ModificationTypes>
      <ModificationType>PW</ModificationType>
    </ModificationTypes>
    <LastModified>2023-03-29</LastModified>
    <Published>2023-03-29</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>358</NominativeListGroupCode>
    <NominativeListCode>35801</NominativeListCode>
    <IdentificationCode>358010000650</IdentificationCode>
    <OldCode />
    <Version>1</Version>
    <Distributor>Venus Medtech Europe</Distributor>
    <ProductName>VenusP Valve Pulmonary Valve System</ProductName>
    <ProductReference>Pxx-25 / Pxx-30 + DS2x-xx</ProductReference>
    <ValidFrom>2023-04-01</ValidFrom>
    <ModificationTypes>
      <ModificationType>A</ModificationType>
    </ModificationTypes>
    <LastModified>2023-03-29</LastModified>
    <Published>2023-03-29</Published>
  </Data>
</NominativeListDetail>