﻿<?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>185</SequenceNumber>
    <ModificationsFrom>2025-06-25</ModificationsFrom>
    <ModificationsTo>2025-07-10</ModificationsTo>
  </Header>
  <Data>
    <NominativeListGroupCode>336</NominativeListGroupCode>
    <NominativeListCode>33606</NominativeListCode>
    <IdentificationCode>336060003183</IdentificationCode>
    <OldCode />
    <Version>1</Version>
    <Distributor>ICB</Distributor>
    <ProductName>HUMERAL STEM</ProductName>
    <ProductReference>DIX-A00T500xxx</ProductReference>
    <ProductPrice>975.63</ProductPrice>
    <Reimbursement>813.03</Reimbursement>
    <PatientSupplement>162.60</PatientSupplement>
    <DeliveryMargin>97.56</DeliveryMargin>
    <ValidFrom>2025-08-01</ValidFrom>
    <ModificationTypes>
      <ModificationType>A</ModificationType>
    </ModificationTypes>
    <LastModified>2025-07-10</LastModified>
    <Published>2025-07-10</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>336</NominativeListGroupCode>
    <NominativeListCode>33607</NominativeListCode>
    <IdentificationCode>336070003883</IdentificationCode>
    <OldCode />
    <Version>1</Version>
    <Distributor>ICB</Distributor>
    <ProductName>Humeral Stem Ti COATED</ProductName>
    <ProductReference>DIX-A01T500xxx</ProductReference>
    <ProductPrice>752.77</ProductPrice>
    <Reimbursement>752.77</Reimbursement>
    <PatientSupplement>0.00</PatientSupplement>
    <DeliveryMargin>75.27</DeliveryMargin>
    <ValidFrom>2025-08-01</ValidFrom>
    <ModificationTypes>
      <ModificationType>A</ModificationType>
    </ModificationTypes>
    <LastModified>2025-07-10</LastModified>
    <Published>2025-07-10</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>336</NominativeListGroupCode>
    <NominativeListCode>33608</NominativeListCode>
    <IdentificationCode>336080004979</IdentificationCode>
    <OldCode />
    <Version>1</Version>
    <Distributor>ICB</Distributor>
    <ProductName>HUMERAL METAPHISIS</ProductName>
    <ProductReference>DIX-B31T5000xx</ProductReference>
    <ProductPrice>407.29</ProductPrice>
    <Reimbursement>358.93</Reimbursement>
    <PatientSupplement>48.36</PatientSupplement>
    <DeliveryMargin>40.72</DeliveryMargin>
    <ValidFrom>2025-08-01</ValidFrom>
    <ModificationTypes>
      <ModificationType>A</ModificationType>
    </ModificationTypes>
    <LastModified>2025-07-10</LastModified>
    <Published>2025-07-10</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>336</NominativeListGroupCode>
    <NominativeListCode>33615</NominativeListCode>
    <IdentificationCode>336150006515</IdentificationCode>
    <OldCode />
    <Version>1</Version>
    <Distributor>ICB</Distributor>
    <ProductName>Humeral Head DIXI + Conical adapter</ProductName>
    <ProductReference>DIX-C10PEx1xxx / DIX-C12CCx1xxx / DIX-L02CC31xxx + DIX-H10T500012</ProductReference>
    <ProductPrice>454.51</ProductPrice>
    <Reimbursement>378.76</Reimbursement>
    <PatientSupplement>75.75</PatientSupplement>
    <DeliveryMargin>45.45</DeliveryMargin>
    <ValidFrom>2025-08-01</ValidFrom>
    <ModificationTypes>
      <ModificationType>A</ModificationType>
    </ModificationTypes>
    <LastModified>2025-07-10</LastModified>
    <Published>2025-07-10</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>336</NominativeListGroupCode>
    <NominativeListCode>33618</NominativeListCode>
    <IdentificationCode>336180003764</IdentificationCode>
    <OldCode />
    <Version>1</Version>
    <Distributor>ICB</Distributor>
    <ProductName>Glène PE DIXI</ProductName>
    <ProductReference>DIX-D10PE00xxx / DIX-D20PE00xxx</ProductReference>
    <ProductPrice>392.00</ProductPrice>
    <Reimbursement>327.19</Reimbursement>
    <PatientSupplement>64.81</PatientSupplement>
    <DeliveryMargin>39.20</DeliveryMargin>
    <ValidFrom>2025-08-01</ValidFrom>
    <ModificationTypes>
      <ModificationType>A</ModificationType>
    </ModificationTypes>
    <LastModified>2025-07-10</LastModified>
    <Published>2025-07-10</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>336</NominativeListGroupCode>
    <NominativeListCode>33622</NominativeListCode>
    <IdentificationCode>336220004584</IdentificationCode>
    <OldCode />
    <Version>1</Version>
    <Distributor>ICB</Distributor>
    <ProductName>CONVERTIBLE METAL BACK DIXI</ProductName>
    <ProductReference>DIX-E10T500xxx</ProductReference>
    <ProductPrice>433.78</ProductPrice>
    <Reimbursement>347.03</Reimbursement>
    <PatientSupplement>86.75</PatientSupplement>
    <DeliveryMargin>43.37</DeliveryMargin>
    <ValidFrom>2025-08-01</ValidFrom>
    <ModificationTypes>
      <ModificationType>A</ModificationType>
    </ModificationTypes>
    <LastModified>2025-07-10</LastModified>
    <Published>2025-07-10</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>336</NominativeListGroupCode>
    <NominativeListCode>33623</NominativeListCode>
    <IdentificationCode>336230000930</IdentificationCode>
    <OldCode />
    <Version>1</Version>
    <Distributor>ICB</Distributor>
    <ProductName>PARTIE INTERNE GLENE DIXI</ProductName>
    <ProductReference>DIX-D32CC00xxx</ProductReference>
    <ProductPrice>237.96</ProductPrice>
    <Reimbursement>198.30</Reimbursement>
    <PatientSupplement>39.66</PatientSupplement>
    <DeliveryMargin>23.79</DeliveryMargin>
    <ValidFrom>2025-08-01</ValidFrom>
    <ModificationTypes>
      <ModificationType>A</ModificationType>
    </ModificationTypes>
    <LastModified>2025-07-10</LastModified>
    <Published>2025-07-10</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>336</NominativeListGroupCode>
    <NominativeListCode>33625</NominativeListCode>
    <IdentificationCode>336250003815</IdentificationCode>
    <OldCode />
    <Version>1</Version>
    <Distributor>ICB</Distributor>
    <ProductName>GLENOSPHERE</ProductName>
    <ProductReference>DIX-G00PE00xxx / DIX-G00PE03xxx</ProductReference>
    <ProductPrice>488.56</ProductPrice>
    <Reimbursement>361.90</Reimbursement>
    <PatientSupplement>126.66</PatientSupplement>
    <DeliveryMargin>48.85</DeliveryMargin>
    <ValidFrom>2025-08-01</ValidFrom>
    <ModificationTypes>
      <ModificationType>A</ModificationType>
    </ModificationTypes>
    <LastModified>2025-07-10</LastModified>
    <Published>2025-07-10</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>336</NominativeListGroupCode>
    <NominativeListCode>33626</NominativeListCode>
    <IdentificationCode>336260004515</IdentificationCode>
    <OldCode />
    <Version>1</Version>
    <Distributor>ICB</Distributor>
    <ProductName>Humeral Cup TiNbN</ProductName>
    <ProductReference>DIX-F12CC0xxxx / DIX-F22CC0xxxx / DIX-F02CC0xxxx</ProductReference>
    <ProductPrice>237.96</ProductPrice>
    <Reimbursement>198.30</Reimbursement>
    <PatientSupplement>39.66</PatientSupplement>
    <DeliveryMargin>23.79</DeliveryMargin>
    <ValidFrom>2025-08-01</ValidFrom>
    <ModificationTypes>
      <ModificationType>A</ModificationType>
    </ModificationTypes>
    <LastModified>2025-07-10</LastModified>
    <Published>2025-07-10</Published>
  </Data>
  <Data>
    <NominativeListGroupCode>336</NominativeListGroupCode>
    <NominativeListCode>33627</NominativeListCode>
    <IdentificationCode>336270001849</IdentificationCode>
    <OldCode />
    <Version>1</Version>
    <Distributor>ICB</Distributor>
    <ProductName>CONICAL ADAPTER</ProductName>
    <ProductReference>DIX-H10T50000x</ProductReference>
    <ProductPrice>214.16</ProductPrice>
    <Reimbursement>178.47</Reimbursement>
    <PatientSupplement>35.69</PatientSupplement>
    <DeliveryMargin>21.41</DeliveryMargin>
    <ValidFrom>2025-08-01</ValidFrom>
    <ModificationTypes>
      <ModificationType>A</ModificationType>
    </ModificationTypes>
    <LastModified>2025-07-10</LastModified>
    <Published>2025-07-10</Published>
  </Data>
</NominativeListDetail>