Urology and Pelvic Health

Transcription

1 Urology and Pelvic Hlth PRODUCT CATALOG AND ORDERING INFORMATION Visualization Products Guidewires Dilation Products Stone Retrieval Devices Ureteral Stents Ureteral Catheters Nephrostomy Products Lithotripsy Products BPH and Oncology Procedure Accessories Pelvic Floor Products

2 C-CODE CROSS-REFERENCE TO BOSTON SCIENTIFIC PRODUCTS KEY POINTS OF THE GUIDE This document cross-references Boston Scientific products at the UPN/order number level to CMS assigned Category C-codes or indicates there are no applicable C-Codes. It also includes a Resource List (see page 92) that cites sources of information on Medicare policy for APCs and the Pass-Through List. Specifically, it highlights Program Memoranda, including those in which the C-codes were published, retired and reinstated; and other notices from CMS. See pages for more information. Important-Plse note: Hlth economic and reimbursement information provided by Boston Scientific Corporation is gathered from thirdparty sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice. Boston Scientific encourages providers to submit accurate and appropriate claims for services. It is always the provider s responsibility to determine medical necessity, the proper site for delivery of any services and to submit appropriate codes, charges, and modifiers for services that are rendered. Boston Scientific recommends that you consult with your payers, reimbursement specialists and/or legal counsel regarding coding, coverage and reimbursement matters. Boston Scientific does not promote the use of its products outside their clred/approved (as applicable) label. ing s Boston Scientific Corporation uses a fully computerized order entry system for the convenience of our customers. The system enables Customer Service Representatives to provide you with instant order entry as well as up-to-date order status information. The system uses UPN order numbers for ch product. The bold blue numbers are the old order numbers (see example). Plse use either of these numbers when placing an order. Boston Scientific Customer Service Representatives will be happy to help you with any questions. We are ger to make the ordering procedure as simple and efficient as possible. Sensor Dual-Flex PTFE-Nitinol Diameter (in) Length M M M M Bold Blue Type is an example of old order number

3 Table of Contents Urology, Female Incontinence and Pelvic Floor Reconstruction & Excessive Uterine Bleeding VISUALIZATION PRODUCTS LITHOVUE SINGLE-USE DIGITAL FLEXIBLE URETEROSCOPE... 5 LithoVue SUD only LithoVue System Workstation GUIDEWIRES SENSOR GUIDEWIRES... 7 Sensor Dual-Flex PTFE-Nitinol Guidewires with Hydrophilic Tip (10cm Flexible Proximal End) Sensor PTFE-Nitinol Guidewires with Hydrophilic Tip ZIPWIRE GUIDEWIRES Standard ZIPwire Guidewires Enhanced Bentson-Type Stiff Shaft ZIPwire Guidewires Bentson-Type ZIPwire Guidewires Enhanced Stiff Shaft ZIPwire Guidewires ZEBRA UROLOGICAL GUIDEWIRES... 9 Zebra Urological Guidewires PTFE COATED GUIDEWIRES PTFE Coated Guidewires (Fixed Core) PTFE Coated Guidewires (Fixed Core, Stiff Bodied) PTFE Coated Guidewires (Movble Core) Amplatz Super Stiff PTFE Coated Guidewires LUBRIGLIDE COATED GUIDEWIRES Standard Lubriglide Coated Guidewires (Fixed Core) Standard Lubriglide Coated Guidewires (Fixed Core, Stiff Bodied) Standard Lubriglide Coated Guidewires (Movble Core) DILATION PRODUCTS URETERAL ACCESS SHEATHS Navigator HD Ureteral Access Shth Sets Navigator Ureteral Access Shth Sets URETERAL BALLOON DILATION CATHETERS UroMax Ultra Balloon Dilatation Catheters Kits UroMax Ultra Balloon Dilatation Catheters Passport Balloon Dilatation Catheters (Kits) Passport Balloon Dilatation Catheters Encore 26 Inflator URETERAL DILATORS Nottingham One-Step Tapered Dilators with HydroPlus Coating Ureteral Dilator with HydroPlus Coating and Procedural Shth Set Ureteral Dilatation Set with HydroPlus Coating Ureteral Dilators with HydroPlus Coating STONE RETRIEVAL DEVICES NITINOL RETRIEVAL DEVICES Zero Tip Nitinol Stone Retrieval Baskets NEW Dakota Nitinol Stone Retrieval Devices Escape Nitinol Stone Retrieval Baskets OptiFlex Nitinol Stone Retrieval Baskets Graspit Nitinol Stone Retrieval Forceps STAINLESS RETRIEVAL DEVICES Bagley Helical Stone Retrieval Baskets Gemini Paired Wire Helical Baskets Segura Hemisphere Stone Retrieval Baskets Tricep Hooked-Prong Grasping Forceps Tricep Hooked-Prong Grasping Forceps with Spool Handle Leslie Parachute Multi-Wire Stone Sweeping Devices LithoCatch Immobilization Device ANTIRETROPULSION DEVICES Stone Cone Nitinol Urological Retrieval Coils URETERAL STENTS STENT STORE Polaris Ultra Ureteral Stents (Dual Durometer Percuflex Material with HydroPlus Coating) Polaris Loop Ureteral Stents (Dual Durometer Percuflex Material with HydroPlus Coating) Percuflex Plus Ureteral Stents (with HydroPlus Coating) Percuflex Plus Ureteral Stents (with HydroPlus Coating and Braided Retrieval Line) Percuflex Ureteral Stents Contour Ureteral Stents (with HydroPlus Coating) A Softer Percuflex Material Stent Contour Ureteral Stents (with HydroPlus Coating and Braided Retrieval Line) Contour VL Ureteral Stents (Percuflex Material with HydroPlus Coating) Contour Injection Stents (with HydroPlus Coating) A Percuflex Material Stent Contour VL Injection Stent Sets (with HydroPlus Coating) A Percuflex Material Stent Mardis Soft Ureteral Stents (with HydroPlus Coating) Stretch VL Flexima Ureteral Stent Sets (with HydroPlus Coating) URETERAL STENTS AND SETS Retromax Plus (Endopyelotomy Stents with HydroPlus Coating) Percuflex Urinary Diversion Stent Sets (Open Tip Configuration) Percuflex Urinary Diversion Stent Sets (Closed Tip Configuration) STENT ACCESSORIES Ureteral Stent Positioners 1

4 Table of Contents Urology, Female Incontinence and Pelvic Floor Reconstruction & Excessive Uterine Bleeding URETERAL CATHETERS TORQUEABLE CATHETERS Dual Lumen Ureteral Catheter Imager II Catheters Flexima Ureteral Catheters Flexima Ureteral Catheters (Sets with.035" PTFE Bentson Tip Guidewire) Axxcess 6 French Ureteral Catheter C-Flex Flexible Tip Open End Ureteral Catheters (Sets) C-Flex Firm Open End Ureteral Catheters (Sets) C-Flex Ureteral Pigtail Catheters NEPHROSTOMY PRODUCTS PERCUTANEOUS KITS Lingeman Percutaneous Tract Kit with ZIPwire Guidewire Percutaneous Tract Kit with ZIPwire Guidewire Percutaneous Access Set Percutaneous Access Sets Pigtail Catheter Percutaneous Access Set Malecot Catheter BALLOON DILATION CATHETERS NephroMax High Pressure Nephrostomy Balloon Catheters NephroMax High Pressure Nephrostomy Balloon Catheter (Kits) INFLATION DEVICES Encore 26 Inflator DILATORS AND SHEATHS Clr Renal Shth Amplatz Type Renal Dilator/Shth Set Amplatz Type Graduated Renal Dilator Set Amplatz Type Renal Dilators (Individual Components) Amplatz Type Renal Shth (Set) Amplatz Type Renal Shths (Individual Components) 8/10 Dilator/Shth Set TORQUEABLE CATHETERS Imager II Catheters OCCLUSION BALLOON CATHETERS Occluder Occlusion Balloon Catheters INTRODUCER SETS Access Needles DRAINAGE CATHETERS Malecot Nephrostomy Catheters Re-Entry Malecot Nephrostomy Catheters Percuflex Locking Loop All Purpose Drainage Catheters with Fader Tip Percuflex Locking Loop Nephrostomy Catheters with Fader Tip Percuflex Combination Stent/Nephrostomy Catheters Percuflex Locking Loop Nephrostomy Catheters LITHOTRIPSY PRODUCTS LASER SYSTEMS Lumenis Laser Systems LASER FIBERS Flexiva TracTip High Power Single-Use Laser Fibers Flexiva High Power Single-Use Laser Fibers AccuTrac Single-Use Holmium Laser Fibers AccuMax Single-Use Holmium Laser Fibers SlimLine EZ Single-Use Laser Fibers SlimLine Reusable Laser Fibers SlimLine EZ SIS Single-Use Laser Fibers SlimLine SIS Reusable Laser Fibers LASER ACCESSORIES Accessories for Lumenis Brand Holmium and Dual Wavelength Laser Systems ULTRASOUND/PNEUMATIC SYSTEMS AND ACCESSORIES Swiss LithoClast Select System Swiss LithoClast Select Accessories Swiss LithoClast Ultrasound Probes (Not compatible with Swiss LithoClast Standard Probe) Swiss LithoClast Pneumatic Probes Swiss LithoClast Select Upgrade Program Swiss LithoClast Select One Time Rental Charge 2

5 Table of Contents Urology, Female Incontinence and Pelvic Floor Reconstruction & Excessive Uterine Bleeding BPH AND ONCOLOGY BPH LASER SYSTEMS GreenLight Laser Therapy Holmium Laser Therapy (vaporization and enucltion) RESECTION DEVICES FOR USE WITH VARIOUS RESECTOSCOPES Compatible for Use with Circon/ACMI Brand USA Elite System /USA Series Resectoscope Compatible for Use with Circon/ACMI Brand Classic Series Resectoscope Compatible for Use with Storz Brand Single Stem Resectoscope Compatible for Use with Storz Brand Double Stem Resectoscope Compatible for Use with Olympus Brand OES Single Stem Resectoscope Compatible for Use with Olympus Brand OES Pro Series Resectoscope Compatible for Use with Wolf Brand E-Line Series Resectoscope BLADDER TUMOR RESECTION LOOPS Bladder Tumor Resection (TURBT) Loops FORCEPS Piranha 3 French Ureteroscopic Biopsy Forceps SUTURE CAPTURING DEVICES Capio RP Suturing Devices for Radical Prostatectomy LASER DEVICES Aura XP Laser Therapy Other Laser System Accessories PROCEDURE ACCESSORIES INFLATION DEVICES Encore 26 Inflator BLADDER EVACUATION DEVICE Urovac Bladder Evacuator IRRIGATION DEVICES AND ACCESSORIES SAPS Single Action Pumping System IRRIGATION, EVACUATION AND RESECTION ACCESSORIES SAPS CF Continuous Flow Single Action Pumping System OTHER UroLok II Scope Adaptor ESP Radiation Reduction Examination Gloves Connecting Tubes for Drainage Bag Ureteral Catheter Connectors Drainage Bag Connectors Gateway Advantage Y-Adapter PELVIC FLOOR PRODUCTS MID-URETHRAL SLING SYSTEMS Advantage Fit System (Transvaginal) Advantage System (Transvaginal) Lynx System (Suprapubic) Obtryx II System with PrecisionBlue Design Halo or Curved (Transobturator) Obtryx System Halo or Curved (Transobturator) Solyx SIS System (Single Incision) INJECTABLE IMPLANTS Coaptite Injectable Implant SUTURING SYSTEMS Capio SLIM Suture Capturing Device Capio Suture Capturing Devices Capio CL Transvaginal Suture Capturing Device Capio Sutures SACROCOLPOPEXY UPsylon Y-Mesh Polyform Synthetic Mesh PELVIC FLOOR RECONSTRUCTION SYNTHETIC MESH KIT Uphold LITE Vaginal Support System with Capio SLIM Suture Capturing Device BIOLOGIC GRAFT MATERIALS Xenform Soft Tissue Repair Matrix Repliform Tissue Regeneration Matrix PELVIC FLOOR ACCESSORIES Single-Step Pelvic Drape PRODUCT INDEX C-CODE CROSS-REFERENCE TO BOSTON SCIENTIFIC PRODUCTS C-CODE RESOURCE LIST TERMS AND CONDITIONS

6 VISUALIZATION PRODUCTS

7 VISUALIZATION PRODUCTS LITHOVUE SINGLE-USE DIGITAL FLEXIBLE URETEROSCOPE LithoVue SUD only Description M LithoVue - Global Standard M LithoVue - Global Reverse LithoVue System Workstation (Includes Touch PC, Cart, Power Cord and User's Manual) Description M LithoVue System Workstation - Global 5

8 GUIDEWIRES

9 GUIDEWIRES SENSOR GUIDEWIRES Sensor Dual-Flex PTFE-Nitinol Guidewires with Hydrophilic Tip (10cm Flexible Proximal End) Diameter Length Tip Design (in) Shape Style M Straight 3cm Flexible bx 5 M Angled 3cm Flexible bx 5 M Straight 3cm Flexible bx 5 M Angled 3cm Flexible bx 5 Applicable Medicare C-codes: C guidewire Sensor PTFE-Nitinol Guidewires with Hydrophilic Tip Diameter (in) Length Shape Tip Design M Straight 3cm Flexible bx 5 M Angled 3cm Flexible bx 5 M Straight 3cm Flexible bx 5 M Angled 3cm Flexible bx 5 Applicable Medicare C-codes: C guidewire Style ZIPWIRE GUIDEWIRES Standard ZIPwire Guidewires Diameter (in) Length Shape Tip Design M B Straight 3cm Flexible bx 5 M B Straight 3cm Flexible bx 5 M B Angled 3cm Flexible bx 5 M B Straight 3cm Flexible bx 5 M B Angled 3cm Flexible bx 5 M B Straight 3cm Flexible bx 5 M B Angled 3cm Flexible bx 5 M B Straight 3cm Flexible bx 5 M B Angled 3cm Flexible bx 5 M B Straight 3cm Flexible bx 5 Applicable Medicare C-codes: C guidewire Style 7

10 GUIDEWIRES ZIPWIRE GUIDEWIRES (Continued) Enhanced Bentson-Type Stiff Shaft ZIPwire Guidewires Diameter (in) Length Tip Design M B Straight 5cm Flexible bx 5 M B Angled 5cm Flexible bx 5 M B Straight 5cm Flexible bx 5 M B Angled 5cm Flexible bx 5 Applicable Medicare C-codes: C guidewire Shape Style Bentson-Type ZIPwire Guidewires Diameter (in) Length Shape Tip Design M B Straight 8cm Flexible bx 5 M B Angled 8cm Flexible bx 5 M B Straight 8cm Flexible bx 5 M B Angled 8cm Flexible bx 5 Applicable Medicare C-codes: C guidewire Style Enhanced Stiff Shaft ZIPwire Guidewires Diameter (in) Length Shape Tip Design M B Straight 3cm Flexible bx 5 M B Angled 3cm Flexible bx 5 M B Straight 3cm Flexible bx 5 M B Angled 3cm Flexible bx 5 M B Straight 3cm Flexible bx 5 M B Angled 3cm Flexible bx 5 Applicable Medicare C-codes: C guidewire Style 8

11 GUIDEWIRES ZEBRA UROLOGICAL GUIDEWIRES Zebra Urological Guidewires Diameter (in) Length Shape Tip Design M Straight 3cm Flexible bx 5 M Angled 3cm Flexible bx 5 M Straight 3cm Flexible bx 5 M Angled 3cm Flexible bx 5 M Straight 3cm Flexible bx 5 M Angled 3cm Flexible bx 5 M Straight 3cm Flexible bx 5 M Angled 3cm Flexible bx 5 Supplied with Torque Vise Applicable Medicare C-codes: C guidewire Style PTFE COATED GUIDEWIRES PTFE Coated Guidewires (Fixed Core) Diameter (in) Length Shape Tip Design Style M Straight 3cm Flexible M Straight 3cm Flexible M Straight 15cm Flexible; Bentson-Type M Straight 3cm Flexible M Straight 15cm Flexible; Bentson-Type Applicable Medicare C-codes: C guidewire PTFE Coated Guidewires (Fixed Core, Stiff Bodied) Diameter (in) Length Shape Tip Design Style M Straight 3cm Flexible M Straight 3cm Flexible M mm J M Straight 3cm Flexible M mm J Applicable Medicare C-codes: C guidewire 9

12 GUIDEWIRES PTFE COATED GUIDEWIRES (Continued) PTFE Coated Guidewires (Movble Core) Diameter (in) Length Tip Design Shape M Straight M mm J M Straight M mm J Applicable Medicare C-codes: C guidewire Amplatz Super Stiff PTFE Coated Guidewires Diameter (in) Length Shape Tip Design Style M Straight 7cm Flexible, Bentson-Type bx 5 M mm J bx 5 M Straight 3.5cm Flexible bx 5 M Straight 6cm Flexible, Bentson-Type bx 5 M mm J bx 5 M Straight 3.5cm Flexible bx 5 Applicable Medicare C-codes: C guidewire 10

13 GUIDEWIRES LUBRIGLIDE COATED GUIDEWIRES Standard Lubriglide Coated Guidewires (Fixed Core) Diameter (in) Length Tip Design M Straight 3cm Flexible M Straight 18cm Coil with 3cm Flexible; Lunderquist-Type M Straight 3cm Flexible M Straight 15cm Flexible; Bentson-Type M Straight 15cm Flexible; Bentson-Type Applicable Medicare C-codes: C guidewire Shape Style Standard Lubriglide Coated Guidewires (Fixed Core, Stiff Bodied) Diameter (in) Length (Shape) Tip Design M Straight 3cm Flexible Applicable Medicare C-codes: C guidewire (Style) Standard Lubriglide Coated Guidewires (Movble Core) Diameter (in) Length Tip Design Shape M Straight M Straight Applicable Medicare C-codes: C guidewire 11

14 DILATION PRODUCTS

15 DILATION PRODUCTS URETERAL ACCESS SHEATHS Single-Tapered Tip Navigator HD Ureteral Access Shth Sets French Size M /13 28 M /13 36 M /13 46 M /14 28 M /14 36 M /14 46 M /15 28 M /15 36 M /15 46 Applicable Medicare C-codes: C introducer/shth, other than guiding, other than intracardiac electrophysiological, non-laser Length Navigator Ureteral Access Shth Sets French Size M /13 28 M /13 36 M /13 46 M /15 28 M /15 36 M /15 46 Length M /13 28 bx 5 M /13 36 bx 5 M /13 46 bx 5 M /15 28 bx 5 M /15 36 bx 5 M /15 46 bx 5 Applicable Medicare C-codes: C introducer/shth, other than guiding, other than intracardiac electrophysiological, non-laser 13

16 DILATION PRODUCTS URETERAL BALLOON DILATION CATHETERS UroMax Ultra Balloon Dilatation Catheters (Kits) Balloon Balloon Inflated O.D. Length Catheter Size (Fr) (mm) (Fr) (mm) UroMax Ultra Balloon Dilatation Catheters Balloon Balloon Inflated O.D. Length Catheter Size (Fr) (mm) (Fr) (mm) Usable Length Usable Length Recommended Guidewire (in) M M M M M M M M M M M M M M M M Kit Includes: UroMax Ultra High Pressure Balloon Dilatation Catheter, Encore 26 Inflator Applicable Medicare C-codes: C catheter, balloon dilatation, non-vascular Recommended Guidewire (in) M M M M M M M M M M M M M M M M Applicable Medicare C-codes: C catheter, balloon dilatation, non-vascular 14

17 DILATION PRODUCTS URETERAL BALLOON DILATION CATHETERS (Continued) Passport Balloon Dilatation Catheters (Kits) Balloon Balloon Inflated O.D. Length (Fr) (mm) Tip Length Shaft Diameter (Fr) Usable Length Recommended Guidewire (in) M M M M Kit Includes: Passport Balloon Balloon Dilatation Catheter and Encore 26 Inflator Applicable Medicare C-codes: C catheter, balloon dilatation, non-vascular Passport Balloon Dilatation Catheters Balloon Inflated O.D. (Fr) (mm) Balloon Length Tip Length Shaft Diameter (Fr) Usable Length Recommended Guidewire (in) M M M M Applicable Medicare C-codes: C catheter, balloon dilatation, non-vascular Encore 26 Inflator Description M ml Encore 26 Inflator with Pressure Gauge bx 5 M ml Encore 26 Inflator with Pressure Gauge 15

18 DILATION PRODUCTS URETERAL DILATORS Nottingham One-Step Tapered Dilators with HydroPlus Coating Taper Size From/To (Fr) Taper Length Usable Length M / M / M / M / Ureteral Dilator with HydroPlus Coating and Procedural Shth Set Description M Ureteral Dilators and Procedural Shth Set Set Includes: One 6, 8, 10, 12, and 14 Fr C-Flex Radiopaque Dilator with HydroPlus Coating; One 16 Fr O.D., 14 Fr I.D. x 37.5cm Length Radiopaque PTFE Procedural Shth;.038 PTFE Coated Guidewire Ureteral Dilatation Set with HydroPlus Coating Ureteral Dilators with HydroPlus Coating Description M Ureteral Dilatation Set Set Includes: One 6, 8, 10, 12, 14, and 16 Fr C-Flex Radiopaque Dilator with HydroPlus Coating and.038 PTFE Coated Guidewire O.D. Size (Fr) Usable Length M M M M M M

19 STONE RETRIEVAL DEVICES

20 STONE RETRIEVAL DEVICES NITINOL RETRIEVAL DEVICES 4-wire O Tip Zero Tip Nitinol Stone Retrieval Baskets Description Shth O.D. (Fr) Working Length Basket O.D. (mm) Shth Material M Nitinol Zero Tip 4 Wire Basket Polyimide/PTFE M Nitinol Zero Tip 4 Wire Basket Polyimide/PTFE M Nitinol Zero Tip 4 Wire Basket Polyimide/PTFE M Nitinol Zero Tip 4 Wire Basket Polyimide/PTFE M Nitinol Zero Tip 4 Wire Basket Polyimide/PTFE M Nitinol Zero Tip 4 Wire Basket Polyimide/PTFE Includes: Introducer Dakota Nitinol Stone Retrieval Devices NEW Description Shth O.D. (Fr) Working Length Basket O.D. (mm) M Dakota Nitinol Stone Retrieval Device M Dakota Nitinol Stone Retrieval Device Includes: Introducer 1.9Fr O Tip Escape Nitinol Stone Retrieval Baskets Description Shth O.D. (Fr) Working Length Basket O.D. (mm) M Escape Nitinol Stone Retrieval Basket M Escape Nitinol Stone Retrieval Basket Includes: Y-Adaptor, T-Connector 19

21 STONE RETRIEVAL DEVICES NITINOL RETRIEVAL DEVICES (Continued) OptiFlex Nitinol Stone Retrieval Baskets Description Shth O.D. (Fr) Working Length Basket O.D. (mm) M OptiFlex Nitinol Stone Retrieval Basket M OptiFlex Nitinol Stone Retrieval Basket Includes: Introducer Graspit Nitinol Stone Retrieval Forceps Description Shth O.D. (Fr) Working Length Basket O.D. (mm) Shth Material M Nitinol 2-Prong Forceps Polyimide/PTFE M Nitinol 2-Prong Forceps Polyimide/PTFE M Nitinol 2-Prong Forceps Polyimide/PTFE M Nitinol 2-Prong Forceps Polyimide/PTFE Includes: Introducer STAINLESS RETRIEVAL DEVICES Bagley Helical Stone Retrieval Baskets Shth O.D. (Fr) Working Length Basket O.D. (mm) M M

22 STONE RETRIEVAL DEVICES STAINLESS RETRIEVAL DEVICES (Continued) Gemini Paired Wire Helical Stone Retrieval Baskets Description Shth O.D. (Fr) Working Length Basket O.D. (mm) M Wire Basket, O Tip M Wire Basket, O Tip M Wire Basket, 5cm Filiform Tip M Wire Basket, O Tip M Wire Basket, 5cm Filiform Tip M Wire Basket, O Tip M Wire Basket, 5cm Filiform Tip M Wire Basket, O Tip M Wire Basket, 5cm Filiform Tip M Wire Basket, O Tip M Wire Basket, 5cm Filiform Tip M Wire Basket, O Tip M Wire Basket, 5cm Filiform Tip M Wire Basket, O Tip M Wire Basket, 5cm Filiform Tip M Wire Basket, O Tip M Wire Basket, 5cm Filiform Tip M Wire Basket, O Tip M Wire Basket, O Tip M Wire Basket, 5cm Filiform Tip M Wire Basket, O Tip M Wire Basket, 5cm Filiform Tip M Wire Basket, O Tip M Wire Basket, 5cm Filiform Tip M Wire Basket, O Tip

23 STONE RETRIEVAL DEVICES STAINLESS RETRIEVAL DEVICES (Continued) Segura Hemisphere Stone Retrieval Baskets Description Shth O.D. (Fr) Working Length Basket O.D. (mm) Shth Material M Wire Basket, O Tip Polyimide M Wire Basket, O Tip Polyimide M Wire Basket, O Tip Polyimide M Wire Basket, O Tip Polyimide M Wire Basket, O Tip Polyimide M Wire Basket, O Tip Polyimide M Wire Basket, O Tip PTFE M Wire Basket, O Tip PTFE M Wire Basket, 5cm Filiform Tip PTFE Tricep Hooked-Prong Grasping Forceps Description Shth O.D. (Fr) Working Length Shth Material M Retracting Grasping Forceps PTFE M Retracting Grasping Forceps PTFE M Prong Mini-Throw Grasping Forceps PTFE M Prong Mini-Throw Grasping Forceps PTFE M Retracting Grasping Forceps PTFE M Retracting Grasping Forceps PTFE M Extra-Strength Grasping Forceps Polyimide M Extra-Strength Grasping Forceps Polyimide Tricep Hooked-Prong Grasping Forceps with Spool Handle Description Shth O.D. (Fr) Working Length Shth Material M Non-Retracting Grasping Forceps Polyimide M Non-Retracting Grasping Forceps Polyimide 22

24 STONE RETRIEVAL DEVICES STAINLESS RETRIEVAL DEVICES (Continued) Leslie Parachute Multi-Wire Stone Sweeping Devices Description Shth O.D. (Fr) Working Length Basket O.D. M Leslie Parachute Basket, O Tip M Leslie Parachute Basket, 5cm Filiform Tip M Leslie Parachute Basket, O Tip M Leslie Parachute Basket, 5cm Filiform Tip LithoCatch Immobilization Device Description Shth O.D. (Fr) Working Length Basket O.D. (mm) Shth Material M Wire Basket, O Tip Polyimide ANTIRETROPULSION DEVICES Coil Shth Radiopaque Marker Stone Cone Nitinol Urological Retrieval Coils Description Shth O.D. (Fr) Working Length O.D. (mm) Shth Material M Nitinol Retrieval Coil PTFE M Nitinol Retrieval Coil PTFE Includes: J-Introducer 23

25 URETERAL STENTS

26 URETERAL STENTS STENT STORE Polaris Ultra Ureteral Stents (Dual Durometer Percuflex Material with HydroPlus Coating) French Size x Length Between Pigtails Without Wire.035" Sensor PTFE-Nitinol Flexible Tip.038" Sensor PTFE-Nitinol Dual-Flex.038" Stiff Shaft PTFE Straight 3cm Flexible Tip 5 x 10 M M M M x 12 M M M M x 14 M M M M x 16 M M NA NA M x 18 M M NA NA M x 20 M M NA NA M x 22 M M M M x 24 M M M M x 26 M M M M x 28 M M M M x 30 M M M M x 20 M M M M x 22 M M M M x 24 M M M M x 26 M M M M x 28 M M M M x 30 M M M M x 20 M M M M x 22 M M M M x 24 M M M M x 26 M M M M x 28 M M M M x 30 M M M M x 20 M M M M x 22 M M M M x 24 M M M M x 26 M M M M x 28 M M M M x 30 M M M M Each Stent Supplied with Attached Retrieval Line and Stent Positioner Set Includes: Polaris Ultra Dual Durometer Ureteral Stent with Percuflex Material and HydroPlus Coating, and Attached Retrieval Line, Stent Positioner, Axxcess 6Fr Ureteral Catheter, and Specified Guidewire Applicable Medicare C-codes: C stent, non-coronary, temporary, without delivery system; C guidewire; C catheter, ureteral 25

27 URETERAL STENTS STENT STORE (Continued) Polaris Ultra Ureteral Stents (Dual Durometer Percuflex Material with HydroPlus Coating) (Continued) French Size x Length Between Pigtails.038" ZIPwire Straight 3cm Flexible Tip.035" Stiff Shaft ZIPwire Straight 3cm Flexible Tip.035" ZIPwire Straight 3cm Flexible Tip " Stiff Shaft PTFE Straight 3cm Flexible Tip 5 x 10 M M M M x 12 M M M M x 14 M M M M x 16 M M M M x 18 M M M M x 20 M M M M x 22 M M M M x 24 M M M M x 26 M M M M x 28 M M M M x 30 M M M M x 20 M M M M x 22 M M M M x 24 M M M M x 26 M M M M x 28 M M M M x 30 M M M M x 20 M M M M x 22 M M M M x 24 M M M M x 26 M M M M x 28 M M M M x 30 M M M M x 20 M M M M x 22 M M M M x 24 M M M M x 26 M M M M x 28 M M M M x 30 M M M M Each Stent Supplied with Attached Retrieval Line and Stent Positioner Set Includes: Polaris Ultra Dual Durometer Ureteral Stent with Percuflex Material and HydroPlus Coating, and Attached Retrieval Line, Stent Positioner, Axxcess 6Fr Ureteral Catheter, and Specified Guidewire Applicable Medicare C-codes: C stent, non-coronary, temporary, without delivery system; C guidewire; C catheter, ureteral

28 URETERAL STENTS STENT STORE (Continued) Kidney Coil (Firm Durometer Percuflex Material) Bladder Loop Design (Soft Durometer Percuflex Material) Tapered Tip Polaris Loop Ureteral Stents (Dual Durometer Percuflex Material with HydroPlus Coating) French Size x Length Between Pigtails Without Wire.035" Sensor PTFE-Nitinol Dual-Flex.038" Sensor PTFE-Nitinol Dual-Flex.038" Stiff Shaft PTFE Straight 3cm Flexible Tip 5 x 10 M M M M x 12 M M M M x 14 M M M M x 16 M M M M x 18 M M M M x 20 M M M M x 22 M M M M x 24 M M M M x 26 M M M M x 28 M M M M x 30 M M M M x 20 M M M M x 22 M M M M x 24 M M M M x 26 M M M M x 28 M M M M x 30 M M M M x 20 M M M M x 22 M M M M x 24 M M M M x 26 M M M M x 28 M M M M x 30 M M M M x 20 M M M M x 22 M M M M x 24 M M M M x 26 M M M M x 28 M M M M x 30 M M M M Each Stent Supplied with Attached Retrieval Line and Stent Positioner Set Includes: Polaris Loop Dual Durometer Ureteral Stent with Percuflex Material and HydroPlus Coating, and Attached Retrieval Line, Stent Positioner, Axxcess 6Fr Ureteral Catheter, and Specified Guidewire Applicable Medicare C-codes: C stent, non-coronary, temporary, without delivery system; C guidewire; C catheter, ureteral 27

29 URETERAL STENTS STENT STORE (Continued) Kidney Coil (Firm Durometer Percuflex Material) Bladder Loop Design (Soft Durometer Percuflex Material) Tapered Tip Polaris Loop Ureteral Stents (Dual Durometer Percuflex Material with HydroPlus Coating) (Continued) French Size x Length Between Pigtails.038" ZIPwire Straight 3cm Flexible Tip.035" Stiff Shaft ZIPwire Straight 3cm Flexible Tip.035" ZIPwire Straight 3cm Flexible Tip.035" Stiff Shaft PTFE Straight 3cm Flexible Tip 5 x 10 M M M M x 12 M M M M x 14 M M M M x 16 M M M M x 18 M M M M x 20 M M M M x 22 M M M M x 24 M M M M x 26 M M M M x 28 M M M M x 30 M M M M x 20 M M M M x 22 M M M M x 24 M M M M x 26 M M M M x 28 M M M M x 30 M M M M x 20 M M M M x 22 M M M M x 24 M M M M x 26 M M M M x 28 M M M M x 30 M M M M x 20 M M M M x 22 M M M M x 24 M M M M x 26 M M M M x 28 M M M M x 30 M M M M Each Stent Supplied with Attached Retrieval Line and Stent Positioner Set Includes: Polaris Loop Dual Durometer Ureteral Stent with Percuflex Material and HydroPlus Coating, and Attached Retrieval Line, Stent Positioner, Axxcess 6Fr Ureteral Catheter, and Specified Guidewire Applicable Medicare C-codes: C stent, non-coronary, temporary, without delivery system; C guidewire; C catheter, ureteral 28

30 URETERAL STENTS STENT STORE (Continued) Firm Durometer Percuflex Material with HydroPlus Coating Tapered Tip Large Side Ports Placement Markers Percuflex Plus Ureteral Stents (with HydroPlus Coating) French Size x Length Between Pigtails Without Wire.038" Stiff Shaft PTFE Straight 3cm Flexible Tip.038" ZIPwire Straight 3cm Flexible Tip.035" Stiff Shaft ZIPwire Straight 3cm Flexible Tip 4.8 x 10 M NA NA NA NA M x 12 M NA NA NA NA M x 14 M NA NA NA NA M x 16 M NA NA NA NA M x 18 M NA NA NA NA M x 20 M NA NA NA NA M x 22 M NA NA NA NA M x 24 M NA NA NA NA M x 26 M NA NA NA NA M x 28 M NA NA NA NA M x 30 M NA NA NA NA M x 20 M M M M x 22 M M M M x 24 M M M M x 26 M M M M x 28 M M M M x 30 M M M M x 20 M M M M x 22 M M M M x 24 M M M M x 26 M M M M x 28 M M M M x 30 M M M M x 20 M M M NA NA 8 x 22 M M M M x 24 M M M M x 26 M M M M x 28 M M M M x 30 M M M M Each Stent Supplied with Attached Retrieval Line and Stent Positioner, and Pigtail Straightener where applicable. Set Includes: Percuflex Plus Stent with HydroPlus Coating, Axxcess 6Fr Ureteral Catheter and Specified Guidewire 8Fr Stents Supplied with Positioner Assembly NA = Not Available Applicable Medicare C-codes: C stent, non-coronary, temporary, without delivery system; C guidewire; C catheter, ureteral 29