Private Health Insurance (Prostheses) Rules 2012 (No. 2) (Cth)
Made under item 4 of the table in section 333-20 of the
This compilation was prepared on 18 February 2013 taking into account amendments up to and including the
Prepared by the Department of Health and Ageing, Canberra
1. Name of Rules 3
2. Commencement 3
3. Revocation 3
4. Definitions 3
5. Listing of, and benefits for, prostheses 5
5A. Circumstances in which a prosthesis is provided other than circumstances in which a medicare benefit is payable 6
5B. Conditions in relation to provision of listed prostheses 6
6. Benefits for prostheses provided as part of hospital treatment 6
7. Benefits for prostheses provided as part of hospital-substitute treatment 7
8. Timing of applications to have a prosthesis listed 8
9. Minister may have regard to recommendations and advice 8
10. Listing criteria for prostheses to be listed in Part C of the Schedule 8
1.
Name of Rules These Rules are the
Private Health Insurance (Prostheses) Rules 20 12 (No.2) .
These Rules commence on 30 August 2012.
These Rules revoke the
Private Health Insurance (Prostheses) Rules 2012 (No. 1) .
4.
Definitions In these Rules:
accredited podiatrist means a podiatric surgeon who holds specialist registration in the specialty of podiatric surgery under the National Law.Note: The registration requirements for an accredited podiatrist for the purposes of these Rules are the same registration requirements for podiatric surgeons as set out in rule 8 of the Private Health Insurance (Accreditation) Rules.
Act means thePrivate Health Insurance Act 2007 .
certified overnight Type C procedure has the same meaning as in rule 3 of the Private Health Insurance (Benefit Requirements) Rules.
certified Type C procedure has the same meaning as in rule 3 of the Private Health Insurance (Benefit Requirements) Rules.
consultant physician has the same meaning as in subsection 3(1) of theHealth Insurance Act 1973.
gap permitted prosthesis means a prosthesis of a kind listed in the Schedule where an amount is set out for that kind of prosthesis in the column under the heading 'Minimum Benefit' and a different amount is set out in the column under the heading 'Maximum Benefit'.
implantable cardiac event recorder includes a component of an implantable cardiac event recorder.
insulin infusion pump includes a component of an insulin infusion pump.
listed prosthesis means a kind of prosthesis listed in the Schedule to these Rules.
listing application has the same meaning as in subsection 72-10(6) of the Act.
listing criteria has the same meaning as in subsection 72-10(6) of the Act.
National Law means:(a) for a State or Territory other than Western Australia — the Health Practitioner Regulation National Law set out in the Schedule to the
Health Practitioner Regulation National Law Act 2009 (Qld)as it applies (with or without modification) as law of the State or Territory; or(b) for Western Australia — the legislation enacted by the
Health Practitioner Regulation National Law (WA) Act 2010 that corresponds to the Health Practitioner Regulation National Law.Note: The Intergovernmental Agreement for a National Registration and Accreditation Scheme for the Health Professions that was made on 26 March 2008 provides for the enactment of the State and Territory legislation mentioned in this definition.
no gap prosthesis means a prosthesis of a kind listed in the Schedule where an amount is set out for that kind of prosthesis in the column under the heading 'Minimum Benefit' and no amount is set out in the column under the heading 'Maximum Benefit'.
private hospital means a hospital in respect of which there is in force a statement under subsection 121-5 (8) of the Act that the hospital is a private hospital.Note: Section 15 of the
Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 deals withthe status ofcertainhospitals for which a declaration had been made before the commencement of the Act.
professional attendance has the same meaning as in clause 1.2.3 of the General Medical Services Table being the table prescribed under section 4 of theHealth Insurance Act 1973 .
professional service has the same meaning as in subsection 3(1) of theHealth Insurance Act 1973 .
public hospital means a hospital in respect of which there is in force a statement under subsection 121-5(8) of the Act that the hospital is a public hospital.Note: Section 15 of the
Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 deals withthe status ofcertainhospitals for which a declaration had been made before the commencement of the Act.
Schedule means the Schedule in these Rules.Note: Terms used in these Rules have the same meaning as in the Act―see section 13 of the
Legislative Instruments Act 2003 . These terms include:complying health insurance policy
hospital-substitute treatment
hospital treatment
medicare benefit
5.
Listing of, and benefits for, prostheses For item 4 of the table in subsection 72-1 (2) of the Act:
(a) the Schedule lists the kinds of prostheses:
(i) in relation to which the Minister has granted an application for listing under subsection 72-10 (5) of the Act; or
(ii) which are listed in accordance with section 12 of the
Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 ; andNote: Section 12 of the
Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 deals with the listing of a prosthesis that was a no gap prosthesis or a gap permitted prosthesis for the purposes of theNational Health Act 1953 immediately before the commencement of the Act.(aa) circumstances in which a listed prosthesis is provided for the purposes of paragraph (d) of item 4 of the table in subsection 72-1(2) are set out in rule 5A; and
(ab) conditions that must be satisfied in relation to the provision of a listed prosthesis for the purposes of paragraphs (c) and (d) of item 4 of the table in subsection 72-1(2) are set out in rule 5B; and
(b) rule 6 sets out the method for working out the minimum benefit and maximum benefit for hospital treatment, covered under a complying private health insurance policy, that is the provision of a listed prosthesis; and
(c) rule 7 sets out the method for working out the minimum benefit and maximum benefit for hospital-substitute treatment, covered under a complying private health insurance policy, that is the provision of a listed prosthesis.
For the purposes of paragraph (d) of item 4 of the table in subsection 72-1(2) of the Act, the following circumstances are set out:
(a) the provision of a listed prosthesis which is associated with podiatric treatment by an accredited podiatrist.
Note: Paragraph (c) of Item 4 of subsection 72-1(2) deals with the provision of a listed prosthesis in circumstances in which a medicare benefit is payable.
For the purposes of paragraphs (c) and (d) of item 4 of the table in subsection 72-1(2) of the Act, conditions that must be satisfied in relation to the provision of a listed prosthesis in the circumstances covered by paragraph (c) or (d) of that item, as the case may be, are:
(a) in relation to any kind of prosthesis where there is a statement of a requirement under the heading 'Condition' in the Schedule under the listing for that kind of prosthesis, that requirement; and
(b) in relation to a listed prosthesis that is an insulin infusion pump, also:
(i) the professional service associated with the provision of the insulin infusion pump must be a professional attendance by a consultant physician in the practice of his or her specialty; and
(ii) the professional service must be provided as a certified Type C procedure or certified overnight Type C procedure; and
(iii) the insulin infusion pump must be provided for the purpose of administering insulin.
Note: Item 4 of the table in subsection 72-1(2) of the Act states other requirements in relation to benefits for the provision of prostheses that a policy that covers hospital treatment must meet. These requirements relate to benefits for hospital treatment and, if the policy covers hospital-substitute treatment, to the benefits of that coverage as well.
(1) For a no gap prosthesis provided as part of an episode of hospital treatment by a private hospital, the minimum benefit and the maximum benefit are each the amount for that prosthesis listed in the column in the Schedule under the heading ‘Minimum Benefit’.
(2) For a gap permitted prosthesis provided as part of an episode of hospital treatment by a private hospital:
(a) the minimum benefit is the amount for that prosthesis in the column in the Schedule under the heading ‘Minimum Benefit’; and
(b) the maximum benefit is the amount for that prosthesis in the column in the Schedule under the heading ‘Maximum Benefit’.
(3) For a no gap prosthesis provided as part of an episode of hospital treatment by a public hospital:
(a) the minimum benefit is the lesser of the following amounts:
(i) the amount for that prosthesis listed in the column under the heading ‘Minimum Benefit’ in the Schedule; or
(ii) the amount of the insured person’s liability to the public hospital for that prosthesis; and
(iii) the maximum benefit is the amount for that prosthesis listed in the column under the heading 'Minimum Benefit'.
(4) For a gap permitted prosthesis provided as part of an episode of hospital treatment by a public hospital:
(a) the minimum benefit is the lesser of the following amounts:
(i) the amount for that prosthesis listed in the column under the heading ‘Minimum Benefit’ in the Schedule; or
(ii) the amount of the insured person’s liability to the public hospital for that prosthesis; and
(iii) the maximum benefit is the amount for that prosthesis listed in the column under the heading ‘Maximum Benefit’ in the Schedule.
Note: Paragraphs (d) and (e) of subsection 72-10(5) of the Act deal with the fixing of minimum and maximum benefits when the Minister is making or varying the Private Health Insurance (Prostheses) Rules.
(1) For a no gap prosthesis provided as part of an episode of hospital-substitute treatment the minimum benefit and the maximum benefit are each the amount for that prosthesis listed in the column in the Schedule under the heading ‘Minimum Benefit’.
(2) For a gap permitted prosthesis provided as part of an episode of hospital-substitute treatment:
(a) the minimum benefit is the amount for that prosthesis in the column in the Schedule under the heading ‘Minimum Benefit’; and
(b) the maximum benefit is the amount for that prosthesis in the column in the Schedule under the heading ‘Maximum Benefit’.
Note 1: Private health insurers cannot cover, as part of hospital-substitute treatment, a service for which medicare benefit is payable unless the service is specified in the
Private Health Insurance (Health Insurance Business) Rules ― see paragraph 121-10 (3) (a) of the Act.Note 2: Paragraphs (d) and (e) of subsection 72-10(5) of the Act deal with the fixing of minimum and maximum benefits when the Minister is making or varying the Private Health Insurance (Prostheses) Rules.
As a matter of normal administrative practice, applications made under subsection 72-10 (2) of the Act will be considered after they have been received and, if the Minister decides to grant the application, the kind of prosthesis will be listed in the Schedule the next time the Minister makes or varies the Rules.
Note 1: Under subsection 72-10 (5) of the Act the Minister must list the kind of prosthesis, set out the minimum benefit and, if the Minister considers it appropriate, the maximum benefit for the prosthesis in these Rules on the next occasion that the Minister makes or varies the Rules after he or she grants an application and the applicant has paid to the Commonwealth any initial listing fee within 14 days of being informed of the Minister's decision to grant the application.
Note 2: Under subsection 72-15 (3) of the Act, the Minister may remove a kind of prosthesis from the list in the Rules if the applicant fails to pay an ongoing listing fee. Minister may have regard to recommendations and advice
9.
Note 2: Under subsection 72-15 (3) of the Act, the Minister may remove a kind of prosthesis from the list in the Rules if the applicant fails to pay an ongoing listing fee. Minister may have regard to recommendations and advice In making the decision under subsection 72-10 of the Act, the Minister may have regard to a recommendation from the Prostheses List Advisory Committee.
For a listing application to be granted to list a kind of prosthesis in Part C of the Schedule, the listing criterion is that the kind of prosthesis is an:
(i) insulin infusion pump; or
(ii) implantable cardiac event recorder.
Note: 1. The power to make listing criteria is in subsection 72-10(6) of the Act.
2. Under subsection 72-10(7) of the Act the Minister must not grant a listing application if any applicable listing criteria are not satisfied in relation to the application.
3. Under the Act the Minister may refuse to grant a listing application even if the listing criteria are satisfied. See Note to subsection 72-10(7) of the Act.
Part A - Prostheses List February 2013
AL003 MTA2UO - MTA6UO PMMA +5 to +30 D $156.00
BL005 Storz (Coburn) Intraocular Lens PMMA Anterior Chamber Intraocular 13.75mm length. 6.0mm $156.00
121UV; L122UV PMMA Anterior lens 1 piece optic size, diopter range 3-
Chamber Lens 30d. L122UV: 6.0mm optic,
13.75mm length, power
range; 5.0 to 30.0 Diopters
EG009 Artisan Anterior Chamber Aphakia ModelComposition: PMMA 5.00mm Optic Diameter x $156.00
Intraocular Lens 8.5 in overall length
AO019 Verisyse AC IOL Aphakic Model 5mm Optic Diameter x 8.5 $250.00
overall length
AO001 Intraocular Lens: Model AC 51L Duralens PMMA, Anterior Chamber 6.00 mm Optic Diameter x $198.00
IOL 13.0mm in overall length
AO016 Verisyse AC IOL Phakic Intraocular Lens: Model 5mm Optic Diameter x 8.5 $680.00
Composition: PMMA overall length; 6mm Optic
Diameter x 8.5 overall
AO017 Verisyse AC IOL Phakic Intraocular Lens: Model 5mm Optic Diameter x 8.5 $680.00
Composition: PMMA overall length
Prostheses List by Category, Groups and Sponsor Page 1 of 1011
EG012 Artisan Anterior Chamber IOL Phakic Intraocular Lens Myopic / 5.00mm Optic Diameter x $680.00
Hyperopic 8.5 in overall length;
AO030 Verisyse Toric (Custom) Phakic intraocular lens: Model toric 5mm Optic Diameter x $1,056.00
7.5mm overall length
EG008 Artisan Anterior Chamber Phakic Intraocular Lens: Model Toric 5.00mm Optic Diameter x $1,056.00
Intraocular Lens Composition: PMMA 7.5 in overall length
AO029 Verisyse Toric (Custom) Phakic intraocular lens: Model toric 5mm Optic Diameter x $1,358.00
7.5mm overall length
AL034 AcrySof Cachet Phakic Lens Anterior chamber foldable, acrylic, -6.0 to -16.5 diopters, in 0.5 $723.00
single piece phakic lens diopter increments
AO025 VeriFlex Foldable Phakic IOL Anterior chamber foldable phakic -2 to -14.5d in 0.5d $723.00
silicone intraocular lens increments. Overall
diameter 8.5mm. Optic
6.0mm
EG010 Artiflex Anterior Chamber Optic: Hydrophobic Polysiloxane. 6mm optic diameter x 8.5 in $723.00
Intraocular Lens Haptic: PMMA overall length
AL002 Models MZ60BD, MC50BD, CZ70BD Other:PMMA Range of Powers:-10 to +34 $156.00
D
Prostheses List by Category, Groups and Sponsor Page 2 of 1011
BL006 Posterior chamber IOLS model PMMA Posterior Chamber lens 1 12.25mm to 13.75mm $156.00
P359 UV, P399 UV, 68 UV, 95 length. 5.5mm to 7mm optic
BUV, or lolab PC One Piece, model size, diopter range -4.5 -
6741B, 8591B, 8191B; Model EZE- 45d to 10 - 34d; EZE-Fit
65: 6.5mm optic, 13.35mm
length, Power range: 10.0
to 30.0 Diopter
CZ016 CT ASPHINA 409M ZEISS Micro Incision Aaspheric 6mm optic, 11mm overall $364.00
(aberration neutral) IOL: Foldable, diameter. Diopter range 0.0
square-edged, single piece IOL for to +32.0D (0.5D steps from
capsular bag fixation 10.0 to 30.0D, 1.0D outside
this range)
CZ017 CT ASPHINA 509M ZEISS Micro Incision Aspheric 6mm Optic, 11mm overall $364.00
(aberration correcting) IOL: Foldable, diameter. Diopter range 0.0
square-edged, single piece IOL for to +32.0D (0.5D steps from
capsular bag fixation 10.0 to 30.0D, 1.0D outside
this range)
BL026 Akreos AO Micro Incision Lens Micro Incision, posterior chamber, 6mm optic overall diameter $374.00
foldable acrylic, aphakic, anterior & 11.0mm(10D-15D), 10.7mm
posterior edge modification, (15.50-22D), 10.5mm
preloaded, with aberration contro, (22.50-30D)
CZ028 CT ASPHINA 409MP Preloaded, micro incision, aspheric Diopter range: 0.0 to $374.00
(aberration neutral), foldable square- 32.0D; Optic size: 6.0mm;
edged single piece inraocular lens for Overall length: 11.0mm
capsular bag fixation.
CZ037 CT ASPHINA 509MP Preloaded, micro incision, aspheric Diopter range: 0.0 to + $374.00
(aberration correcting), foldable 32.0D; Optic Size: 6.0mm;
square-edged single-piece intraocular Overall length: 11.0mm
lens for capsular bag fixation
Prostheses List by Category, Groups and Sponsor Page 3 of 1011
CZ031 AT TORBI 709MP (Standard Bitoric, preloaded, micro incision, Diopter range: Sph -10.0 to $760.00
aspheric (aberration neutral), foldable, 32.0, Cyl +1.0 to 6.5
square-edged, single-piece IOL for Optic size: 6.0mm, Overall
capsular bag fixation length: 11.0mm
CZ032 AT TORBI 709MP (high cyl) Bitoric, preloaded, micro incision, Diopter range: Sph -10.0 to $1,061.00
aspheric (aberration neutral), foldable, 32.0, Cyl +7.0 to 12.0,
square-edged, single-piece IOL for Optic size: 6.0mm. Overall
capsular bag fixation Length 11.0mm
CZ020 AT TORBI 709M STANDARD RANGE BITORIC - 6mm optic, 11mm overall $740.00
ZEISS Micro Incision Aspheric diameter. Diopter range:
(abberation neutral) IOL: Foldable, Sph -10.0 to +32.0D, Cyl
square-edged, single piece IOL for +1.0 to 6.5D (all 0.5D
capsular bag fixation
CZ027 AT TORBI 709M HIGH CYLINDER BITORIC - ZEISS 6mm optic, 11mm overall $1,041.00
Micro Incision Aspheric (aberration diameter. Diopter range:
neutral) IOL: Foldable square edged, Sph -10.0 to +32.0D, +7.0
single piece IOL for capsular bag to 12.0D (all 0.5D steps)
fixation
XE002 Staar foldable silicone intraocular Polyimide haptics 6.3mm optic - low 14.0mm length $281.00
lens: Model AQ 5010V diopters
XE001 Staar Toric foldable silicone Plate haptics 6.0mm optic 10.8mm - 11.2mm length $579.00
intraocular lens: Model AA4203TF;
Model AA4203TL
Prostheses List by Category, Groups and Sponsor Page 4 of 1011
AL004 Acrysof Multipiece Models Foldable Acrylic Multi-piece Lens -5 D to +30 D $322.00
MA50BM, MA60AC
AL011 Acrysof Model SA60AT Foldable Acrylic Single-piece Lens, Range of Powers: +6 to +40 D $322.00
asymmetric optic/consistent edge
AO002 Sensar AR40 Monofocal Acrylic Soft Acrylic, Foldable, UV 6 mm Optic Diameter x $322.00
Sensar OptiEdge AR40e Absorbing, Posterior 13mm in overall length.
Foldable Acrylic IOL
AO006 Clariflex, Model CLRFLXB Foldable Silicone IOL with OptiEdge One size only $322.00
Posterior Chamber Intraocular Lens design
BL020 Akreos Adapt acrylic foldable Composition: Hydrophilic acrylic 10.0 to 15.0 Diopter in 1.0 $322.00
posterior chamber intraocular lens polymer. Packaged in lens folding Diopter increments15.0 to
Four haptic 25.0 Diopter in 0.5 Diopter
design increments25.0 to 30.0
Diopter in 1.0 Diopter
increments
BL021 SoflexSE, Intraocular lenses, Composition: silicone, Lenses - Range of powers: 5.0 to $322.00
Posterior Chamber foldable, posterior chamber 30.0 Diopter - Optic
intraocular lenses diameter 6.0mm; 13.0mm
CZ029 CT 53N Foldable, 3-piece, monofocal, square- Diopter range: 0.0 to 40.0, $322.00
edged, hydrophilic acrylic (with Optic size: 6.0mm, Overall
hydrophobic surface properties) length: 13.0mm
intraocular lens for capsular bag or
sulcus fixation.
DE398 Oculentis LENTIS L-302-1 Foldable one-piece monofocal C loop Optic Size 6.0mm, Overall $322.00
acrylic IOL. Length 12.00mm. +-0.0D to
+35.0D (1.0D steps) and
+15.5D to +26.5D (0.5D
steps).
Prostheses List by Category, Groups and Sponsor Page 5 of 1011
XE003 Staar foldable silicone IOLs: Plate haptics 6.0mm; Polymide 10.8mm 0 13.5mm length $322.00
Models AQ2010V, AQ2017V and haptics 5.5 or 6.3mm optic;
KG001 Rayner C-Flex Hydrophilic HEMA-MMA 5.75mm dia optic, 12.00mm $322.00
copolymer, foldable with injector dia overall
KG002 Superflex Hydrophilic HEMA-MMA 6.25mm dia optic, 12.5mm $322.00
copolymer, foldable with injector dia overall
AO014 TECNIS™ Intraocular Lens (Z9002 Foldable Intraocular Lenses - 5-10 dioptre in 1.0 dioptre $364.00
& ZA9003) Ultraviolet light absorbing posterior increments; 10.5 - 30
chamber intraocular lenses, dioptre in 0.5 increments
Silicone/Acrylic
AO024 Tecnis™ One Piece (ZCB00) One piece intraocular lens with edge +5 diopters to +34 diopters $364.00
modification and 360 degree square in 0.5d increments
edge
BL022 SofPort Advanced Optic (AO) Posterior chamber, foldable silicone 0 D to 30.0 D $364.00
IOL with anterior optic-haptic square
edge, posteriof optic-haptic square
edge, 360-degree optic square edge
and asperic optic for aberration control
BL023 Akreos Advanced Optic Posterior chamber, foldable acrylic 0 D to 30.0 D $364.00
IOL, with anterior optic-haptic square
edge, posterior optic-haptic square
edge, 360 degree optic square edge
and aspheric optic for aberration
BL030 enVista The enVista, Model MX60, is an ultra- Overall diameter 12.5mm, $364.00
violet-absorbing, posterior chamber, optic body diameter 6.0mm
hydrophobic acrylic one-piece in dioptric powers ranging
Has an from +0.0 to +34D
aspheric lens optic, square posterior 0.0D to 10.0D in 1 Diopter
edge, modified C haptics and available increments
in dioptric powers ranging from +0.0 11.0D to 30.0D in 0.5
to +34.0D. Diopter increments
31.0D to 34.0D in 1
Diopter increments
Prostheses List by Category, Groups and Sponsor Page 6 of 1011
CZ030 CT ASPHINA 404 Small incision, foldable, single piece, Diopter range: -10.0 to $364.00
monofocal, aspheric (aberration 42.0, Optic size: 6.0mm,
neutral), square-edged, hydrophilic Overall length: 11.0mm
acrylic (with hydrophobic surface
properties) intraocular lens for
capsular bag fixation. (Monofocal lens
for powers outside standard 409MP
MICS range).
DE399 Oculentis LENTIS L-312 Foldable one-piece monofocal acrylic Optic size 6.0mm, Overall $364.00
C Loop IOL Length 12.00mm. Central
Thickness 1.02mm
(+22.0D). Available
Diopters: -10.0D to35.0D
(1.0D steps). +10.5D to
DE400 Oculentis LENTIS L-313 Foldable one-piece monofocal acrylic Optic size 6.0mm, Overall $364.00
IOL Length 11.00mm. Available
Diopters: +-0.0D to 35.0D
(1.0D steps). +10.5D to
29.5D (0.5D steps)
DE401 Oculentis LENTIS L-402 Foldable three piece monofocal acrylic Optic Size 6.0mm, Overall $364.00
IOL. Length 13.00mm. +-0.0D to
+35.0D (1.0D) + 15.5D to
+26.5D (0.5D). Minus range
on demand.
IQ004 Softec Acrylic, single piece, foldable Available in dioptric $364.00
intraocular lens with anterior and powers from -5.0 to +36.0,
posterior optic-haptic square edge, 1D steps: -5.0 to +10.0 and
360 degree optic square edge design, +31.0 to +36.0; 0.5D steps:
precision power calculation and +10.5 to +18.0 and +25.0 to
aberration technology +29.5; 0.25D steps: +18.0
to +25.0
IQ010 PreciSAL 302AC Acrylic, single piece, foldable Available in dioptric $364.00
intraocular lens with anterior and powers from 0.0 to +30.0.
posterior optic-haptic square edge, 1D steps: 0.0 to +10.0;
360 degree optic square edge design, 0.5D steps: +10.5 to + 17.5
precision power calculation, and +28.5 to +30.0; 0.25D
aberration technology and UV light steps: +18.0 to +28.0
Prostheses List by Category, Groups and Sponsor Page 7 of 1011
KG012 Rayner "C-Flex" and Superflex" Aspheric Intra Ocular Lenses with C-Flex -970C + 22.5D to $364.00
Aspheric IOL Amon-Apple enhanced 360 Degree +34D Superflex-920H - 10D
square edge, Anti-vaulting Haptics to +22D
AO034 TECNIS® 1-Piece Pre-Loaded IOL 1-piece IOL Posterior Chamber +5.0 to +34.0 diopter $374.00
Intraocular lens, incorporates a powers in 0.5 diopter
proprietary wavefront-designed increments. Overall
aspheric optic with a squared diameter 13mm, Optic size
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 a screw style
disposable injector.
XE004 Preloaded Aspheric Intraocular Silicone intraocular lens 6.0mm $374.00
DV253 HOYA AF-1 351 Toric Preloaded injector system, correct IOL Power: + 10.0 to 30.0 $800.00
T3/T4/T5/T6/T7/T8/T9 corneal astigmatism micro-incision, (0.5 steps), IOL Cylinder
ashperic, blue-blocker, single piece power: 1.50D (351T3),
hydophobic. 2.25D (351T4), 3.00D
(351T5), 3.75D (351T6),
4.50D (351T7), 5.25D
(351T8), 6.00D (351T9)
AL024 AcrySert model SN60WS Foldable Acrylic Single-piece Lens +6 to +30 D $405.00
with Blue light protection and
aspheric correction, in cartridge.
AL031 AcrySert C Model SN6CWS Posterior chamber, UV absorbing, +6.0 to +30.0 D $405.00
foldable, acrylic, single piece lens
with blue light protection and
aspheric correction, in cartridge
Prostheses List by Category, Groups and Sponsor Page 8 of 1011
DV250 Hoya-PS AF-1 (UY) PY-60AD Preloaded in cartridge, Aspheric, Blue +6.0D to +30.0D (0.5D $405.00
blocker, Foldable, Single-Piece,
Hydrophobic Acrylic
DV252 HOYA iSert® 251 Preloaded injector system, Micro- +6.0D to 30.0D (5 steps) $405.00
incision, Aspheric, Blue-Blocker,
Single Piece, Hydrophobic
AO031 TECNIS® Toric 1-Piece IOL 1-piece IOL Posterior chamber +5.0 to +34.0 diopter $740.00
Intraocular lens, incorporates a powers in 0.5 diopter
proprietary wavefront designed toric increments. Cylinder
aspheric optic with a squared power: 1.00 diopter, 1.50
posterior optic edge designed to diopter, 2.25 diopter, 3.00
provide a 360 degree barrier. The edge diopter and 4.00 diopter (as
of the optic has a frosted design to measured at the IOL plane).
reduce potential edge glare effects. Overall diameter 13mm,
Optic size 6mm.
BL032 enVista Toric The enVista toric (Model MX60T) is a Overall diameter is 12.5mm $740.00
one-piece glistening-free for the entire lens power
hydrophobic IOL. The enVista Toric, range, with spherical
model MX60T IOL has a Toric equivalent powers from +6.0
aspheric lens optic, a square posterior to +30.0 Diopters in 0.5
edge and modified C haptics, an Diopter steps and cylinder
overall diameter of 12.5mm and an powers from +1D to 6D
It is available in Diopters (at the IOL plane).
multiple spherical and cylindrical
powers.
DE390 Oculentis LENTIS Tplus LU-313T Patient Specific: Foldable one-piece Optic Size 6.0mm, overall $740.00
monofocal toric acrylic IOL length 11.0mm. Sph +/-0.0D
to +35.0D (in 0.01D
increments) Cyl +0.25 to
+6.99D cyl (in 0.01D
increments)
Prostheses List by Category, Groups and Sponsor Page 9 of 1011
DE397 Oculentis LENTIS Tplus LS-313 Foldable one-piece monofocal toric Optic Size 6.0mm, Overall $740.00
T1-T6 acrylic IOL. Length 11.00mm. Available
diopters: +10.0D to +30.0D
(0.5D). Cyl: (T1 +1.5D) (T2
+2.25D) (T3 +3.0D) (T4
+3.75D) (T5 +4.5D) (T6
+5.25D)
DE392 Oculentis LENTIS LU-313-TY Patient Specific: Foldable one-piece Optic Size: 6.0mm, overall $780.00
monofocal toric acrylic IOL. Violet length 11.00mm. Sph +/-
Light Filter 0.0D to +35.0D (in 0.01D
increments) Cyl +0.25D to
+6.99D cyl (in 0.01D
increments)
DE391 Oculentis LENTIS Tplus LU-313T Patient Specific: Foldable one-piece Optic Size: 6.0mm, overall $1,042.00
monofocal toric acrylic IOL length 11.00mm. Sph +/-
0.0D to +35.0D (in 0.01D
increments) Cyl +6.99D to
+12.0D cyl (in 0.01D
increments)
DE393 Oculentis LENTIS T plus LU-313-TY Patient Specific: Foldable one-piece Optic Size: 6.0mm, overall $1,084.00
monofocal toric acrylic IOL. Violet length 11.00mm. Available
Light Filter. diopters: Cyl +7.00D to
+12.0D inclusive in 0.01D
increments.
AL021 Alcon AcrySof SN60WF Foldable Acrylic Single-piece Lens + 6.0 D to +30.0 D $385.00
with Blue Light Protection and
Aspheric Correction
Prostheses List by Category, Groups and Sponsor Page 10 of 1011
BL025 SofPort Advanced Optic (AO) Posterior chamber, aphakic, foldable 6mm optic 13mm overall $385.00
Violet Shield silicone, anterior & posterior edge lengthModified C 5
modification intraocular lens with degree angulation 0-30D,
aberration technology, a violet light 0.5D steps
DV247 HOYA AF-1 iMics1 NY-60 Mini Incision, Aspheric, Blue- +6.0D to 30.0D (0.5 steps) $385.00
blocker, Single-piece, Hydrophobic
DE402 Oculentis LENTIS LS-312Y Foldable one-piece monofocal C Loop Optic Size 6.0mm, Overall $385.00
Acrylic IOL. Violet Light filter. Length 12.0mm. Available
Diopters: +-0.0D to 35.0D
(1.0D steps) +15.5D to
26.5D (0.5D steps).
DE403 Oculentis LENTIS LS-313Y Foldable one-piece monofocal acrylic Optic Size 6.0mm, Overall $385.00
plate haptic IOL. Violet Light Filter Length 11.00mm. Available
Diopters: +-0.0D to 35.0D
(1.0D steps). +15.5D to
26.5D (0.5D steps).
IQ009 Softec HDY Acrylic, single piece, foldable Available in dioptric $385.00
intraocular lens with anterior and powers from -5.0 to + 36.0,
posterior optic-haptic square edge, 1D steps: -5.0 to +10.0 and
360 degree optic square edge design, +31.0 to +36.0; 0.5D steps:
precision power calculation, +10.5 to +18.0 and +25.0 to
aberration technology and blue light 29.5; 0.25D steps: + 18.0 to
+25.0
IQ011 PreciSAL 302A Acrylic, single piece, foldable Available in dioptric $385.00
intraocular lens with anterior and powers from 0.0 to +30.0.
posterior optic-haptic square edge, 1D steps: 0.0 to +10.0;
360 degree optic square edge design, 0.5D steps: +10.5 to +17.5
precision power calculation, and +28.5 to +30.0; 0.25D
aberration technology and blue light steps: +18.0 to +28.0
XE005 Staar KS-Xs Preloaded Acrylic Preloaded acrylic lens with anterior Optic diameter 6.0mm, $332.00
Intraocular Lens and posterior edge modification overall length 12.5mm,
diopter range +10 to +28.0
Prostheses List by Category, Groups and Sponsor Page 11 of 1011
BL028 Akreos Toric Astigmatism- Single piece, foldable, acrylic The overall diameter is 11 $698.00
Correcting Lens intraocular lens with a toric optic on millimetres for the entire
the posterior surface and axis marks on lens power range (spherical
the posterior optic's flat meridian. equivalent powers from
+10.0 to +30.0 diopters in
0.5 diopter steps and
cylinder powers of +1.25,
+2.00 & +2.75 diopters).
KG003 Rayner Standard Toric C-Flex Hydrophilic HEMA-MMA 5.00mm dia optic, 12.00mm $698.00
copolymer, foldable with injector dia overall, cyls 2.0D to
6.0D in 2D increments
AL032 AcrySof IQ Toric IOL Posterior chamber, UV absorbing, +6 to +30 D spherical; 1.00 $780.00
foldable, acrylic, toric, single piece to 6.00 D cylinder.
lens with blue light protection and
aspheric correction
DV251 HOYA AF - 1 311 Toric T3/T4/T5 Correct Corneal Astigmatism, Micro- lOL Power: 6.0D to 30.0D $780.00
incision,Aspheric, Blue-Blocker, (0.5 steps)lOL Cylinder
Single Piece, Hydrophobic Power: 1.50D (311T3),
2.25D (311T4), 3.00D
(311T5)
AL023 Alcon AcrySof Toric PC IOL Models Posterior chamber, UV absorbing, +6 to +34 D spherical; 1.50 $740.00
foldable, acrylic, toric, single piece to 6.00 D cylinder
lens with blue light protection
KG004 Rayner Premium Toric C-Flex HEMA-MMA copolymer, foldable 5.75mm dia optic, 12.00mm $1,000.00
with injector dia overall, cyls 1.5D to
11.0D in 0.5D increments
Prostheses List by Category, Groups and Sponsor Page 12 of 1011
KG013 Rayner Super Premium Toric I.O.L. Acrylic foldable toric single piece -10.0D to 0.00D Sphere: 1D $1,000.00
to 11.00D Cylinder in 0.25
+31.00D to +35.00
Spit: 1D to 11.00D
Cylinder in 0.25steps
AL016 Alcon Acrysof Natural Model Foldable Acrylic Single-piece Lens, +6 to +40D $364.00
SN60AT asymmetric optic/consistent edge,
with blue light protection
AL025 AcrySof Multipiece Models Foldable Acrylic multi-piece Lens - 5 D to + 30 D $364.00
MN60MA, MN60AC with Blue light Protection
AO020 ReZoom Acrylic Multifocal Acrylic, foldable, posterior chamber, 6.0mm Optic Diameter x $780.00
Intraocular Lens intraocular lens 13.0mm overall length
AO026 TECNIS™ Multifocal Intraocular Posterior chamber lens with UV light- +5 diopters to +34 diopters $822.00
Lens (ZMA00) absorbing, foldable acrylic, 3-piece in 0.5d increments
with a diffractive posterior optic and a
modified anterior surface technology
with edge modification and 360
degree square edge.
AO027 Tecnis Multifocal 1-Piece Lens, A multifocal posterior chamber lens 6.0mm Optic Diameter x $822.00
Model ZMB00 with UV-blocking, foldable acrylic, 1- 13.0mm in overall length.
piece with a diffractive posterior optic +5.0 Diopter to +34.0
and a modified anterior surface Diopter in 0.5 Diopter
technology with edge modification increments.
and a 360 degree square edge.
CZ015 AT LISA 809M ZEISS micro incision, aspheric 6mm optic, 11mm diameter. $822.00
Diffractive bifocal Diopter range 0.0D to
anterior surface with asymmetric light +32.0D (0.5D steps)
distribution (65% distance / 35%
near), 3.75D addition for near focus.
Prostheses List by Category, Groups and Sponsor Page 13 of 1011
DE396 Oculentis LENTIS Mplus LS-313 Foldable one-piece multifocal plate Overall Length 11.0mm and $822.00
haptic acrylic IOL. Optic Size 6.0mm Available
diopters +-0.0D to +36.0D
(0.05D steps)
KG009 Rayner "M-Flex" Mulitfocal Acrylic, Foldable, Single piece multi- 6.5mm Optic-Overall $822.00
Foldable IOL zoned refractive aspheric multifocal diameter 12.5mm: +3D or +
with Amon-Apple 360 Degree Square 4D Addition: +14D to
edge, Anti Vaulting Haptics +25D in 1.0D increments:
+8.5D to +23.5D in 0.5D
CZ033 AT LISA 809MP Preloaded, micro incision, aspherical Diopter range: 0.0 to 32.0 $842.00
bifocal, square edged, single-piece Optic size: 6.0mm. Overall
IOL for capsular bag fixation. The length: 11.0mm
anterior aspheric bifocal surface has an
asymmetric light distribution 65/35
for distance/near vision, and 3.75D
add for the near focus.
CZ034 AT LISA tri 839MP Trifocal (aspheric) micro incision, Diopter range: 0.0 to $842.00
single-piece IOL for capsular bag +32.0D (0.5D increments).
fixation, implantable with preloaded Optic size: 6.0mm. Overall
The trifocal (anterior) Length: 11.0mm
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.
CZ035 AT LISA toric 909MP ZEISS pre-loaded, micro incision, 6mm optic, 11mm diameter. $1,218.00
multifocal toric IOL. Aspheric toric Diopter range: Sph +6.0D
anterior surface, diffractive bifocal to 24.0D, Cyl +1.0 to 4.0D
posterior surface with asymmetric (all 0.5D steps)
light distribution (65% distance/ 35%
near), and 3.75D addition for near
Prostheses List by Category, Groups and Sponsor Page 14 of 1011
AO033 Tecnis Multifocal Toric Toric Multifocal Intraocular Lens +5.0 Diopters to +34.0 $1,198.00
Diopters in 0.5 Diopter
Cylinder
powers 1.50D, 2.25D,
3.00D and 4.00D
DE388 Oculentis LENTIS Mplus Toric LU- Patient specific one-piece multifocal- Overall Length 11.0mm and $1,198.00
313MFT toric plate haptic acrylic IOL Optic Size 6.0mm + 0.0D to
+36.0D inclusive in 0.01D
increments. Cyl +0.25 to
+6.99D inclusive in 0.01D
increments
DE394 Oculentis LENTIS Mplus Toric LU- Patient specific one-piece multifocal- Overall Length 11.0mm and $1,240.00
313 MF30TY toric plate haptic acrylic IOL. Optic Size 6.0mm, +-0.0D to
+36.0D inclusive in 0.01D
increments. Cyl +0.25D to
+6.99D inclusive in 0.01D
increments.
DE389 Oculentis LENTIS Mplus LU- Patient specific one-piece multifocal- Overall Length 11.0mm and $1,500.00
313MFT toric acrylic plate haptic IOL Optic size 6.0mm +-0.0D to
+36.0D inclusive in 0.01D
increments. Cyl +6.99D to
+12.0D inclusive in 0.01D
increments
DE395 Oculentis LENTIS Mplus LU-313 Patient specific one-piece multifocal Overall Length 11.00mm $1,542.00
MFTY toric plate haptic acrylic IOL. Violet and Optic Size 6.0mm +-
Light Filter 0.0D to +36.0D inclusive in
Cyl
+7.00D to +12.0D inclusive
in 0.01D increments.
Prostheses List by Category, Groups and Sponsor Page 15 of 1011
AL028 AcrySof IQ ReSTOR SN6AD3 Posterior Chamber, UV absorbing, +6 D to + 34 D $864.00
foldable, acrylic, single piece lens
with apodised diffractive optic and
blue light protection
AL030 AcrySof IQ ReSTOR SN6AD1, Posterior Chamber, UV absorbing, +6 D to + 34 D $864.00
SV25T0 and MN6AD1 foldable, acrylic, single piece lens
with apodised diffractive optic and
blue light protection
DV248 HOYA PY-60MV Preloaded in cartridge, Multifocal, +14.0D to 27.0D (0.5 steps) $864.00
Aspheric, Blue-blocker, Single Piece,
Hydrophobic
CZ036 AT LISA tri Toric 939MP Trifocal (aspheric), bitoric, micro Diopter range: + 6.00 to $1,218.00
incision, single-piece IOL for 24.0 DS and + 1 to +4 DC;
capsular bag fixation, implantable Optic size: 6.0mm; Overall
with preloaded injector system. The length: 11.0mm
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,
CZ025 AT LISA toric 909M ZEISS micro incision, multifocal toric 6mm optic, 11mm diameter. $1,198.00
IOL (standard cyl range). Aspheric Diopter range: Sph -10.0D
toric anterior surface, diffractive to +32.0D, Cyl +1.0 to 6.5D
bifocal posterior surface with (all 0.5D steps)
asymmetric light distribution (65%
distance / 35% near), 3.75D addition
for near focus.
Prostheses List by Category, Groups and Sponsor Page 16 of 1011
KG010 Rayner M-Flex Toric (Standard) Acrylic, Foldable, Single Piece, 5.75mm / 12.0mm: 6.25mm / $1,198.00
Multi-zoned Refractive Aspheric 12.5mm +3.00D or +4.00D
Toric Mulitfocal with Amon-Apple Addition FAR: +14.0D to
enhanced 360 degree Square edge, +32.00D in 0.5 STEPS:
Anti Vaulting Haptics +2.00D +3.00D +4.00D
Cylinder. NEAR: +14.0D to
27.0D in 0.5 STEPS:
+4.00D
Cylinder
KG011 Rayner "M-Flex" Toric (Non Acrylic, Foldable, Single Piece, Muli- 5.75/12.0mm: 6.25/12.5mm $1,198.00
Standard) Zoned Refractive, Toric Multifocal +3.00D to +4.00D Addition
with Amon-Apple enhanced 360 FAR: +14.0D to +32.0D in
Degree square edge, Anti-vaulting 0.5D Increments: NEAR:
Haptics, Patient Specific. +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
AL033 AcrySof IQ ReSTOR multifocal toric Posterior chamber UV absorbing +6 to +34 D spherical; 1.00 $1,240.00
IOL (SND1T2-5; SV25T2-6) foldable, acrylic, aspheric, toric single to 3.00 D cylinder
piece lens with apodised diffractive
optic and blue light protection.
CZ024 AT LISA toric 909M ZEISS micro incision, multifocal toric 6mm optic, 11mm diameter. $1,500.00
IOL (high cyl range). Aspheric toric Diopter range: Sph -10.0D
anterior surface, diffractive bifocal to +32.0D, Cyl +7.0 to
posterior surface with asymmetric 12.0D (all 0.5D steps)
light distribution (65% distance /
35% near), 3.75D addition for near
Prostheses List by Category, Groups and Sponsor Page 17 of 1011
AO035 Synchrony Vu Accommodating IOL Synchrony Vu Dual Optic 5.50mm Anterior Optic, $822.00
Accommodating Posterior Chamber 6.00mm Interior Optic,
IOL 9.80mm Overall Length,
Diopter Range: +16.00 to
+28.00 in 0.5D Increments
BL031 Crystalens Toric The Crystalens Toric IOL, Models Overall diameter is 11.5mm $1,198.00
BL1AT/BL2AT and BL1UT/BL2UT (BL1AT/BL1UT) or 12.0mm
is an accommodating IOL (BL2AT/BL2UT) for the
incorporating a toroidal posterior entire lens power range.
surface. The Crystalens toric IOL has a Spherical equivalent
square posterior edge with polyimide powers range from +5.0 to
footplates and is available in multiple +33.0 Diopters in 0.5
spherical and cylindrical powers. Diopter steps and cylinder
powers of +1.25, +2.00 and
+2.75 Diopters (at the IOL
plane).
BL027 Crystalens HD Accommodating lens with > 3 10.0 to 33.0 Dioptres in .05 $780.00
Dioptres of accommodation with dual Dioptre steps
mechanism of action: (1) forward axial
movement of lens and (2)
Posterior chamber, polyspheric
optics, 3-piece, plate haptic, foldable
UV light filtering, bic
IQ003 Tetraflex Acrylic single piece, foldable Available in dioptric $780.00
accommodating intraocular lens with powers from +5.0 to +36.0,
sqare edge design, custom control 1D steps: +31.0 to +36.0;
precision and closed loop haptic 0.5D steps: +5.0 to +18.0
and +25.0 to +30.0; 0.2D
steps; +18.0 to +25.0
Prostheses List by Category, Groups and Sponsor Page 18 of 1011
BL029 Crystalens AO Accommodating lens designed to 10.0 to 33.0 D in 0.50 $822.00
provide > 3 Diopters of Diopter steps. 10.0 - 16.5
accommodation with dual mechanism Diopters (12mm length) and
of action: (1) forward axial movement 17.0 - 33.0 Diopters
of lens and (2) accommodative arching (11.5mm length).
Posterior chamber, aspheric,
aberration free optics, 3-piece, plate
haptic, fol
AO028 Synchrony Accommodating IOL Synchrony Dual Optic 5.50mm Anterior Optic, $800.00
Accommodating Posterior Chamber 6.00mm Interior Optic,
9.80mm Overall Length,
Diopter Range: +16.00 to
+28.00 in 0.5D Increments
DV246 Rayner Sulcoflex Ashperic Pseudophakic Supplementary -10.0D to -5.50D in 0.5D $323.00
(Premium) I.O.L. I.O.L.O.L. increments. +5.50D
to 10.00D in 0.5D
KG008 Rayner "Sulcoflex" Pseudophakic Sulcoflex Aspheric Pseudophakic I.O.L -5D to +5D $365.00
I.O.L.
KG005 Rayner Sulcoflex Aspheric Toric Acrylic, Aspheric, Toric SE -3 to +3 in 0.5 D steps $698.00
Pseudophakic Secondary I.O.L - Pseudophakic Secondary IOL: Cyl +1 to +3 in 1D steps
Standard Sulcus fixated with undulating
Haptics and Posterior Haptic
Prostheses List by Category, Groups and Sponsor Page 19 of 1011
KG007 Rayner Sulcoflex Aspheric Toric Acrylic, Aspheric, Toric SE -6.00 to +6.00 in 0.5 D $698.00
Pseudophakic Secondary IOL Pseudophakic Secondary IOL: Sulcus steps Syl +1.00 to +6.00 in
(Premium) fixated with undulating Haptics and 0.5D steps
Posterior Haptic Angulation
KG006 Rayner "Sulcoflex" Aspheric Multi- Acrylic, Aspheric Multi-focal 6.5mm / 13.5mm - $822.00
focal Pseudophakic Secondary IOL Pseudophakic Secondary IOL: 5.00D+5.00D sphere with
Sulcus-Fixated with Undulating + 3.00 Addition
Haptics and Posterior Haptic
DV254 Rayner Premium Sulcoflex 653Z-Premium Multifocal Toric -7D to +7D (Spherical $1,198.00
Multifocal Toric Supplementary IOL Supplementary IOL Equivalent) Cylinder 1D,
4D, 5D, 6D Addition 3.5D
DV255 Rayner Standard Sulcoflex 653Z-Standard Multifocal Toric -3D to +3D (Spherical $1,198.00
Multifocal Toric Supplementary IOL Supplementary IOL Equivalent) Cylinders 2D
and 3D Addition 3.5D
AL006 PROVISC VISCOELASTIC PROVISC contains sodium 0.85mL pack $80.00
SOLUTION
AL007 VISCOAT Viscoelastic Fluid Chondroitin sulfate and sodium 0.75mL $80.00
hyaluronate
AL015 Cellugel viscoelastic fluid Hypromellose 2%. $80.00
AL029 DisCoVisc Ophthalmic Sodium hyaluronate 17 mg/mL and 0.5 mL and 1.0 mL $80.00
Viscosurgical Device chondroitin sulfate 40mg/mL
AO008 Healon, Intraocular Viscoelastic Sodium Hyaluronate 10mg/ml Healon 0.4ml, 0.55ml & $80.00
0.85ml
AO032 Healon Endocoat Viscoelastic 0.85ml $80.00
Prostheses List by Category, Groups and Sponsor Page 20 of 1011
BL008 Ocucoat Intraocular Fluid 20mg/mL hydroxypropylmethyl 1ml and 2ml Sterile $80.00
cellulose for intraocular use
BL015 Amvisc Plus injection 15mg/mL Sodium Hyaluronate for 0.5mL and 0.8mL $80.00
intraocular use
CZ012 Z-HYALIN Viscoelastic Cohesive Viscoelastic Solution - Volume 1.0ml $80.00
(previously called Ophthalin)
CZ013 Z-HYALIN Plus Viscoelastic Cohesive Viscoelastic Solution - Volume 1.0ml $80.00
(previously called Opthalin Plus)
CZ022 VISTHESIA 1.5% VISCOANAESTHETIC syringe 0.8ml syringe & 2x0.3ml $80.00
contains sodium hyaluronate (NaHA, ampoules
1.5%) and lidocaine hydrochloride
(1%). Also contains two topical
ampoules with NaHA (0.3%) and
lidocaine (2%)
IQ002 Ocuvis and Ocumax 2% 20mg/mL hydroxypropylmethyl 2mL sterile $80.00
Hydroxypropylmethylcellulose cellulose for intraocular use. Pre-
loaded in a sterile syringe with one
cannula for injection, in a sterile
Tyvek pouch
AO009 Healon 5, Intraocular Viscoelastic HEALON5- Sodium hyaluronate 0.6ml $85.00
Fluid 23mg/ml .
AO010 Healon GV Intraocular Viscoelastic Sodium Hyaluronate 14mg/mL 0.5mm and 0.85ml $85.00
Fluid
AL005 DUOVISC VISCOELASTIC SYSTEM PROVISC contains sodium Small & large packs $110.00
hyaluronate, VISCOAT contains
chondroitin sulfate and sodium
hyaluronate
Prostheses List by Category, Groups and Sponsor Page 21 of 1011
CZ019 TWINVISC Viscoelastic TWINVISC includes a cohesive and a Total volume 1.4 ml $110.00
dispersive viscoelastic in one
Dispersive: sodium hyaluronate
Cohesive: sodium
DV231 Vision Blue Trypan blue dye for ophthalmic 0.5ml syringe $48.00
applications
AL001 Capsular Tension Rings - 10.0 - 12.0 compressed, $159.00
12.3 - 14.5 uncompressed
AO021 Stabileyes Capsular Tension Ring Polymethylmethacrylate (PMMA) 12mm ring, and 13mm ring $159.00
Implant
CZ002 Tensiobag: Capsular Tension Ring PMMA Diameter 10 - 14mm $159.00
DV009 Morcher Capsular Tension Ring PMMA Implant 14, 14A, 14C $159.00
EG001 Capsular Tension Rings Clear PMMA Implant 10/08, 12/10, 13/11mm $159.00
DV029 Eyejet CRT Capsular tension ring made of PMMA 14 (10mm), 14C (11mm), $243.00
per-load on disposable injector 14A (12mm)
Prostheses List by Category, Groups and Sponsor Page 22 of 1011
IS001 Preloaded Capsulan Tension Ring Capsular tension ring preloaded 13/11mm $243.00
(acrylic)
DV010 Morcher Coloboma Diaphram PMMA Implant 96G, 96L $334.00
AO012 Baerveldt Glaucoma Implant BG Non-valved artificial drainage device, Surface area 250, 350, $425.00
101-350, Baerveldt Glaucoma composition silicone - smooth, 425mm2
Implant BG 103-425, Baerveldt tumble-polished finish
Glaucoma Implant BG 103-250
DV020 Molteno Implant Double plate - dual chamber One size only $425.00
DV242 Molteno Implant Glaucoma Drainage Device - Single N/A $425.00
Plate/Single Plate-Dual
Chamber/Double Plate
DV230 Molteno 3 Drainage implant for glaucoma, made 2 Sizes: *230 mm square $625.00
of silicon *175mm square
AL037 ExPress Minature Glaucoma Shunt Miniature Glaucoma Shunt 50 & 200 microns $715.00
Prostheses List by Category, Groups and Sponsor Page 23 of 1011
SO017 FCI Ptose-up Expanded PTFE 15cm long x 2 or 3mm wide $348.00
x 0.35mm thick
DE183 Lid Load Gold Eyelid Weights; Gold 0.6, 0.8, 1.0, 1.2, 1.4, 1.6 $425.00
grams
DE182 Lid Load Gold Eyelid Weights; Gold 1.8, 2.0, 2.2, 2.4, 2.6, 2.8 $800.00
grams
RC001 LIDCHAIN Platinum Eyelid Implant Platinum Weights - 0.8, 1.0, 1.2, 1.4, $1,300.00
1.6, 1.8 grams
DV022 Eyetec DCR Tubes Stainless steel, silicone tubing, 30cm $135.00
Bodkin lacrimal intubation set
DV241 Eyetec DCR Tubes Crawford and Cannaliculus N/A $135.00
Intubation Sets
DV256 LIS 052 "StenTube" Large Diameter Lachrymal Intubation 1.32mm Tube diameter $135.00
Set
Prostheses List by Category, Groups and Sponsor Page 24 of 1011
DE191 Canaliculus Intubation Sets Silicone, SS & Nylon 17.7 x .064 x 29cm, 15.5 x $135.00
.051 x 33cm
DE278 BD Visitec Lacrimal Intubation Sets Stainless steel probes with solid 1. Probes 0.90mm x 4.5cm, $135.00
silicone rods or silicone tubing - rod 40cm x 0.80mm. 2.
packaged sterile Probes 0.40mm x 11cm,
tubing 35cm x 0.64mm.
Probes 0.60mm x 11mm,
tubing 35cm x 0.30mm.
SO021 FCI Lacrimal Intubation Set PVP Coated Silicone Tubing/PVP PVP Bika: 0.64mm O.D. $135.00
Coated Silicone Plug/Metal Tube/80 x 0.8mm probes,
Probes/Polypropylene Thread PVP Differential Bika: 0.64
& 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/
SO043 FCI Bi-Canalicular Lacrimal Silicone tubing swaged, imbedded Probes: 40mm to 120mm x $135.00
Intubation Set into or around malleable and flexible 0.7mm to 1.2mm. Tube:
stainless steel probes. PEEK thread. 0.64mm to 1.18mm x 25mm
PEEK Thread:
0.2mm to 0.4mm x 500mm.
SO044 FCI Mono-Canalicular Lacrimal Silicone tubing with plug swaged, Probes: 40mm to 120mm x $180.00
Intubation Set imbedded into or around malleable or 0.7mm to 1.2mm. Tube:
flexible stainless steel probes or 0.64mm to 1.18mm x 30mm
guides. PEEK thread. Introducer. to 350mm. PEEK Thread:
Plug Collar: 2mm to 4mm.
Prostheses List by Category, Groups and Sponsor Page 25 of 1011
DE177 Lester Jones Tear Duct Tubes Glass 3 x 9 to 16mm, 3.5 x 9 to $84.00
18mm, 4.0 x 9 to 24mm, 5.0 x
9mm
DV258 Lacricath Lachrymal Duct Balloon Unilateral Lachrymal Duct Balloon 2mm, 3mm & 5mm $485.00
Catheter Catheter system including inflation
device
DV257 Lacricath Lachrymal Duct Balloon Bilateral Lachrymal Duct Balloon 2mm, 3mm and 5mm $879.00
Catheter Catheter System including inflation
device.
DE188 Acrylic Implant Acrylic 12, 14, 16, 18, 20mm. $55.00
DE202 John Weiss Glass Mule Globes Glass No: 12, 14, 16, 18, 20mm $55.00
SO040 FCI Orbital Implants Silicone - Sterile 12mm to 22mm $55.00
SO006 FCI Orbital Implants Orbital Implant, Bioceramic Bioceramic diameter, 12, 14, $1,200.00
(Aluminium Oxide)/Hydroxyapatite 16, 18, 20, 21, 22mm;
(Synthetic) Synthetic Diameter, 10, 12,
14, 16, 18, 20, 22mm
Prostheses List by Category, Groups and Sponsor Page 26 of 1011
SK521 Sphere Orbital Sphere Models 6316, 6326, Orbital Sphere Models $785.00
6327, 6317 and 6322 8702-8704. 6316: 14mm, 6326: 16mm,
COI implant, models 7222, 7223 & 6327: 18mm, 6317: 20mm,
80026. MCOI implant, models 7207 - 6322: 22mm, 8702: 19mm,
7209 Quad Motility Implants 9866 - 8703: 21mm, 8704: 23mm,
9868 & 80022 COI Implants 7222: Approx
4ml, 7223: Approx 5ml,
80026: Approx 6ml, MCOI
7207: Approx 3ml, 7208:
7209:
Approx 5.6ml, QUAD
Motility Small 16ml,
Medium: 18ml, Large: 20ml,
Extra Large: 22ml.
SO007 FCI Orbital Implants Mesh wrapped orbital implant: mesh Bioceramic diameter: 16, 18, $1,600.00
wrapped bioceramic (aluminium 20, 22mm; Synthetic
oxide), mesh wrapped hydroxyapatite Hydroxyapatite diameter:
(synthetic), mesh wrap (polyglycolic 16, 18, 20, 22mm
acid)
MW002 Biopore Sphere An implantable device made of high- 14mm, 16mm, 18mm, 20mm, $1,930.00
density polyethylene material with an 22mm, 24mm (diameter)
interconnecting pore structure that
supports tissue ingrowth. The device
is available in sizes to meet the
Used for
orbital reconstruction following
enucleation and evisceration
procedure.
Prostheses List by Category, Groups and Sponsor Page 27 of 1011
SO019 FCI Orbital Implants Peg & Sleeve Standard Large $863.00
DE277 Frontalis Suspension Set Stainless steel needles with solid needles 0.90mm x 6.5cm, rod $315.00
silicone rods and silicone tubing - 40cm - 0.80mm, sleeve 10 x
packaged sterile 2mm
SO045 FCI Ptosis Probes Stainless steel needle probes swaged 80mm x 0.8mm needle $315.00
with silicone tubing. probes, 280mm 0.64mm
tubing.
AP003 Mira: Scleral Implants Solid Silicone- Tires-Mira 286 Wendel $45.00
Tire/Meridional/Wedge/Pad. Retinal Symmetrical Oval Tire 6mm,
Implant used in Scleral Buckling Mira Symmetrical Oval Tire
(Dimethylmethylvinyl Siloxane 7mm, Mira 287WG Murray
Copolymer) 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 10m
AP004 Mira: Scleral Implants Solid Silicone-Sleeve. Retinal Implant Sleeves-Mira 70 Sleeve 1mm $45.00
used in Scleral Buckling I.D., Mira 71 Sleeve 1mm
(Dimethylmethylvinyl Siloxane I.D., Mira 72 McNutt Sleeve
Copolymer) 1.57mm I.D., Mira 270
Sleeve 0.76mm I.D.
Prostheses List by Category, Groups and Sponsor Page 28 of 1011
AP006 Mira: Scleral Implants Solid Silicone-Band/Strip/Boat/Clip. Bands-Mira 40 Circling $45.00
Retinal Implant used in Scleral Band 2mm, Mira 240
Buckling (Dimethylmethylvinyl Circling Band 2.5mm.
Siloxane Copolymer) 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
DE179 Silicon Retinal Implant Tire 7.0, 9.0, 12.5, 6.0, 8.5, 10.0mm $45.00
DE181 Silicon Retinal Implant Band 0.75 x 2.0 x 125mm, 0.60 x $45.00
2.5 x 125mm, 0.75 x 2.5 x
125mm
SO009 FCI Scleral Buckling Devices Band/strip: solid silicone Band - 2.0 x 0.75mm Type $45.00
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 0.6mmStrip - 5.7mm Type
20, 7.2mm Type 31, 9.2mm
Type 32, 6mm Type 219,
7.5mm Type 220, 8mm Type
225
SO011 FCI Scleral Buckling Devices Tire: Solid Silicone Symmetrical: (2.5 mm $45.00
Groove, 7 to 9mm wide),
Biconvex: (2.5mm Groove, 7
to 10mm wide),
Asymetrical: (2.5mm
Groove, 7 to 10mm wide)
SO013 FCI Scleral Buckling Devices Strip: Solid Silicone Strip: 1.4 x 4.4 x 100mm, $45.00
Morin Strip: 7mm wide x
100mm long, Caputo Zip
Strip: 7 to 9mm wide x
120mm long, Korobelnik
Oval Strip: 2 x 5mm
Prostheses List by Category, Groups and Sponsor Page 29 of 1011
AP002 Mira: Scleral Implants Silicone Sponge- Retinal Implant Sponge- Mira 502 Cylinder $90.00
Used in Scleral Buckling (Silicone 2mm, Mira 5025 Cylinder
Elastomer Sponge) 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 cyl
DE178 Silicon Retinal Implant Sponge 2.5 x 4.0 x 80mm, 3.0 x 5.0 x $90.00
100mm, 3.25 x 7.0 x 80mm,
5.5 x 7.5 x 80mm, 1.5 x
80mm, 2.0 x 80mm, 2.5 x
80mm, 3.0 x 80mm, 4.0 x
80mm, 5.0 x 80mm, 7.0 x 80mm
SO012 FCI Scleral Buckling Devices Sponge/Cord: Silicone Cord: 1.0 to 5.0mm O.D. x $90.00
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
12mm; Gain Sponge:
6 x
Prostheses List by Category, Groups and Sponsor Page 30 of 1011
DE201 Labtician Tantalum Clips Tantalum 2, 2.5mm $50.00
DE180 Silicon Retinal Implant Sleeve 1mm, .76mm, 1.5mm $25.00
SO010 FCI Scleral Buckling Devices Fixation Sleeve: Solid silicone O.D: 1.65 to 2.41mm, $25.00
Length 30mm
AL035 ISPAN Retinal Gases for Tamponade gases for retinal surgery 125g cylinder, dispensed in $75.00
Constellation® Vision System C3F8 and SF6 single dose syringe
AL036 ISPAN retinal gases Tamponade gases for retinal surgery 125 g cylinder, dispensed $75.00
C3F8 and SF6 in single dose syringe
DE284 Single Dose Ophthalmic Gases Single dose tamponading gas for 30ml $75.00
retinal surgery
IQ012 EasyGas Endotamponade Gases for Retinal 60ml dispensed in a single $75.00
Surgery, EasyGas SF6, C2F6 or C3F8, dose, sterile syringe
each supplied in a 60ml syringe,
Prostheses List by Category, Groups and Sponsor Page 31 of 1011
AL013 Perfluoron Kits Perfluoro-n-octane for use as a retinal 5mL $240.00
surgery additive
AL014 Perfluoron Kits Perfluoro-n-octane for use as a retinal 7mL $240.00
surgery additive
BL017 Perfluo-octane (Oktaline) Okta- Perfluorocarbon Liquid for use as a 5mL $240.00
retinal surgery additive
BL018 DK Line 100% purified Perfluorodecalin 7ml $240.00
perfluorodecalin
DV244 D.O.R.C. Eftiar Eftiar Decaline and Octane 5ml 5ml $240.00
DE204 Arcaline (Perfluorodecaline) Liquid perfluorocarbon aid for retinal 3ml, 5ml, 7ml $240.00
surgery, operative device for retinal
surgery, in particular retinal
detachment (RD), RD with giant tear
etc.
DE205 Arcotane (Perfloro-N-Octane) Liquid perfluoro-N-Octane aid for 5ml, 7ml $240.00
retinal surgery, pre-operative device
for retinal surgery, in particular retinal
detachment (RD), RD with giant tear,
RD with proliferative vitreal
retinopathy (PVR) etc.
IQ005 Densiron Heavy Tamponade Liquid Medium, 10 ml, Sterile $240.00
Postoperative
IQ008 Octane & Decalin Perfluorocarbon retinal tamponade 5ml & 7ml, Sterile $240.00
medium, intraoperative
SO023 FCI - DECA, FCI - OCTA FCI - DECA: Purified 5ml $240.00
perfluorodecalin, FCI - OCTA:
Purified perfluoro-N-octane
Prostheses List by Category, Groups and Sponsor Page 32 of 1011
SO024 FCI - DECA, FCI - OCTA FCI - DECA: Purified 7ml $240.00
perfluorodecalin, FCI - OCTA:
Purified perfluoro-N-Octane
BL016 Oxane LMWC Fractioned Silicone Purified fractioned silicone oil 10mL $195.00
Oil
BL024 Oxane HD Silicone oil - RMN3 mixture 10ml $195.00
DV243 D.O.R.C. Silicon Oil D.O.R.C. Silicon Oil 1000/5000CS 10ml $195.00
DE228 LSO Silicone Oil Silicone oil for tamponade use in 10ml, vial or syringe $195.00
vitreoretinal surgery
IQ006 Siluron 1000 & Siluron 5000 Silicone Oils 10 ml, Sterile $195.00
SO022 FCI Purified Silicone Oil (Solvent Viscosity: 1000 cst/5000 cst: solvent 10ml $195.00
Free) free purified silicone oil
Prostheses List by Category, Groups and Sponsor Page 33 of 1011
AY022 Cobalt Chromium Balloon Cobalt Chromium Diameter 4-10mm, Length $1,800.00
Expandable Peripheral Stent 12-58mm
AY024 Omnilink Stainless Steel Balloon Stainless Steel Balloon Expandable 018 & 035 system: 5-10mm $1,800.00
Deployable Peripheral Stent Peripheral Stent on 018/035 system diameter by 12, 16, 18, 28,
38, 58mm length
BB244 Coroflex Blue Cobalt Chromium Alloy L605 2-4mm diameter, 8-25mm $1,800.00
length
BA218 Lifestent Valeo Stainless Steel Balloon Expandable 6-10mm diameter 17-56mm $1,800.00
Peripheral Stent length
BT094 Dynamic PTA Balloon Expandable Stent Diameters: 5-10mm, $1,800.00
Lengths: 15, 25, 38, 56mm
BS059 Express Vascular LD Stent; Express Stainless Steel, Balloon Expanding Stent Diameters up to 10mm $1,800.00
Vascular SD Stent Stent and lengths up to 60mm
WC234 Formula 414 Rx Renal Stent System Balloon Expandable Vasc/Biliary Rapid exchange 014/018, $1,800.00
80-135cm delivery system.
Diameters 4-10mm, lengths
0.8 - 4cm
JJ057 Palmaz Balloon Expandable Stent Stainless steel stent Diameter 4-12mm, length $1,800.00
20-30mm
JJ058 Palmaz Balloon Expandable Stent Stainless steel stent Extra-large $1,800.00
JJ305 Palmaz Genesis Peripheral Stent Stainless steel balloon expandable Diameter 4-8mm, length 12- $1,800.00
and Delivery System on Opta Pro stent mounted on an Opta Pro 39mm
JJ306 Palmaz Genesis Peripheral Stent Stainless steel peripheral stent Diameter 4-12mm, length $1,800.00
11-79mm
Prostheses List by Category, Groups and Sponsor Page 34 of 1011
JJ567 PALMAZ® BLUE™ .018 L605 Cobalt Chromium Alloy 12, 15, 18, 24mm length 4, $1,800.00
Peripheral Stent System Balloon Expandable Stent 5, 6, 7mm diameter
JJ688 Palmaz Blue .014 Renal Stent CoCr balloon expandable stent 12, 15, 18, 24mm Lengths $1,800.00
System (on Aviator Plus) 40, 50,
80, 142cm shaft
lengths
MB009 ArchStent Ostial System The ArchStent Ostial System is a 7Fr: 5mm x 16mm x 135mm. $1,800.00
0.14" guidewire-compatible, rapid 7Fr: 6mm x 16mm x 135mm
exchange balloon expandable stent
system for the treatment of
atherosclerotic stenosis at the renal-
ostial junction. It consists of a 316L
stainless steel stent with flaring of the
proximal 1/5 segment, and a dual
balloon delivery catheter featuring a
Locator balloon that enables the
operator to precisely position and
conform the stent to aorto-ostial
anomalies.
MC328 Racer Renal Stent System Cobalt Alloy Diameter: 4-7mm; Lengths: $1,800.00
12 &18mm
MC773 Assurant Cobalt Stent Iliac balloon expandable stent system Diameter: 6 - 10mm, $1,800.00
20 - 80mm
MC959 Hippocampus Renal Stent System Hippocampus Renal Rapid Exchange Diameter 4.0mm - 7.00mm $1,800.00
Stainless Steel Stent system, 5F Length: 10mm - 24mm
sheath, 0.014" guide wire compatible
MC977 Chromis deep cobalt Chromium, Chromis deep - Cobalt Chromium, pre- Diameter: 2.0 mm 4.0mm $1,800.00
infrapopliteal OTW stent mounted balloon expandable, 0.014" Length: 10mm - 76mm
compatable stent
AY015 Xact/ Xact Flex Carotid Stent Nitinol Self-Expanding stent on rapid Diameter 7-10mm Length 20 $1,800.00
exchange delivery system + 30mm Straight; Diameter
8-6, 9-7, 10-8mm Length 20
+ 30mm Tapered
Prostheses List by Category, Groups and Sponsor Page 35 of 1011
AY021 Nitinol Self Expanding Peripheral Nitinol Diameter 3-10mm $1,800.00
Stent
AY031 Xpert Xpert is a laser cut nitinol self 3 - 8mm in diameter, 20 - $1,800.00
expanding stent, used to treat 80mm in length
peripheral vessel disease, Xpert is a
low profile system designed for small
vessels and is 4 french.
AY032 ACCULINK Peripheral Stent Nickel-Titanium Intra-vascular stent 4-10mm diameter, 13-56mm $1,800.00
length
AY035 Absolute Pro (Long Length) Laser cut nitinol self expanding stent Diameter 5mm to 10mm; $1,800.00
<150mm length 120mm
BA178 Luminex Vascular Stent Luminex nitinol self-expanding stent 4mm - 20mm diameters, 2cm - $1,800.00
12cm lengths
BA199 Lifestent Laser cut nitinol self expanding stent, Diameter: 6-8mm, Length: $1,800.00
used to treat peripheral disease 120mm
BA216 Lifestent Lifestent cut nitinol self expanding 6-10mm diameter 20mm- $1,800.00
120mm length
BT072 Astron Peripheral self expanding nitinol, Diameters: 6 - 12mm, $1,800.00
coated stent Lengths: 30 - 100mm
BT103 Astron Pulsar Astron Pulsar is a 4F compatible, 4-7mm by 20-80mm $1,800.00
Nitinol self expanding stent (OTW
design) used to treat peripheral vessel
disease.
BT126 Pulsar 18 Peripheral self expanding Pulsar 18 self expanding Nitinol Stent: Ø 4- 7mm length: 20- $1,800.00
Nitinol stent system stent system 120mm Catheter length: 90-
135mm
BT133 Pulsar 35 Peripheral self-expanding Pulsar 35 Peripheral self-expanding Diameter: 5-7mm; Length: $1,800.00
Nitinol stent system Nitinol stent system 30-120mm; Catheter length:
90cm
BS035 Expandable Endoprosthesis Biomedical superalloy, self expanding Stent Diameters up to 30mm $1,800.00
stent and lengths up to 100mm
BS056 Carotid Wall Stent Elgiloy self expanding stent Stent diameters up to 10mm $1,800.00
and lengths up to 40mm
Prostheses List by Category, Groups and Sponsor Page 36 of 1011
BS137 EPIC Nitinol Stent Nitinol self expanding stent Stent diameters up to 14mm $1,800.00
and lengths up to 120mm
BS167 Placehit Wallstent Biomedical cobalt-based alloy, self Stent diameters up to 19mm $1,800.00
expanding stent and lengths up to 100mm
BS168 Wallstent RP Tracheobronchial, Iliac, Biomedical 20-24mm; length 18-90mm $1,800.00
Superalloy Wire, Braided Mesh,
Stainless Steel Stent with Unistep
Delivery System
BS189 Adapt Monorail Carotid Stent System Nitinol self expanding stent 21-40mm length, 4-9mm $1,800.00
diameter
BS196 Innova Self-Expanding Stent Nitinol, self expanding stent Diameters up to 8mm, $1,800.00
lengths less than 150mm
WC168 Cook Vascular/Biliary Stent Vascular/Biliary stent 5/6 Fr delivery system, 4 - $1,800.00
14mm diameter, 2 - 8cm
length
WC278 Zilver Vascular Stent with Rapid Zilver Stent Vascular Design, self- Delivery System 5Fr, $1,800.00
Exchange Delivery System expandable nitinol stent. Preloaded in 125cm. Stent diameter 4mm-
a 5.0 French Rapid Exchange delivery 10mm. Stent length 2cm-8cm.
catheter.
WC287 Zilver® Flex 35™ Vascular Stent The Zilver® Flew 35™ Stent (ZFV) is The Zilver® Flex 35™ $1,800.00
a self-expandable stent made of Stent is available in the
The special laser-cut pattern following sizes: stent outer
of the nitinol tube provides a diameters of 5 -10mm and
construction with a strong radial force stent lengths of 20 -140mm.
The stent has
The
stent is supplied preloaded in a 6.0
French inducer catheter. A radiopaque
marker on the distal tip of the sheath
is used to visualize deployment of the
stent. Stent deployment is controlled
by means of a hand held device.
WC290 Zilver® Vena ™ Venous Stent The Zilver® Vena™ Venous Stent is a 14mm and 16mm diameters, $1,800.00
self-expanding, flexible, slotted-tube and 60mm/100mm/140mm
nitinol stent. Post-deployment, the lengths.
stent is designed to impart an outward
radial force upon the inner lumen of
the vessel, establishing patency in the
stented region.
Prostheses List by Category, Groups and Sponsor Page 37 of 1011
DE376 Supra Veritas Peripheral Vascular Interwoven Self-Expanding Nitnol 20mm x 4,5,6,7mm $1,800.00
Stent 30mm x 4,5,6,7mm
60mm x 4,5,6,7mm
80mm x 4,5,6,7mm
100mm x 4,5,6,7mm
120mm x 4,5,6,7mm
ET037 SX-Ella Endovascular Stent Uncovered, self-expanding nitinol Dia 6-16mm, length 22-77mm $1,800.00
EE006 Protégé GPS Peripheral Stent Protégé RX Peripheral Stent Diameter 6-10mm Length $1,800.00
20-60mm
EE024 Protégé EverFlex Peripheral Stent Protégé EverFlex is a self expanding Diameter 5-8, Length 20- $1,800.00
Nitinol stent premounted on an OTW 120mm
delivery system.
JJ419 SMART Control Peripheral Stent SMART Control is a laser cut nitinol Dia 6 – 14mm; Length 20 – $1,800.00
System self expanding stent, used to treat 100mm
peripheral vessel disease.
JJ592 SMART Nitinol Stent System Long 120mm Stent, 6F compatible 6-8mm diameter, 120mm $1,800.00
stent length, 120cm
delivery system
JJ646 Precise Pro Rx Nitinol Stent System Nitinol self expanding stent Diameter: 5, 6, 7, 8, 9, $1,800.00
Length: 20, 30, 40mm
MC743 Complete SE Stent Nitinol 20mm - 80mm $1,800.00
MC744 Complete SE Stent Nitinol 100mm - 120mm $1,800.00
MC978 Cristallo Ideale Carotid Self Cristallo Ideale Nitinol, Carotid Self Cylinder Diameter: 7.0mm - $1,800.00
Expanding Stent System Expanding Hybrid Stent system, 5F 11.0 mm. Taper Diameter
introducer sheath compatible, Rapid 6.0/9.0 - 7.0/10.0. Length
Exchange design, .014" guide wire 20mm - 40 mm.
compatible.
MI010 Maris Plus Peripheral Self- Nitinol, self expanding, peripheral Diameter: 6.0-12.0mm; $1,800.00
Expanding Stent System stent system Length: 30-120mm
Prostheses List by Category, Groups and Sponsor Page 38 of 1011
PY028 Sinus-XL Stent Self-expanding Nitinol stent Diameter: 16mm, 18mm. $1,800.00
Length: 40-100mm
nominal; 41-100 expanded.
PY031 Optimed Sinus Stents Sinus-wave nitinol stent 3-14mm Diameter x 20- $1,800.00
130mm Length
PY036 sinus-Venous Stents sinus-Venous Stent used for treating 12-18mm Diameter, 60- $1,800.00
venous insufficiency, occlusion and 150mm Length
stenosis
PY029 Sinus-XL Stent ≥20mm Self-expanding Nitinol stent Diameter: 20mm, 22mm, $2,970.00
24mm, 26mm, 28mm, 30mm,
32mm, 34mm. Length: 30-
100mm nominal; 32-102
expanded.
AY036 Absolute Pro (Long Length) Laser cut nitinol self expanding stent Diameter 5mm to 10mm; $2,970.00
≥150 length 150mm, 170mm,
200mm
BA217 Lifestent Laser cut nitinol self expanding stent Diameter 5mm to 10mm; $2,970.00
length 150mm - 200mm
BT127 Pulsar 18 Peripheral self expanding Pulsar 18 self expanding Nitinol Stent: 4-7mm Stent length: $2,970.00
Nitinol stent system stent system 150-200mm Catheter
length: 90-135mm
BT132 Pulsar 35 Peripheral self-expanding Pulsar 35 Peripheral self-expanding Diameter: 5-7mm; Length: $2,970.00
Nitinol stent system Nitinol stent system 150-200mm; Catheter
length: 90cm, 135cm
BS197 Innova Self-Expanding Stent Nitinol, self expanding stent Diameters up to 8mm, $2,970.00
Lengths greater than 150mm
Prostheses List by Category, Groups and Sponsor Page 39 of 1011
WC285 Zilver® Flex35™ Vascular Stent The Zilver® Flex35™ Stent (ZFV) is a Diameter: 5-8mm; $2,970.00
self-expandable stent made of nitinol. Length:170mm and 200mm
The special laser-cut pattern of the
nitinol tube provides a construction
with a strong radial force and high
The stent has radiopaque
markers at both ends.
DE375 Supera Verita Peripheral Vascular Interwoven Self-Expanding Nitnol 150mm x 4,5,6mm $2,970.00
System 180mm x 4,5,6mm
200mm x 4,5,6mm
EE025 Protégé EverFlex Peripheral Stent Protégé EverFlex is a self expanding Diameter 5-8mm, Length $2,970.00
Nitinol stent premounted on an OTW 150-200mm
delivery system.
JJ617 SMART Nitinol Stent System Long 150mm stent, 6F compatible 6-8mm diameter, 150mm $2,970.00
length, 120cm delivery
system
MC760 Complete SE Stent Nitinol 150mm $2,970.00
MI011 Maris Plus Peripheral Self- Nitinol, self expanding, peripheral Diameter: 6.0-12.0mm; $2,970.00
Expanding Stent System stent system Length: 150mm
PY016 Optimed Iliac Sinus Stent - extra long Sinus-wave nitinol stent - extra long 6-8 mm x 150-200mm $2,970.00
PY037 sinus-Venous Stent sinus-Venous stent used for treating 18mm diameter, 150mm $2,970.00
venous insufficiency, occlusion and Length
stenosis
Prostheses List by Category, Groups and Sponsor Page 40 of 1011
WC288 Zenith Dissection Endovascular The Zenith Dissection Endovascular Diameter: 46mm (designed $4,650.00
Stent with the H&L-B One-Shot for vessel diameters 24-
Introduction System is indicated for 38mm). Length: 82, 123,
the endovascular treatment of patients 164mm
with aortic dissection distal to the left
subclavian artery.
WC289 Zilver PTX The Zilver PTX Drug Eluting 6French: 5, 6, 7, 8, 9, 10mm $2,400.00
Model 4600; Classic Annuloplasty Composition: Elgiloy Bands;
Polyester Film Strips; Silicone
Rubber; Polyester Cloth, Cosgrove-
Edwards
MC005 Medtronic Duran Annuloplasty Annuloplasty Devices - Models 610R Model 610R 25-35mm & $2,200.00
Ring; Duran Ancore Ring 620R; & 620R Silicone / Barium Sulphate, Model 620R 23-35mm
Duran Ancore Chordal Model 620RG Dacron.
SA127 AnnuloFlo Annuloplasty System Annuloflex Ring or AnnuloFlo Ring 26-36mm $2,200.00
SJ035 SJM Tailor Annuloplasty Ring Fully Flexible 25mm - 35mm $2,200.00
EL049 McCarthy-Edwards IMR Etlogix Rigid mitral annuloplasty ring with 24mm, 26mm, 28mm, 30mm, $2,400.00
Annuloplasty Ring (Model: 4100) an assymetric design 32mm, 34mm, 36mm
EL050 Edwards MC3 Tricuspid Ring 3D rigid annuloplasty ring with a 26mm, 28mm, 30mm, 32mm, $2,400.00
Annuloplalsty System (Model: tricuspid specific design 34mm, 36mm
Prostheses List by Category, Groups and Sponsor Page 1002 of 1011
EL057 Geoform Geoform annuloplasty ring Model 26, 28, 30 and 32mm $2,400.00
4200 with Holder
EL059 Carpentier-Edwards PHYSIO ll PHYSIO II is a semi rigid mitral 24, 26, 28, 30, 32, 34, 36, $2,400.00
Mitral Annuloplasty Ring annuloplasty ring, with an improved 38, 40mm
saddle shape and global disease based
design
EL061 Carpentier-Edwards Physio The Carpentier-Edwards Physio 24, 26, 28, 30, 32, 34, 36mm $2,400.00
Tricuspid Annuloplasty Ring Tricuspid annuloplasty ring, model
6200 is intended for use in patients
with tricuspid valvular insufficiency.
Designed with selective flexibility
and 3D waveform shape.
MC745 CG Future Composite Ring Semi-rigid mitral annuloplasty ring, 24, 26, 28, 30, 32, 34, 36 & $2,400.00
with anterior flexibility 38mm
MC844 Profile 3D Annuloplasty Ring 3D, rigid annuloplasty ring with Diameter (mm) 24 - 40mm $2,400.00
physiologic mitral valve shape
SA150 MEMO 3D Memo 3D Semirigid Mitral 24-38mm $2,400.00
Annuloplasty Ring, with 3D
flexibility and coasted with Carbofilm
SJ087 St Jude Medical Rigid Saddle Ring Rigid Annuloplasty Ring 24 - 34mm $2,400.00
SJ195 Attune Flexible Adjustable Flexible annuloplasty ring 25mm - 43mm $2,400.00
Annuloplasty Ring
SJ316 Seguin Annuloplasty Ring Semi-rigid annuloplasty ring 24-40mm $2,400.00
Prostheses List by Category, Groups and Sponsor Page 1003 of 1011
MC709 Posterior Annuloplasty Band; Annuloplasty - Model 610B & 620B Model 610B: 25-35mm; $2,200.00
Colvin - Galloway Future Band Silicone / Barium Sulphate, Dacron. Models 620B & 620BG:
Model 638B; Duran Ancore Band Models 638B semi-regid metal alloy 23-35mm, Model 638B - 26-
620B; Duran Ancore Chordal core, silicone coating, polyester knit 38mm
Model 620BG fabric, kit includes-band, malleable
handle, template with suture markers,
sizers
SJ088 SJM Tailor Annuloplasty Band Flexible double-velour, polyester 25 - 35mm $2,200.00
BX292 Supple Peri-Guard (4 x 4cm) Model No PC0404SN - 4 x 4cm 4 x 4cm $350.00
Bovine pericardium patch
BX293 Supple Peri-Guard (6 x 8cm) Model No PC0608SN -6 x 8cm 6 x 8cm $550.00
Bovine pericardium patch
BX294 Supple Peri-Guard (10 x 16cm) Model No PC1016SN - 10 x 16 10 x 16cm $760.00
Bovine pericardium patch
BX295 Supple Peri-Guard (8 x 14cm) Nodel No PC0814SN - 8 x 14 Bovine 8 x 14cm $760.00
pericardium patch
Prostheses List by Category, Groups and Sponsor Page 1004 of 1011
EL033 Baxter Augmentation / Substitution Edwards Pericardial Patch. Bovine 10cm x 16cm $760.00
Material, Human or Animal Origin, Pericardium.
Sterile Pericardial Patch.
GT117 Gore-Tex - Cardiovascular Patch ePTFE 0.4mm Thickness 2 x 9cm $240.00
GT118 Gore-Tex - Cardiovascular Patch ePTFE 0.4mm - 3 x 6cm0.6mm - $240.00
2.5cm x 15cm & 5cm x 7.5cm
GT126 Acuseal Cardiovascular Patch ePTFE 0.5mm Thickness 1 x 9cm; $240.00
Vascular 0.8 x 7.5cm
GT127 Acuseal Cardiovascular Patch ePTFE 0.5mm Thickness 3 x 6cm & $240.00
5 x 7.5cm
TM040 Repel - CV Bioresorbable Adhesion Barrier 18cmx13.5cmx137 microns $521.00
GT120 Gore-Tex Cardiovascular Patch ePTFE 0.6mm Thickness 5 x 15cm $521.00
GT121 Gore-Tex Cardiovascular Patch ePTFE 0.6mm Thickness 10 x 15cm $521.00
GT122 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 6 x 12cm $360.00
Prostheses List by Category, Groups and Sponsor Page 1005 of 1011
GT123 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 8 x 16cm $643.00
GT124 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 12 x 12cm $643.00
GT125 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 15 x 20cm $1,455.00
TU036 Gelweave Valsalva Graft Woven vascular prosthesis, polyester, Diameter 24 - 34 mm, $3,320.00
gelatin sealed Overall length 18.4 -
TU038 Gelweave Graft Straight Thoracic Graft, with antiflo 20 -34 mm x 20-40 cm $1,715.00
side branch, Polyester, woven, gelatin
sealed
TU037 Gelweave Plexus Graft Multi Branched, for Aortic Arch 20 - 34 mm x 40 cm $2,150.00
reconstruction, Polyester, Woven,
gelatin sealed
Prostheses List by Category, Groups and Sponsor Page 1006 of 1011
BH175 Supacondylar Nail System Solid End Cap Titanium Unsterile or One size only $57.00
Sterile
DE301 Suture Button Multiple hole button for fixation of 2.6mm - 7.5mm $248.00
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
BH219 Ace External Fixator Peg, titanium 5mm $81.00
BH202 Ace External Fixator Wire bayonet point - stainless steel 1.8mm $41.00
BH201 Ace External Fixator Olive wire bayonet point - stainless 1.5 or 1.8mm $260.00
steel, packet of 3
Prostheses List by Category, Groups and Sponsor Page 1007 of 1011
SY123 AO/ASIF Intermedullary Nails Femoral reamed, tibial nail 9 - 19mm, length 200 - $649.00
500mm.
BI286 Uniflex Tibial Nail Tibial Nail, Titanium 8-14mm x 240-420mm $950.00
BH334 Small / Large Fragment Set S/S CHS Compression Screw - Stainless Neutral to +2 $35.00
Steel
MO195 Acumed Congruent Plate System Screw - titanium 2.7, 3.5, 4.0mm dia, 30 - 65 $120.00 $147.00
length
DP364 Control Cable with Sleeve Control Cable with sleeve One size only $350.00
GO183 Actifuse ABX MIS Actifuse ABX MIS, Applicator and 7.5ml $2,300.00
Cartridge, 7.5ml
GO184 Actifuse ABX MIS Actifuse ABX MIS, Refill Cartridge, 7.5ml $1,560.00
7.5ml
Prostheses List by Category, Groups and Sponsor Page 1008 of 1011
GO162 Actifuse ABX Easyfill Putty Actifuse ABX Easyfill Putty - A 5ml $1,300.00 $1,540.00
silicate substituted synthetic bone
GO161 Actifuse ABX Easyfill Actifuse ABX Easyfill - A silicate 1.5mL to 4mL $1,080.00 $1,200.00
substituted synthetic bone graft
GO163 Actifuse ABX Easyfill Putty Actifuse ABX Easyfill Putty - A 10ml $2,300.00
silicate substituted synthetic bone
DY187 Limb Preservation System Beaded, 'Porocoat' Standard & Neutral, 15deg Left & Right $6,990.00
Trochanter Replacement in both styles
GO177 ACTIFUSE ABX Putty Actifuse AVX Putty - A silicated 20ml $4,600.00
substituted synthetic bone graft.
ZI265 Continuum hip system Hedrocel AVN Rod 3mm - 12mm block $3,208.00
Prostheses List by Category, Groups and Sponsor Page 1009 of 1011
HW044 Exeter Hip System X-Change Revision Mesh - Stainless Acetabular, Femoral and $889.00
Steel Flat Mesh
HW045 Exeter Hip System X-Change Revision Mesh -Rim - Small $886.00
Stainless Steel
HW046 Exeter Hip System X-Change Revision Mesh - Rim - Large $855.00
Stainless Steel
ZI329 CPT Impaction Grafting Mesh Titanium Femoral or acetabular mesh 6 sizes acetabular rim (small $3,367.00
and large), medial wall
(small and large), flat and
femoral meshes
Prostheses List by Category, Groups and Sponsor Page 1010 of 1011
BI487 Mimix Calcium Phosphate Bone Calcium Phosphate 5 grams $1,004.00
Void Filler
BI488 Mimix Calcium Phosphate Bone Calcium Phosphate 10 grams $1,900.00
Void Filler
BI489 Mimix Calcium Phosphate Bone Calcium Phosphate 20 grams $2,300.00
Void Filler
Prostheses List by Category, Groups and Sponsor Page 1011 of 1011
PART B - Human Tissue List February 2013
LEM03 Lions Eye Donation Service $770.00
LEM01 Lions Eye Donation Service $2,000.00
LEN01 Lions NSW Eye Bank $2,026.00
LEW01 Lions Eye Bank of Western Australia $2,500.00
QEB01 Queensland Eye Bank $2,100.00
SAE01 The Eye Bank of South Australia $1,838.00
LEW03 Lions Eye Bank of Western Australia $3,000.00
LEM04 Lions Eye Donation Service $2,660.00
LEN03 Lions NSW Eye Bank $1,216.00
LEM02 Lions Eye Donation Service $150.00
LEN02 Lions NSW Eye Bank $304.00
LEW02 Lions Eye Bank of Western Australia $250.00
QEB02 Queensland Eye Bank $298.00
SAE02 The Eye Bank of South Australia $196.00
TBV56 Donor Tissue Bank of Victoria $1,117.00
QHV09 The Prince Charles Hospital - Queensland Heart Valve Bank $6,300.00
SHV03 Sydney Heart Valve Bank, St. Vincent's Hospital $987.00
TBV03 Donor Tissue Bank of Victoria $1,116.00
Page 1 of 14
QHV08 The Prince Charles Hospital - Queensland Heart Valve Bank $6,600.00
QHV07 The Prince Charles Hospital - Queensland Heart Valve Bank $1,915.00
QHV03 The Prince Charles Hospital - Queensland Heart Valve Bank $1,743.00
QHV05 The Prince Charles Hospital - Queensland Heart Valve Bank $1,915.00
QHV04 The Prince Charles Hospital - Queensland Heart Valve Bank $1,743.00
TBV50 Donor Tissue Bank of Victoria $540.00
QHV11 The Prince Charles Hospital - Queensland Heart Valve Bank $1,915.00
QHV01 The Prince Charles Hospital - Queensland Heart Valve Bank $6,600.00
RPH01 Royal Perth Hospital T/A Heart Valve Bank $6,406.00
SHV01 Sydney Heart Valve Bank, St. Vincent's Hospital $5,350.00
TBV01 Donor Tissue Bank of Victoria $7,278.00
QHV10 The Prince Charles Hospital - Queensland Heart Valve Bank $6,300.00
QHV02 The Prince Charles Hospital - Queensland Heart Valve Bank $6,600.00
RPH02 Royal Perth Hospital T/A Heart Valve Bank $6,406.00
SHV02 Sydney Heart Valve Bank, St. Vincent's Hospital $5,350.00
TBV02 Donor Tissue Bank of Victoria $7,278.00
QBB72 The Queensland Bone Bank $477.00
QBB73 The Queensland Bone Bank $705.00
Page 2 of 14
QBB71 The Queensland Bone Bank $248.00
MVS23 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $1,396.00
QBB60 The Queensland Bone Bank $1,568.00
RNB02 Hunter New England Bone Bank $1,470.00
QBB56 The Queensland Bone Bank $1,986.00
TBV52 Victorian Institute of Forensic Medicine $683.00
TBV53 Victorian Institute of Forensic Medicine $1,364.00
NBB62 New South Wales Bone Bank $903.00
NBB61 New South Wales Bone Bank $1,647.00
NBB60 New South Wales Bone Bank $2,498.00
QBB09 The Queensland Bone Bank $1,609.00
QBB10 The Queensland Bone Bank $680.00
TBV09 Donor Tissue Bank of Victoria $1,073.00
TBV10 Donor Tissue Bank of Victoria $2,044.00
NBB65 New South Wales Bone Bank $903.00
NBB64 New South Wales Bone Bank $1,647.00
NBB63 New South Wales Bone Bank $2,498.00
Page 3 of 14
AUB08 Australian Biotechnologies $2,215.00
AUB04 Australian Biotechnologies $2,070.00
TBV55 Donor Tissue Bank of Victoria $1,157.00
TBV54 Donor Tissue Bank of Victoria $578.00
PBT37 Perth Bone and Tissue Bank $750.00
PBT08 Perth Bone and Tissue Bank $2,409.00
PBT10 Perth Bone and Tissue Bank $3,445.00
QBB45 The Queensland Bone Bank $1,993.00
QBB03 The Queensland Bone Bank $2,524.00
PBT09 Perth Bone and Tissue Bank $3,030.00
PBT38 Perth Bone and Tissue Bank $900.00
TBV11 Donor Tissue Bank of Victoria $1,285.00
TBV12 Donor Tissue Bank of Victoria $2,299.00
AUB02 Australian Biotechnologies $2,457.00
QBB68 The Queensland Bone Bank $2,022.00
QBB67 The Queensland Bone Bank $2,524.00
Page 4 of 14
NBB05 New South Wales Bone Bank $1,224.00
PBT03 Perth Bone and Tissue Bank $500.00
TBV07 Donor Tissue Bank of Victoria $762.00
TBV08 Donor Tissue Bank of Victoria $827.00
PBT11 Perth Bone and Tissue Bank $300.00
QBB12 The Queensland Bone Bank $210.00
TBV17 Donor Tissue Bank of Victoria $430.00
AUB05 Australian Biotechnologies $2,451.00
QBB52 The Queensland Bone Bank $441.00
TBV14 Donor Tissue Bank of Victoria $842.00
PBT07 Perth Bone and Tissue Bank $2,364.00
PBT48 Perth Bone and Tissue Bank $2,732.00
PBT06 Perth Bone and Tissue Bank $1,981.00
QBB04 The Queensland Bone Bank $713.00
QBB14 The Queensland Bone Bank $2,205.00
TBV18 Donor Tissue Bank of Victoria $5,787.00
NBB09 New South Wales Bone Bank $922.00
TBV21 Donor Tissue Bank of Victoria $889.00
PBT15 Perth Bone and Tissue Bank $1,590.00
QBB11 The Queensland Bone Bank $5.00
Page 5 of 14
PBT16 Perth Bone and Tissue Bank $854.00
ACT01 ACT Bone Bank $2,432.00
APH01 The Avenue Private Hospital Bone Bank $1,131.00
AUB03 Australian Biotechnologies $2,354.00
CSA01 Rachel Forster Bone Bank $802.00
DHR01 Barwon Health Bone Bank $3,028.00
HBB01 The Hobart Private Hospital Bone Bank $2,113.00
LPH01 Lingard Private Hospital Bone Bank $1,103.00
MMH01 Mater Misericordiae Hospital Bone Bank Theatres $400.00
MVS05 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,370.00
NBB16 New South Wales Bone Bank $2,354.00
PBT22 Perth Bone and Tissue Bank $2,632.00
QBB27 The Queensland Bone Bank $2,163.00
RNB01 Hunter New England Bone Bank $2,250.00
SVN01 Mater Hospital $731.00
TBV26 Donor Tissue Bank of Victoria $2,596.00
QBB61 The Queensland Bone Bank $2,163.00
QBB28 The Queensland Bone Bank $2,163.00
NBB59 New South Wales Bone Bank $2,271.00
PBT21 Perth Bone and Tissue Bank $2,295.00
TBV46 Donor Tissue Bank of Victoria $1,330.00
NBB17 New South Wales Bone Bank $1,606.00
PBT24 Perth Bone and Tissue Bank $1,662.00
QBB30 The Queensland Bone Bank $1,591.00
QBB31 The Queensland Bone Bank $670.00
Page 6 of 14
QBB23 The Queensland Bone Bank $2,247.00
QBB66 The Queensland Bone Bank $2,811.00
NBB57 New South Wales Bone Bank $2,778.00
NBB13 New South Wales Bone Bank $2,507.00
TBV24 Donor Tissue Bank of Victoria $2,357.00
NBB56 New South Wales Bone Bank $1,687.00
NBB55 New South Wales Bone Bank $1,687.00
PBT19 Perth Bone and Tissue Bank $2,791.00
MVS02 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
PBT17 Perth Bone and Tissue Bank $3,471.00
TBV22 Donor Tissue Bank of Victoria $4,251.00
NBB10 New South Wales Bone Bank $2,778.00
QBB20 The Queensland Bone Bank $2,800.00
NBB11 New South Wales Bone Bank $2,606.00
MVS03 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
NBB12 New South Wales Bone Bank $6,200.00
QBB22 The Queensland Bone Bank $4,268.00
TBV23 Donor Tissue Bank of Victoria $7,120.00
PBT18 Perth Bone and Tissue Bank $5,882.00
MVS04 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
Page 7 of 14
PBT20 Perth Bone and Tissue Bank $3,471.00
TBV25 Donor Tissue Bank of Victoria $4,220.00
NBB15 New South Wales Bone Bank $2,921.00
QBB25 The Queensland Bone Bank $3,020.00
NBB14 New South Wales Bone Bank $1,306.00
TBV51 Donor Tissue Bank of Victoria $4,095.00
MVS07 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
NBB18 New South Wales Bone Bank $6,041.00
PBT25 Perth Bone and Tissue Bank $2,667.00
QBB32 The Queensland Bone Bank $2,651.00
TBV27 Donor Tissue Bank of Victoria $6,863.00
NBB54 New South Wales Bone Bank $2,359.00
PBT28 Perth Bone and Tissue Bank $1,472.00
MVS14 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
TBV29 Donor Tissue Bank of Victoria $1,164.00
MVS13 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
TBV28 Donor Tissue Bank of Victoria $762.00
TBV30 Donor Tissue Bank of Victoria $2,419.00
NBB21 New South Wales Bone Bank $2,905.00
PBT29 Perth Bone and Tissue Bank $2,940.00
QBB33 The Queensland Bone Bank $2,762.00
TBV31 Donor Tissue Bank of Victoria $3,300.00
MVS08 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
Page 8 of 14
NBB24 New South Wales Bone Bank $6,500.00
PBT30 Perth Bone and Tissue Bank $5,411.00
QBB37 The Queensland Bone Bank $4,268.00
TBV32 Donor Tissue Bank of Victoria $7,487.00
NBB22 New South Wales Bone Bank $2,705.00
PBT31 Perth Bone and Tissue Bank $1,174.00
QBB34 The Queensland Bone Bank $2,478.00
TBV33 Donor Tissue Bank of Victoria $2,984.00
NBB23 New South Wales Bone Bank $1,195.00
PBT32 Perth Bone and Tissue Bank $1,067.00
QBB35 The Queensland Bone Bank $1,195.00
TBV34 Donor Tissue Bank of Victoria $1,149.00
QBB36 The Queensland Bone Bank $735.00
TBV37 Donor Tissue Bank of Victoria $1,823.00
NBB26 New South Wales Bone Bank $1,545.00
NBB50 New South Wales Bone Bank $3,090.00
QBB39 The Queensland Bone Bank $1,612.00
NBB51 New South Wales Bone Bank $1,671.00
MVS19 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
NBB25 New South Wales Bone Bank $2,359.00
TBV49 Donor Tissue Bank of Victoria $2,472.00
MVS20 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
NBB29 New South Wales Bone Bank $3,142.00
QBB43 The Queensland Bone Bank $3,035.00
Page 9 of 14
NBB30 New South Wales Bone Bank $3,182.00
PBT33 Perth Bone and Tissue Bank $3,343.00
NBB27 New South Wales Bone Bank $2,769.00
PBT35 Perth Bone and Tissue Bank $1,174.00
TBV36 Donor Tissue Bank of Victoria $3,054.00
NBB28 New South Wales Bone Bank $2,778.00
MVS09 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
PBT34 Perth Bone and Tissue Bank $2,886.00
TBV35 Donor Tissue Bank of Victoria $2,919.00
NBB53 New South Wales Bone Bank $1,448.00
NBB31 New South Wales Bone Bank $1,781.00
TBV38 Donor Tissue Bank of Victoria $1,964.00
PBT47 Perth Bone and Tissue Bank $1,921.00
QBB05 The Queensland Bone Bank $1,400.00
TBV40 Donor Tissue Bank of Victoria $1,306.00
TBV39 Donor Tissue Bank of Victoria $2,368.00
PBT60 Perth Bone and Tissue Bank $1,267.00
QBB47 The Queensland Bone Bank $788.00
TBV41 Donor Tissue Bank of Victoria $1,125.00
PBT40 Perth Bone and Tissue Bank $2,654.00
Page 10 of 14
MVS18 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
NBB06 New South Wales Bone Bank $3,024.00
PBT13 Perth Bone and Tissue Bank $1,800.00
QBB15 The Queensland Bone Bank $2,258.00
TBV19 Donor Tissue Bank of Victoria $3,436.00
NBB49 New South Wales Bone Bank $1,854.00
NBB47 New South Wales Bone Bank $2,975.00
MVS21 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $382.00
PBT41 Perth Bone and Tissue Bank $300.00
TBV43 Donor Tissue Bank of Victoria $537.00
AUB07 Australian Biotechnologies $1,854.00
AUB10 Australian Biotechnologies $2,184.00
NBB01 New South Wales Bone Bank $1,922.00
PBT61 Perth Bone and Tissue Bank $1,985.00
QBB62 The Queensland Bone Bank $1,922.00
TBV05 Donor Tissue Bank of Victoria $1,129.00
QBB65 The Queensland Bone Bank $1,433.00
NBB02 New South Wales Bone Bank $2,228.00
PBT01 Perth Bone and Tissue Bank $2,301.00
QBB01 The Queensland Bone Bank $1,922.00
TBV06 Donor Tissue Bank of Victoria $2,300.00
AUB09 Australian Biotechnologies $2,228.00
Page 11 of 14
NBB69 New South Wales Bone Bank $2,728.00
QBB69 The Queensland Bone Bank $1,922.00
QBB59 The Queensland Bone Bank $1,922.00
QBB48 The Queensland Bone Bank $2,055.00
QBB63 The Queensland Bone Bank $1,570.00
PBT02 Perth Bone and Tissue Bank $1,918.00
NBB33 New South Wales Bone Bank $2,147.00
TBV42 Donor Tissue Bank of Victoria $2,368.00
NBB68 New South Wales Bone Bank $2,647.00
NBB72 New South Wales Bone Bank $2,184.00
NBB73 New South Wales Bone Bank $2,184.00
NBB70 New South Wales Bone Bank $2,185.00
QBB70 The Queensland Bone Bank $1,922.00
PBT46 Perth Bone and Tissue Bank $2,398.00
NBB67 New South Wales Bone Bank $2,184.00
QBB58 The Queensland Bone Bank $1,922.00
TBV57 Donor Tissue Bank of Victoria $2,300.00
NBB71 New South Wales Bone Bank $2,184.00
QBB57 The Queensland Bone Bank $1,922.00
Page 12 of 14
TBV47 Donor Tissue Bank of Victoria $1,832.00
MVS17 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
QBB51 The Queensland Bone Bank $1,892.00
TBV48 Donor Tissue Bank of Victoria $2,401.00
NBB35 New South Wales Bone Bank $2,518.00
NBB36 New South Wales Bone Bank $2,551.00
PBT45 Perth Bone and Tissue Bank $2,635.00
QBB54 The Queensland Bone Bank $2,365.00
TBV45 Donor Tissue Bank of Victoria $2,722.00
TBV44 Donor Tissue Bank of Victoria $2,826.00
MVS11 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
AUB06 Australian Biotechnologies $2,562.00
QBB08 The Queensland Bone Bank $2,800.00
PBT44 Perth Bone and Tissue Bank $4,118.00
NBB46 New South Wales Bone Bank $3,986.00
NBB45 New South Wales Bone Bank $1,448.00
MVS16 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
NBB37 New South Wales Bone Bank $4,065.00
QBB55 The Queensland Bone Bank $4,248.00
Page 13 of 14
QBB64 The Queensland Bone Bank $4,268.00
NBB44 New South Wales Bone Bank $5,455.00
QBB53 The Queensland Bone Bank $992.00
NBB41 New South Wales Bone Bank $3,747.00
NBB43 New South Wales Bone Bank $2,450.00
NBB42 New South Wales Bone Bank $2,645.00
QBB02 The Queensland Bone Bank $872.00
NBB66 New South Wales Bone Bank $1,208.00
MVS15 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
NBB07 New South Wales Bone Bank $2,787.00
PBT14 Perth Bone and Tissue Bank $1,500.00
QBB16 The Queensland Bone Bank $2,258.00
TBV20 Donor Tissue Bank of Victoria $3,167.00
NBB40 New South Wales Bone Bank $1,854.00
NBB38 New South Wales Bone Bank $2,450.00
Page 14 of 14
Part C - Other Prostheses February 2013
DF001 DANAIIS Insulin Pump Continuous insulin infusion pump 75mm x 45mm x 19mm $4,000.00
AN011 Animas Vibe Insulin Pump & CGM Ambulatory insulin infusion pump Pump/Monitor: 8.26 x 5.08 $8,950.00
System with real-time continuous glucose x 2.18cm
monitoring (CGM) capability Sensor/Transmitter: 3.8 x
2.3 x 1.3cm
DF002 DANAR Insulin Pump The DANAR Insulin Pump is a small 75 x 45 x 19mm, 60grams $8,950.00
device about the size of a pager. It
holds up to 300 units of insulin,
which is delivered continuously
through a small tube to the patient.
The DANAR Insulin Pump also has
an integrated blood glucose meter and
remote control via bluetooth
communication.
RO044 Accu-Chek Combo System Insulin delivery device capable of The Accu-Chek Combo $8,950.00
remotely receiving and acting on System is only available in
information about blood glucose one size.
levels, performing bolus calculation
and bolus advice on additional
parameters than what is normally
AN005 Animas 2020 Insulin Pump. Ambulatory Insulin Infusion Pump 7.4cm x 5cm x 1.9cm $7,750.00
MS031 Medical Specialties "Deltec Cozmo Ambulatory Insulin Infusion Pump Deltec Cozmo Insulin Pump $7,750.00
Insulin Pump" - each
Page 1 of 3
MC839 Medtronic MiniMed Insulin Paradigm Veo Model MMT-554. 5.1 x 7.6 x 2.0cm $9,500.00
Infusion Pump 'Smart' Insulin Pump with REAL-
Time continuous glucose monitoring
capability, incorporating a low
glucose suspend and with remote
MC840 Medtronic MiniMed Insulin Paradigm Veo Model MMT-754. 5.1 x 9.4 x 2.0cm $9,500.00
Infusion Pump 'Smart' Insulin Pump with REAL-
Time continuous glucose monitoring
capability, incorporating a low
glucose suspend and with remote
Page 2 of 3
MC763 Reveal XT Reveal XT Insertable Cardiac Monitor 61 x 19 x 8 mm with a $3,900.00
volume of 9cc
MC768 Reveal DX Insertable Cardiac Monitor 61 x 19 x 8 mm with a $3,900.00
volume of 9cc
SJ152 SJM Confirm Model DM2102 Implantable cardiac monitor with 6.5cc, 12g $3,900.00
atrial fibrillation monitoring.
SJ159 SJM Confirm Model DM2100 Implantable cardiac monitor 6.5cc, 12g $3,900.00
Page 3 of 3
Endnotes
Endnote 1 – Legislation history This endnote sets out the details of the legislation history of the
Private Health Insurance (Prostheses) Rules 2012 (No. 2) .
| 21 August 2012 (F2012L01722) | 30 August 2012 | ||
| 30 August 2013 (F2012L01788) | 30 August 2012 | _ | |
| 15 February 2013 (F2013L00203) | 5 March 2013 | _ | |
| 22 February 2013 (F2013L00265) | 5 March 2013 | _ |
11.
Endnote 2 – Amendment history This endnote sets out the amendment history of the
Private Health Insurance (Prostheses) Rules 2012 (No. 2) .
| |
|
|
|
|
Endnote 3—Application, saving and transitional provisions This endnote sets out application, saving and transitional provisions for amendments of the
Private Health Insurance (Prostheses) Rules 2012 (No. 2) . There are no application, saving or transitional provisions.
This endnote sets out amendments of the
Private Health Insurance (Prostheses) Rules 2012 (No. 2) that have not yet commenced. For commencement details see Endnote 1.There are no uncommenced amendments.
This endnote sets out amendments of the
Private Health Insurance (Prostheses) Rules 2012 (No. 2) that have been misdescribed.
at page 56 of 975, after the “Sponsor” column starting “ | |
at page 320 of 975, after the “Sponsor” column starting “ |
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